Directing Glance On Dopaminergic System Physiology: Can The Dopamine Be A Reliable Bridge Between Rls/wed And Pd
Dopamine is the most common catecholamine in the central nervous system that can modulate different functions, like movement, cognition, reward and motivation . DA derived from the conversion of 2,3-dihydroxyphenylalanine by the enzyme DOPA decarboxylase . Tyrosine hydroxylase is the enzyme responsible for converting the amino acid tyrosine to DOPA, monitoring the DA amount.
It is known that there are three groups of dopaminergic cells that give rise to three different axonal pathways with different functions: nigrostriatal, mesocorticolimbic, and tuberoinfundibular system. The latter is the smallest in terms of brain DA content and controls the pituitary system. Nigrostriatal DA pathway controls voluntary movement, and dysfunction in this pathway has been implicated in movement disorder like PD. Mesocorticolimbic systems DA modulate various cognitive/emotive functions, and their degeneration may lead to some psychiatric disorders. Several studies have pointed out that mesocorticolimbic system can also modulate thalamocortical arousal state . Studies from the effect of psychomotor stimulant with a molecular structure similar to DA, like amphetamine, , has demonstrated that endogenous DA is involved in promoting wakefulness .
Take into consideration his contribution to sleep-wake state in addition to other waking behaviors like movement, DA has been considered the bridge that underlying PD and RLS/WED .
Treatment Of Rls In Pd
Regardless of the above discussion, it is clear that many people with PD have difficulty falling asleep because of annoying sensations in the legs accompanied by a sometimes unbearable sense of restlessness in the legs. For these people, taking dopamine agonists before bed can be helpful. Caution is in order, of course, because in some patients with PD, especially older or more advanced patients, these medications can cause confusion and hallucinations and are thus not well-tolerated. A long-acting levodopa formulation or medications such as gabapentin, gabapentin enacarbil and pregabalin can also be effective. Trying to address sleep issues such as RLS in patients who have sleep complaints can be an important aspect of maximizing therapy for PD.
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Parkinsons & Restless Leg Syndrome: Using Dopaminergic Medication
Because RLS is well-treated by medications that also treat PD, it is likely that some aspect of brain dopamine function is altered in RLS. However, unlike in PD, in which the deficit in substantia nigra dopamine-producing cells can be proven in many ways, no such abnormality has been shown in RLS. For example, studies show that DaTscan results are not abnormal in RLS.
Using dopaminergic medications to treat RLS however can be tricky. In some people they can lead to a phenomenon known as augmentation, in which long term use of dopaminergic medications can worsen the symptoms making them appear earlier in the day or migrating to the upper body in addition to the legs.
How Do You Know If You Have Restless Leg Syndrome
- A strong urge to move your legs. This urge often, but not always, occurs with unpleasant feelings in your legs. When the disorder is severe, you also may have the urge to move your arms.
- Symptoms that start or get worse when youre inactive. The urge to move increases when youre sitting still or lying down and resting.
- Relief from moving. Movement, especially walking, helps relieve the unpleasant feelings.
- Symptoms that start or get worse in the evening or at night.
What Causes Restless Legs Syndrome
In most cases, the cause of RLS is unknown . However, RLS has a genetic component and can be found in families where the onset of symptoms is before age 40. Specific gene variants have been associated with RLS. Evidence indicates that low levels of iron in the brain also may be responsible for RLS.
Considerable evidence also suggests that RLS is related to a dysfunction in one of the sections of the brain that control movement that use the brain chemical dopamine. Dopamine is needed to produce smooth, purposeful muscle activity and movement. Disruption of these pathways frequently results in involuntary movements. Individuals with Parkinsons disease, another disorder of the basal ganglias dopamine pathways, have increased chance of developing RLS.
RLS also appears to be related to or accompany the following factors or underlying conditions:
- end-stage renal disease and hemodialysis
- iron deficiency
- certain medications that may aggravate RLS symptoms, such as antinausea drugs , antipsychotic drugs , antidepressants that increase serotonin , and some cold and allergy medications that contain older antihistamines
- use of alcohol, nicotine, and caffeine
- pregnancy, especially in the last trimester in most cases, symptoms usually disappear within 4 weeks after delivery
- neuropathy .
Sleep deprivation and other sleep conditions like sleep apnea also may aggravate or trigger symptoms in some people. Reducing or completely eliminating these factors may relieve symptoms.
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How Can I Get A Good Night’s Sleep Despite Restless Legs Syndrome
Experts agree that simply changing your behavior can often help you sleep if you have restless legs syndrome. For people with mild to moderate RLS, these steps can reduce or prevent symptoms:
- Cut down on caffeine.
- Stop smoking, or at least cut back.
