Thursday, September 22, 2022
Thursday, September 22, 2022
HomeIs Restless Leg Syndrome Related To Parkinson's Disease

Is Restless Leg Syndrome Related To Parkinson’s Disease

Cbd May Support Healthy Dopamine Levels In The Brain

Pain in Legs in Parkinsonism with Dr. Abdul Rana Neurologist

While it’s not definitive, some evidence correlates restless leg syndrome with low dopamine levels in the brain.

Dopamine is a hormone with a lot of jobs. One of them is to regulate purposeful muscle movement and coordination by modulating the motor control center in the brain . It’s been observed that any disruptions in this pathway could result in involuntary movements like tremors associated with Parkinson’s disease.

Endogenous cannabinoids help keep the dopamine system in balance. CBD supports the endocannabinoid system by preventing the release of enzymes that break down cannabinoids.

These higher cannabinoids are like boosting your wi-fi signal to relay messages throughout the body much more efficiently.

CBD is also suggested to directly support the mesolimbic dopamine system, which is responsible for our motivation, reward-related motor function, and learning .

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.;;

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 .

Restless Legs Syndrome And Periodic Limb Movement Disorder

Restless Leg Syndrome And Multiple Sclerosis Connection

Cases of restless leg syndrome in multiple sclerosis patients greatly vary from 13.3 percent to 65.1 percent. These numbers are still larger than rates of restless leg syndrome in the general population. Multiple sclerosis patients with RLS rate higher on the Expanded Disability Status Scale compared to MS patients without RLS. RLS can negatively impact a persons sleep and cause further complications such as worsened fatigue and greater inflammation, which can contribute to pain. Further research will be conducted to better understand the connection between RLS and MS and provide more effective treatment.

Other Conditions Associated With Restless Legs Syndrome

The following medical conditions are also associated with RLS, although the relationships are not clear. In some cases, these conditions may contribute to RLS. Others may have a common cause, or they may coexist due to other risk factors:

The Link Between Rls And Parkinsons: Dopamine Agonists

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.

Is Restless Leg Syndrome A Precursor To Other Ailments

Also Check: What Medications Are Prescribed For Parkinson’s Disease

Characteristics Of Restless Leg Syndrome

There are certain features of RLS that make it a unique and specific disorder.

  • The hallmark of RLS is a feeling of restlessness, usually in the legs. The restlessness is often accompanied by additional sensations such as tingling, creepy-crawly or electric sensations, usually located in the legs. The symptoms are usually not restricted to the toes or feet, as in peripheral neuropathy, but rather are present more generally in the legs, often the calves or thighs.
  • The restlessness is worse when the person is at rest or not moving. This feature makes it hard for people with RLS to get to sleep and can also interfere with the ability to sit still in order to read, relax, or do desk work.
  • Symptoms are improved with moving, particularly walking. Unfortunately, the relief lasts only as long as the movement continues, which makes some people pace the floor for hours when the condition is severe. Besides walking, sometimes providing other stimuli to the legs is helpful, such as rubbing, massage, or stretching.
  • RLS can be accompanied by a related disorder called Periodic Limb Movements of Sleep which are repetitive leg movements that occur during sleep.
  • Levodopa And Other Dopaminergic Drugs

    What The Heck Is Restless Leg Syndrome?

    Dopaminergic drugs increase the availability of the chemical messenger dopamine in the brain and are one of the first-line treatments for severe RLS and PLMD. These drugs reduce the number of limb movements per hour and improve the subjective quality of sleep. People with either condition who take these drugs have experienced up to 100% initial reduction in symptoms.

    Dopaminergic drugs, however, can have severe side effects . They do not appear to be as helpful for RLS related to dialysis as they do for RLS from other causes.

    Dopaminergic drugs include dopamine precursors and dopamine receptor agonists.

    Dopamine Precursors

    The dopamine precursor levodopa was once a popular drug for severe RLS, although today it is usually recommended only for patients with occasional symptoms who may take it nightly as needed. It may also be helpful for long car rides or plane trips. The standard preparations combine levodopa with carbidopa, which improves the action and duration of levodopa and reduces some of its side effects, particularly nausea. Levodopa combinations are well tolerated and safe.

    Levodopa acts fast, and the treatment is usually effective within the first few days of therapy.

