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.
Risk Factors For Periodic Limb Movement Disorder
About 6% of the general population has PLMD. However, the prevalence in older adults is much higher, reaching almost 60%. Studies suggest that PLMD may be especially common in older women. As with RLS, there are many conditions that are associated with PLMD. They include sleep apnea, spinal cord injuries, stroke, narcolepsy, and diseases that destroy nerves or the brain over time. Certain drugs, including some antidepressants and anti-seizure medications, may also contribute to PLMD. About a third of people with PLMD also have RLS.
Home Care Tips For Restless Legs Syndrome
The following approaches can reduce symptoms in patients with mild or moderate RLS and may be used in combination with medication in RLS patients who have severe symptoms.
- Sleep hygiene: Good sleep hygiene means maintaining a bedroom environment and a daily routine that supports high-quality sleep. Avoiding alcohol and caffeine is especially important for RLS patients because these substances can worsen symptoms.
- Exercise: Because physical inactivity often triggers RLS symptoms, exercise may be helpful. A research study found that RLS patients showed af 39% reduction in symptom severity after six weeks of engaging in an exercise program compared to an 8% symptom reduction in patients who did not exercise.
- Pneumatic pressure therapy: Pneumatic compression devices increase blood flow to the legs by filling with air to squeeze the legs. Researchers found that the device improved RLS symptoms, quality-of-life, and fatigue after one month of daily use compared to a control group.
- Massage and hot baths: Using massage and hot baths to stimulate the legs is widely recommended in RLS literature however, there is limited scientific evidence supporting the effectiveness of these methods at this time.
Learn more about treating RLS here.
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Having RLS in 2002 and/or 2008 was associated with a higher risk of constipation in 2012, compared with controls. Only individuals who had RLS in both 2002 and 2008 showed higher odds of having possible RBD alone, and both constipation and possible RBD in 2012, indicating a potential association between continuous/recurrent RLS and , according to the researchers.
They cautioned that constipation is a relatively non-specific Parkinsons symptom and may not indicate a direct link between RLS and Parkinsons.
No differences were found between olfactory scores of men with or without RLS. However, the team noted that olfactory scores were only available from a subset of participants. Additionally, the timing of the smell sense analysis may also have influenced this result, since a loss of sense of smell has been reported as a relatively late symptom in the early stages of Parkinsons compared with RBD and constipation, they said.
We assessed the association between RLS and prodromal signs, but not between RLS and incidence. However, our focus was on identifying whether RLS is an early indicator of the underlying common disease process in , the authors wrote.
The findings warrant future studies for RLS and Parkinsons incidence in the long-term, they said.
Among the studys limitations, the authors mentioned that the link between Parkinsons and RLS may differ by gender, since women, although they have a reduced risk for Parkinsons, are more susceptible to RLS.
Detections Of The Levels Of Iron And Related Proteins In Csf And Serum
The levels of iron and related proteins, including ferritin, transferrin and lactoferrin in CSF and serum from PD patients were detected by Enzyme Linked Immunosorbent Assay. Ab83366 kit for iron, Ab108837 kit for ferritin and Ab108911 kit for transferrin were from Abcam Company . E01L0224 kit for lactoferrin was from Shanghai Lanji Biological Limited Company .
Assessments Of Clinical Symptoms
Severity of PD was evaluated by Hohen and Yahr stage. Motor symptoms of PD were evaluated by the Unified Parkinson Disease Rating Scale III. Levodopa equivalent does were calculated for PD patients.
Non-motor symptoms were firstly screened by Non-motor Symptoms Quest followed by series of rating scales, including Hamilton Depression Scale for depression, Hamilton Anxiety Scale for anxiety, Montreal Cognitive Assessment Scale for cognitive impairment, Modified Indifference Rating Scale for apathy, Fatigue Severity Scale for fatigue, Pittsburgh Sleep Quality Index for sleep disorders, and the Scale For Outcomes in PD For Autonomic Symptoms for autonomic dysfunction.
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.
The Link Between Rls And Parkinsons: Dopamine Agonists
Although the cause of RLS remains unknown, we know that RLS runs in families in about one-half of the cases, and that some families have an abnormality on chromosome 12. Because RLS is well treated by medications that also treat Parkinsons disease, it is likely that some aspect of brain dopamine function is altered in RLS. However, unlike in Parkinsons disease, 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 there is no major deficit on PET or other imaging studies of the brain, as is there is in PD. The spinal fluid is normal in RLS, but shows low dopamine in PD.