- Go to bed and get up at the same time each day, including weekends.
- Exercise regularly, but moderately .
- Apply heat or ice, or soak in a hot bath.
Parkinson’s And Restless Legs Syndrome
It is difficult to confirm exactly how Parkinsons can affect RLS or vice versa. RLS is a condition in its own right, occurring in people both with and without Parkinsons although it is thought to be almost twice as likely to occur in people with Parkinsons.
RLS can also be difficult to diagnose in Parkinson’s as it may come and go and can be confused with other symptoms of the condition such as akathisia or internal tremor. RLS can also cause night-time pain which may be mistaken for articular issues in people with Parkinson’s.
Repetitive Transcranial Magnetic Stimulation
A noninvasive procedure thats typically used to treat depression could be helpful in relieving RLS symptoms. So far, studies have been limited and more research is needed, but the results are promising (4, 41,
Repetitive transcranial magnetic stimulation sends magnetic impulses to certain areas of the brain.
Its not entirely clear why rTMS could help relieve RLS symptoms. One theory is that the impulses increase the release of dopamine in the brain. Another suggests that rTMS could help calm the hyperarousal in parts of the brain that are associated with RLS .
In one 2015 study, 14 people with RLS were given 14 sessions of rTMS over 18 days. The sessions significantly improved their RLS symptoms and improved their sleep. The results lasted for at least two months after the treatment ended .
How Is Restless Legs Syndrome Diagnosed Do I Need Any Tests
A doctor will usually make the diagnosis of RLS from the typical symptoms. There is no test to prove the diagnosis. A doctor may do some tests to rule out a secondary cause. For example, you would normally have a blood test to check for a lack of iron and to rule out kidney disease. In some cases further tests may be needed if the diagnosis is not clear.
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Evidence Of Dopaminergic Dysfunction In Rls
Observation studies of RLS in diseases which involve dopaminergic systems lend support to the hypothesis that dopaminergic dysfunction is present in RLS. One family with comorbidity of Huntington’s disease and idiopathic RLS has been reported. All family members affected by RLS also had HD, but not vice versa . Ondo and colleagues found a very high rate of undiagnosed RLS in their patients presenting with essential tremor. However, unlike other “secondary” forms of RLS, this finding was also associated with a high familial history of RLS . A study of comorbidities in Tourette syndrome including RLS investigated 144 probands with TS or chronic tics and their parents. RLS was present in 10% of probands and 23% of parents with no gender differences .
Is Restless Leg Syndrome A Precursor To Other Ailments
One of the more interesting and somewhat unusual behaviors that can affect residents of Mount Vernon and elsewhere is Restless Legs Syndrome. It affects about 10 percent of the U.S. population, including some receiving hospice care, and ranges from occasional twitches to full motion throughout the day.
Its also a condition that the team at Above and Beyond Home Health Care has experience with. Some of our clients have it or have had Restless Legs Syndrome and we also are happy to educate people who may have recently been diagnosed with it. In some cases, it may be accompanied by other health conditions, or sometimes it may indicate a higher risk of other conditions in the future. It also can be scary and confusing when someone is diagnosed.
According to the National Institutes of Healths National Library of Medicine, science has been officially tracking Restless Legs Syndrome as its own behavior since the mid-1990s. Prior to this, it may have been observed but thought of more as a symptom of various types of health conditions.
Since then, research has continued into how Restless Legs Syndrome behaves and different methods or medications that may be able to reduce its strength and duration. As with any health topic, some knowledge has changed as more cases are observed or as medical professionals learn more about possible interactions with Restless Legs Syndrome and other conditions.
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Where Can I Get More Information
For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network at:
Office of Communications and Public LiaisonNational Institute of Neurological Disorders and StrokeNational Institutes of HealthBethesda, MD 20892
NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.
The First Step In Treating Restless Legs Syndrome
The first line of defense against restless legs syndrome is to avoid substances or foods that may aggrivate or worsen the problem. Stay away from alcohol, caffeine, and nicotine. This may help relieve your symptoms. In addition, review all medications you are taking with your doctor to determine if any of these drugs could be causing the problem.
Any underlying medical conditions, such as anemia, diabetes, nutritional deficiencies, kidney disease, thyroid disease, varicose veins, or Parkinsons disease, should be treated. Dietary supplements to correct vitamin or mineral deficiency may be recommended. For some people, these treatments are all that is needed to relieve RLS symptoms.
You may also benefit from physical therapy and self-care treatments, such as stretching, taking hot or cold baths, whirlpool baths, applying hot or cold packs to the affected area, limb massage, or vibratory or electrical stimulation of the feet and toes before bedtime. Exercise and relaxation techniques also may be helpful.