    A rebound effect causes increased leg movements at night or in the morning as the dose wears off, or as tolerance to the drug builds up.

    Regimens

    Side Effects

    Long-term use of dopaminergic drugs can lead to tolerance, in which the drugs become less effective.

    Withdrawal Symptoms

    Don’t Miss: How Common Is Parkinson’s Disease

    Is It Difficult To Diagnose Restless Legs Syndrome In People With Parkinson’s

    Because there isn’t a specific test for restless legs syndrome, it can be difficult to diagnose the condition. Sometimes symptoms only happen briefly or from time to time.

    Also, the condition can cause discomfort at night-time and this can be mistaken for arthritis in people with Parkinson’s.

    Another reason why a person with Parkinson’s may experience disturbed sleep is due to dyskinesia. Dyskinesia is involuntary movements sometimes seen in people with Parkinson’s. If you’re concerned about this, speak to your GP, specialist or Parkinson’s nurse.

    Your treatment will depend on how severe your symptoms are and what may be causing them.

    Nonmotor Features Of Pd In Rls/wed

    Interestingly, a study of autonomic function in RLS/WED found significantly higher prevalences of sialorrhea and constipation when compared with controls, the latter becoming nonsignificant after adjustment for age, sex and medications4747. Shneyder N, Adler CH, Hentz JG, Shill H, Caviness JN, Sabbagh MN et al. Autonomic complaints in patients with restless legs syndrome. Sleep Med. 2013 Dec;14:1413-6. https://doi.org/10.1016/j.sleep.2013.08.781.

    Don’t Miss: Does Parkinson’s Cause Pain

    Interrupted Sleep: Exploring Links Between Parkinsons Disease And Restless Leg Syndrome

    Restless Legs Syndrome;and Parkinsons disease have interesting dopamine connections. Some Parkinsons pain may actually be restless legs or arms. Could changes in RLS treatment over the past few years be relevant to getting a good nights sleep with PD?

    To those unfamiliar with the condition, the terminology Restless Legs makes it difficult to accept as the serious condition that it is. Whenever I hear the term;Restless Legs Syndrome, my brain thinks ants in my pants. I picture myself back in elementary school, being forced to sit at a desk, when Id rather be running around outside. ;That is far from being an accurate description of this medical condition.

    The USA National Institutes of Health describes RLS;as follows:

    I know the feeling all too well. Sitting anywhere for more than an hour or so where I cant stretch/straighten out my legs leads to extreme pain that can usually be walked off with just a few minutes of movement. Gymnasium bleachers are the worst for me. I used to prefer bulkhead rows on airplanes, but now they can be painful because I cannot stretch my legs into the space under the seat in front of me. Movie theaters generally arent a problem, as the old theaters have been replaced by megaplexes that are focused more on comfy recliner seats. By contrast, traditional theatre can be torturealthough an aisle seat usually provides me with enough wiggle room to endure until intermission.

    What causes RLS?

    According to the NIH:

    Suggested further reading:

    Abnormalities Of Iron Metabolism

    Living with Parkinson’s-restless leg syndrome 6 years after diagnosis

    Iron deficiency, even at a level too mild to cause anemia, has been linked to RLS in some people. Some research suggests that RLS in some people may be due to a problem with getting iron into cells that regulate dopamine in the brain. Some studies have reported RLS in a quarter to a third of people with low iron levels.

    You May Like: What Type Of Doctor Diagnosis Parkinson’s Disease

    Collections Of Csf And Serum

    Anti-parkinsonian drugs were withheld for 1214hours prior to sampling the CSF. Total 3ml CSF were obtained by lumbar puncture and 2ml venous whole blood was collected between 7 a.m. and 10 a.m. under fasting condition, and then placed in a polypropylene tube. Approximately 0.5ml volume of CSF and serum were aliquotted into separate Nunc cryotubes and kept frozen at 80°C until ready for assay. Each aliquot dedicated for each measure to avoid freeze-thawing and protein degradation.

    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.

    You May Like: What Kind Of Pain Is Associated With Parkinson’s

    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.

    Treatment Of Rls In Pd

    (PDF) Restless legs syndrome in Parkinson

    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.