Lastly, RLS does not progress to cause other major symptoms such as tremor, gait disorder, or loss of taste or smell, and does not progress to PD. In fact, one of the leading possibilities as the cause of RLS and for which there is good scientific evidence and much research is a form of iron-transport abnormality in the brain. In effect, RLS patients may have low levels of iron in brain nerve cellsjust the opposite of some portions of the brain in PD.
Dr. Poceta is a Consultant in Neurology and Sleep Disorders in the Division of Neurology, Scripps Clinic, La Jolla, and the Scripps Clinic Sleep Center. His current interests include organized medicine and Internet medicine.
Restless Legs Syndrome And Leg Motor Restlessness In Parkinsons Disease
1Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi 321-0293, Japan
2School of Nursing, Dokkyo Medical University, Tochigi, Japan
3Department of Neurology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
2. The Diagnosis of RLS
IRLSSG Consensus Diagnostic Criteria for Restless Legs Syndrome/Willis-Ekbom Disease
Essential Diagnostic Criteria . Consider the following:An urge to move the legs is usually but not always accompanied by, or felt to be caused by, uncomfortable and unpleasant sensations in the legs.The urge to move the legs and any accompanying unpleasant sensations begin or worsen during periods of rest or inactivity such as lying down or sitting.The urge to move the legs and any accompanying unpleasant sensations are partially or totally relieved by movement, such as walking or stretching, at least as long as the activity continues.The urge to move the legs and any accompanying unpleasant sensations during rest or inactivity only occur or are worse in the evening or night than during the day.The occurrence of the above features is not solely accounted for as symptoms primary to another medical or a behavioral condition .
3. The Pathophysiology of RLS
4. Imaging in RLS
5. RLS and PD
6. RLS Mimics in PD
7. Variants of RLS in PD
8. Leg Motor Restlessness in PD
9. Treatment of RLS and LMR in PD
Conflict of Interests
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Restless Legs Syndrome And Leg Motor Restlessness In Parkinson’s Disease
Sleep disturbances are important nonmotor symptoms in Parkinson’s disease that are associated with a negative impact on quality of life. Restless legs syndrome , which is characterized by an urge to move the legs accompanied by abnormal leg…
Several conditions observed in PD, including sensory symptoms, pain, motor restlessness, akathisia, and the wearing-off phenomenon, should be differentiated from RLS.
Wondered about your EMAIL out on OCT 10th from the forum which quoted a couple of posts from me re Akathisia which apparently I described very well. Never heard that term before and neuro just talked a0out Anxiety. Wondering if I had that or not ?
Having been diagnosed for 2 years have had plenty of time to think about my symptoms. Most of these are as you would expect, stiffness, slowness and coordination issues plus the typical Parkinson shake… Add to this a certain amount of fatigue and I think my symptoms are similar to most people who have Parkinsons. I find that the levadopa that I take three or four times a day helps with the stiffness slowness and coordination but no
Acute and Tardive Drug-induced Akathisia P.S.Sachdev
Pharmaceutical Drugs: From Bad To Worse
Mirapex is the most commonly-prescribed drug for RLS. This drug is also used for Parkinsons. Unfortunately, these medications often do not effectively treat the problem. And in many cases the side effects can make the condition even worse!
In fact, heres what the National Institute of Neurological Disorders & Stroke has to say about this class of medications for RLS:
Although dopamine-related medications are effective in managing RLS symptoms, long-term use can lead to worsening of the symptoms in many individuals. With chronic use, a person may begin to experience symptoms earlier in the evening or even earlier until the symptoms are present around the clock. Over time, the initial evening or bedtime dose can become less effective, the symptoms at night become more intense, and symptoms could begin to affect the arms or trunk. Fortunately, this apparent progression can be reversed by removing the person from all dopamine-related medications.5
If you didnt quite catch that, I would encourage you to read the paragraph above quite carefully. They are clearly saying that the leading pharmaceutical medication for Restless Leg Syndrome can cause the symptoms to worsen or increase those symptoms until they are occurring around the clock!
Along the same vein, it is important to note that other commonly-prescribed medications may also aggravate RLS symptoms, including:
Is There A Link Between Restless Leg Syndrome And Parkinson’s Disease
Previous studies have suggested that there is a link between RLS and PD due to both conditions sharing the common feature of dysfunction in the part of the brain that produces dopamine. Another commonality between these two conditions is that they have been shown to run in the family. About half of the cases are in patients that have relatives with the disorder. Another argument for the medical linkage of these neurological disorders is that they share the same treatments – no other common disorder is treated with the same dopamine agents.