What is restless legs syndrome?
Restless legs syndrome , also known as Willis-Ekbom disease, is a condition that causes uncomfortable sensations, most often in the legs. These sensations have been described as tingly, crawling, creeping feelings, and cause the overwhelming urge to move the affected limb.
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Fact #: There Are Many Household Remedies For Restless Legs Syndrome
You dont always need to take a lot of prescription drugs to treat restless legs syndrome. There are a number of easy home remedies for the same. First and foremost, sufficient amount of sleep is of paramount importance to the body for living a healthy life and regulating the sleep patterns which can help reduce the magnitude of symptoms of restless legs syndrome. Other than this, reducing the quantity of intake of alcohol, nicotine and caffeine will also help in treating and managing restless legs syndrome and thereby giving you a peaceful life, devoid of such annoying conditions.
Is Restless Leg Syndrome Common During Pregnancy
Restless leg syndrome is relatively common during pregnancy, especially in the second half of pregnancy. While most medications used to treat restless leg syndrome have not been adequately studied in pregnant women, the non-medication treatments and techniques described above can be very helpful. Furthermore, avoiding caffeine, warm compresses, massage, and regular exercising according to the doctors suggestions can be helpful.
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How Is Restless Leg Syndrome Treated
If you think you or your loved one may have restless leg syndrome, see your doctor or primary healthcare provider to confirm a diagnosis. Beyond the dopamine medications available, there are other simple lifestyle changes that can help RLS. These changes include:
- Iron supplements for those with iron deficiency
- Regular bedtime routine, getting up and going to bed at the same time each day
- Do not nap during the day
- Exercise during the day, but not close to bedtime
- Avoid caffeinated drinks or alcohol before bedtime
As science continues to investigate the causes of RLS and it’s potential link to Parkinson’s Disease, it’s important to seek medical attention if you or a loved one are presenting symptoms. Catching most diseases early enough increases the likelihood that a treatment can be effective.
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Diagnosing Restless Leg Syndrome
Restless legs syndrome is diagnosed when the following criteria are met:
- Uncomfortable feelings in the legs cause the urge to keep moving the legs
- Urges are worse when relaxed, lying down or sitting
- Moving around eases the discomfort
- Sensation worsens at night
While these symptoms are indicative of restless leg syndrome which can occur alongside multiple sclerosis. You should be aware that MS, itself, can mimic these symptoms.
- Extensor Spasms happen when a limb stiffens and the person cannot bend the joint. These muscle spasms usually affect the quadriceps causing the leg to kick out. These are not movement urges, they are wholly involuntary movements. Some extensor spasms can be so severe that the person will fall out of the bed or chair.
- Parasthesias: include unpleasant sensations that occur primarily in the lower legs and feet. These are often described as tingling, numbness or pins and needles. MS, as opposed to RLS, symptoms tend to be present all day, not just at night.
What Are Common Signs And Symptoms Of Restless Legs
People with RLS feel the irresistible urge to move, which is accompanied by uncomfortable sensations in their lower limbs that are unlike normal sensations experienced by people without the disorder. The sensations in their legs are often difficult to define but may be described as aching throbbing, pulling, itching, crawling, or creeping. These sensations less commonly affect the arms, and rarely the chest or head. Although the sensations can occur on just one side of the body, they most often affect both sides. They can also alternate between sides. The sensations range in severity from uncomfortable to irritating to painful.
Because moving the legs relieves the discomfort, people with RLS often keep their legs in motion to minimize or prevent the sensations. They may pace the floor, constantly move their legs while sitting, and toss and turn in bed.
A classic feature of RLS is that the symptoms are worse at night with a distinct symptom-free period in the early morning, allowing for more refreshing sleep at that time. Some people with RLS have difficulty falling asleep and staying asleep. They may also note a worsening of symptoms if their sleep is further reduced by events or activity.
People with RLS can sometimes experience remissionsspontaneous improvement over a period of weeks or months before symptoms reappearusually during the early stages of the disorder. In general, however, symptoms become more severe over time.
What Is The Prognosis For People With Restless Legs Syndrome
RLS is generally a lifelong condition for which there is no cure. However, current therapies can control the disorder, minimize symptoms, and increase periods of restful sleep. Symptoms may gradually worsen with age, although the decline may be somewhat faster for individuals who also suffer from an associated medical condition. A diagnosis of RLS does not indicate the onset of another neurological disease, such as Parkinsons disease. In addition, some individuals have remissionsperiods in which symptoms decrease or disappear for days, weeks, months, or yearsalthough symptoms often eventually reappear. If RLS symptoms are mild, do not produce significant daytime discomfort, or do not affect an individuals ability to fall asleep, the condition does not have to be treated.