    Tips and Takeaways

    Do you have a question or issue that you would like Dr. Gilbert to explore? Suggest a Topic

    Dr. Rebecca Gilbert

    APDA Vice President and Chief Scientific Officer

    Don’t Miss: What Is The Difference Between Dystonia And Parkinson’s Disease

    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 .

    What Is The Pooled Prevalence Of Rls/wed And Its Mimics In Pd

    In view of these contrasting results, what is the overall prevalence of the sum of true, secondary and mimics of RLS/WED in PD? A recently-published meta-analysis4343. Yang X, Liu B, Shen H, Li S, Zhao Q, An R et al. Prevalence of restless legs syndrome in Parkinsons disease: a systematic review and metaanalysis of observational studies. Sleep Med. 2018 Mar;43:40-6. https://doi.org/10.1016/j.sleep.2017.11.1146 tried to answer this question comparing 28 clinical studies. The pooled prevalence among diverse populations was 14%, being higher among those who had previously received dopaminergic treatment than among drug-naïve patients . Differences were also marginal for gender prevalence, favoring women . In their discussion, the authors were careful enough to acknowledge the intrinsic limitations of these studies, including a variety of biases.

    Pramipexole Is Not Recommended In Pregnancy Or Breastfeeding

    There is a lack of clinical data in pregnancy, along with evidence that pramipexole impairs implantation and disrupts early pregnancy in rats .6 Pramipexole is expected to inhibit lactation because of its effects on prolactin. It may be excreted into breast milk and should not be used during breastfeeding.6

    Pathological Evidence Of Dopamine Dysfunction In Pd And Rls

    Pramipexole May Be Useful For Severe Restless Legs Syndrome

    Recommended Reading: How Many People In The World Have Parkinson’s Disease

    Pathological And Functional Imaging Data

    A comparative summary of the similarities and differences between PD and RLS/WED is shown in .

    Table 1

    Although there is general agreement on the fact that treatment with dopaminergic drugs induces a dramatic symptomatic improvement in RLS/WED as it does in PD, there is little, if any, solid evidence from pathological, and both standard and functional imaging studies, indicating a pathophysiological relationship between the two disorders. This lack of evidence has been demonstrated using diverse techniques such as, for instance, transcranial ultrasonography findings and postmortem studies of patients with RLS/WED, which did not demonstrate any of the typical pathological characteristics of PD, such as accumulation of -synuclein in Lewy bodies88. Pittock SJ, Parrett T, Adler CH, Parisi JE, Dickson DW, Ahlskog JE. Neuropathology of primary restless leg syndrome: absence of specific tau- and alpha-synuclein pathology. Mov Disord. 2004 Jun;19:695-9. https://doi.org/10.1002/mds.20042,99. Ryu JH, Lee MS, Baik JS. Sonographic abnormalities in idiopathic restless legs syndrome and RLS in Parkinson’s disease. Parkinsonism Relat Disord. 2011 Mar;17:201-3. https://doi.org/10.1016/j.parkreldis.2010.11.014.

    How Can I Help Myself Non

    Restless Leg Syndrome in Parkinsonism with Dr. Abdul Rana MD

    There are many ways you can help yourself but it does depend on how disruptive the symptoms are and what changes you are willing to make.

    First, review your lifestyle and see what changes you can make to reduce or eliminate RLS symptoms. Suggestions include:

    • Establish the right level of exercise – too much worsens it, too little may trigger RLS. Some people find that a few minutes of exercise just before bedtime is particularly effective, although others find that exercise in the evening worsens the symptoms.
    • Avoid stimulants, such as caffeine, alcohol and smoking, particularly in the evening.
    • Eliminate from your diet foods that trigger RLS these may include sugar, triglycerides , gluten, sugar substitutes , or following a low-fat diet. Experiment to see what works for you but before significantly changing your diet, always check with your doctor or a dietician first.
    • Create a peaceful, cool sleeping environment.
    • Discuss with your doctor adding supplements such as potassium, magnesium, B-12, folate, vitamin E, and calcium to your diet. Whilst it has not been clinically proven, there is anecdotal evidence to suggest these supplements can ease RLS symptoms.

    To relieve the symptoms, you could try:

    These are simply suggestions and what works for some people, wont for others. If you have any concerns talk to your doctor or healthcare professional first.

    You May Like: What Helps Constipation In Parkinson’s Disease

    RELATED ARTICLES

    Popular Articles