Even though earlier studies have shown a significant prevalence of RLS in patients with Parkinsons, researchers have not been able to find a common patient demographic or Parkinsons treatment to reliably predict the development of restless leg syndrome. Also through studies, they have found that though both conditions present dysfunction in the dopamine-producing neurons in the brain, the actual mechanisms, or how the neurons are affected, are not identical.
Earlier studies involved patients with advanced cases of Parkinsons disease that have been taking dopamine drugs for years, which may account for the significance of RLS. The use of dopamine drugs makes it much harder to correctly diagnose restless leg syndrome. The dopamine can cause restlessness that may be confused with RLS.
Tic And Tourette Syndrome:
Motor tics are repetitive, usually quick movements that can usually be suppressed by the person who has them, at least for a few seconds. They are not a nervous habit, but are believed to be neurological in their origin. Tourette syndrome is the name applied when motor tics associated with vocal tics begin in childhood, last longer than a year, and change over time. Most people who have Tourette syndrome do not have the famous symptom of uttering obscenities.
Tic is common, particularly in childhood, and may improve or cease altogether as one grows older. Occasionally it is sufficiently troubling that medication is warranted. Teasing from other children, or misunderstanding and criticism from parents and teachers are sometimes more problematic than the tic itself.
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How Is Restless Legs Syndrome Treated
RLS can be treated, with care directed toward relieving symptoms. Moving the affected limb may provide temporary relief. Sometimes RLS symptoms can be controlled by finding and treating an associated medical condition, such as peripheral neuropathy, diabetes, or iron deficiency anemia.
Iron supplementation or medications are usually helpful but no single medication effectively manages RLS for all individuals. Trials of different drugs may be necessary. In addition, medications taken regularly may lose their effect over time or even make the condition worse, making it necessary to change medications.
Treatment options for RLS include:
Lifestyle changes. Certain lifestyle changes and activities may provide some relief in persons with mild to moderate symptoms of RLS. These steps include avoiding or decreasing the use of alcohol and tobacco, changing or maintaining a regular sleep pattern, a program of moderate exercise, and massaging the legs, taking a warm bath, or using a heating pad or ice pack. There are new medical devices that have been cleared by the U.S. Food & Drug Administration , including a foot wrap that puts pressure underneath the foot and another that is a pad that delivers vibration to the back of the legs. Aerobic and leg-stretching exercises of moderate intensity also may provide some relief from mild symptoms.
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.
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Attention Deficit Hyperactivity Disorder
There is significant overlap between some of the symptoms and treatments for RLS and attention deficit hyperactive disorder . Up to a quarter of children diagnosed with attention-deficit hyperactivity disorder may also have RLS, sleep apnea, or PLMD. These conditions may actually contribute to inattentiveness and hyperactivity. The disorders have much in common, including poor sleep habits, twitching, and the need to get up suddenly and walk about frequently. Some evidence suggests that the link between the diseases may be a deficiency in the brain chemical dopamine.
Pathological Evidence Of Dopamine Dysfunction In Pd And Rls
Post-mortem studies in PD demonstrate loss of nigral neurons resulting in striatal dopamine deficiency, with differing morphological lesion patterns according to the clinical subtypes of PD. Cell loss in the ventrolateral part of the substantia nigra pars compacta projecting to the dorsal putamen is more prominent in the akinetic-rigid type, whereas tremor-dominant PD shows predominantly medial SNPC cell loss . Variability in lesion patterning might explain why some patients with PD may develop RLS. In addition, loss of dopamine 2 receptors has been documented in advanced PD .
At autopsy of 8 patients with primary RLS, there was a significant decrease in dopamine 2 receptors in the putamen compared to a neurologically normal control group. The decrease in the D2 receptors correlated to the severity of the RLS . This evidence that the nigrostriatal dopaminergic system is affected in both RLS and PD might provide a stronger argument for an etiologic link between the two. Moreover, there were significant increases in tyrosine hydroxylase in the substantia nigra, but not in the putamen of the RLS group. Phosphorylated tyrosine hydroxylase was found to be increased in both the substantia nigra and putamen. These findings are consistent with data from animal iron deficiency models demonstrating increased presynaptic dopaminergic activity .
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