One in 20 people over 60 suffers from restless legs syndrome, a common cause of insomnia. Without any warning during sleep. their legs start to tingle, and walk off the bed. Since restless legs syndrome occurs commonly, but not exclusively, in people who suffer from Parkinson's disease that causes shaking and loss of coordination, the same drugs are used to treat both diseases, but these so called dopamine agonists lose their beneficial effects over time. Exciting new research shows that combinations of low doses of dopamine agonists, such as levodopa and ropinirole, control restless legs syndrome for many months and years (1,2).
A report from Spain shows that the anticonvulsant, gabapentin, known under the trade name of Neurontin, helps to control restless legs syndrome, primarily because this condition is caused by an irritation of the nerves and drugs used to treat seizures, also help to control abnormal nerve messages (1A)
Most of the time, the only harmful effect of restless legs syndrome is that it interferes with sleep, but sometimes the sudden uncontrolled movement of your legs can be painful, cause pulled calf muscles, and leave you exhausted in the morning. Causes include pregnancy, lack of iron, vitamin B12 or folic acid, diabetes, Parkinson's disease, low thyroid function, several drugs including lithium, beta blockers, antidepressants, antihistamines, drinking coffee and alcohol and smoking. If you suffer from restless legs syndrome, avoid coffee, alcohol and smoking and if you take a medication, check with your doctor to see if you should stop taking it. If you lack vitamin B12 or iron, you can correct these deficiencies with pills. Doctors often prescribe drugs used to treat Parkinson's disease, tranquilizers such as Valium, anticonvulsant such as Tegretol and gabapentin, blood pressure medications such as beta blockers and clonidine, and opioids such as codeine, but these drugs work only some of the time (3,4,5).
If you stay on any drug, it loses effect and you will constantly increase the dose. It is often effective to have several drugs. Then when one drug stops working, you can switch to another drug. Most effective drugs are those that treat Parkinson's disease (Sinemet, L-Dopa with Carbidopa, pramipexole and ropinirole) After that try Klonopin, Restoril, bromocriptine, lisuride or pergolide, Dihydroergocriptine or cabergoline.
1A) Treatment of restless legs syndrome with gabapentin - A double-blind, cross-over study. Neurology, 2002, Vol 59, Iss 10, pp 1573-1579. D GarciaBorreguero, O Larrosa, Y delaLlave, K Verger, X Masramon, G Hernandez. Garcia-Borreguero D, Univ Autonoma Madrid, Fdn Jimenez Diaz, Dept Neurol, Sleep Disorders Unit, Avda Reyes Catolicos 2, Madrid 28040, SPAIN.
1B) Restless legs syndrome in the older adult - Diagnosis and management. Drugs & Aging, 2002, Vol 19, Iss 10, pp 741-751. SA Milligan, AL Chesson. Chesson AL, Louisiana State Univ, Hlth Sci Ctr, Dept Neurol, 1501 Kings Highway, Shreveport,LA 71130 USA
1) M Oechsner. Idiopathic restless legs syndrome: Combination therapy with levodopa and ropinirole. Aktuelle Neurologie 25: 5 (AUG 1998):190-192. levodopa 500 mg with ropinirole 0.75 mg daily.
2) O Pogarell, WH Oertel. New dopamine agonists for the treatment of Parkinson's disease. Aktuelle Neurologie 25: 5 (AUG 1998):202-209. address O Pogarell, Philipps Univ Marburg, Neurol Klin, Poliklin, Rudolf Bultmann Str 8, D-35033 Marburg, Germany. In addition to the established oral ergoline dopamine agonists bromocriptine, lisuride and pergolide new compounds have been developed and investigated in studies to further improve long-term therapy of Parkinson's disease. Dihydroergocriptine and cabergoline are also ergoline dopamine agonists. Ropinirole and pramipexole are two non-ergoline derivates without affinity for D1 receptors but with high affinity for the dopamine D3 receptor subtype.
3) O'Keeffe ST, Restless Legs Syndrome. Archives of Internl Medicine 1996;156:243-248.
4) ST Okeeffe, K Gavin, JN Lavan. Iron Status and Restless Legs Syndrome in the Elderly. Age and Ageing 1994(May);23(3):200-203.
5) ST Okeeffe, J Noel, JN Lavan. Restless Legs Syndrome in the Elderly. Postgraduate Medical Journal 1993(Sep);69(815):701-703.
6) VGH Evidente, CH Adler. How to help patients with restless legs syndrome - Discerning the indescribable and relaxing the restless.Postgraduate Medicine, 1999, Vol 105, Iss 3, pp 59+
7) Newer dopamine agonists in the treatment of restless legs syndrome. Annals of Pharmacotherapy, 2001, Vol 35, Iss 5, pp 627-630. PR Weimerskirch, ME Ernst.
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