How common is Restless Legs Syndrome in your practice and what treatments do you typically recommend?
Read RLS: Diagnostic time-savers, Tx tips,
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I treat restless leg syndrome by first trying to find the underlying illness, if possible. I start out by examining the blood for iron deficiency. I have patients eliminate caffeine and alcohol. I also try to get them to stop smoking. I try to get them to get better sleep and exercise daily.Medications I use to treat restless leg syndrome include carbidopa-levodopa, opioids (such as propoxyphene) or tramadol (Ultram) for intermittent symptoms, carbamazepine, clonazepam, diazepam, triazolam, temazepam, baclofen, bromocriptine, and clonidine. I also recently used gabapentin (Neurontin) which was helpful. The FDA has now approved ropinirole (Requip) and pramipexole (Mirapex) for the treatment of restless leg syndrome. Other treatments that have been helpful for some patients include avoiding caffeine, warm/cold baths, electric nerve stimulation, oral magnesium, and acupuncture.
ReplyDeleteDr. George P. Bahadue
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ReplyDeleteRLS is very common in primary care. I have been interested in RLS and treating my family practice patients for over 15 yrs. I didn't believe the quoted 5-10% frequency so I surveyed our hospital employees and all my patients during a 2 month period and found 15% with symptoms more than once a week.This was confirmed by Nichols DA et al who found the same frequency in 2000 primarycare patients over a 1 yr. period published in Arch Intern Med, Oct.2003. Several studies report RLS in 15-20% of pregnancies occurring in the last trimester, resolving after delivery. I delivered 500 women some years ago and never diagnosed RLS because I never asked about sleep problems. Nor is it restricted to adults. Dr. Picchietti et al found a frequency of 2% in a survey of 10,000 families reported in Pediatrics in Aug. 2007. Some "growing pains" are RLS. Only about half need treatment but all need to know their symptoms are real and treatment is available if it worsens. The crux of RLS Dx is asking all new and periodic Px patients about sleep problems. Regarding treatment, 95% of patients can be managed by us. 5% with severe and/or daytime symptoms I refer to neurology or sleep specialists. Clonazepam has been generally firstline because it is generic, dirt cheap, on most formularies, and worked well for both intermittent and persistent nocturnal symptoms in young and old over many years. The prospective controlled negative clonazepam study is flawed by its small size. It involved only 6 patients, Many other clonazepam studies reported benefit. Its advantages are that it works promptly and lasts through the night. Caveats are daytime somnolence in some and long halflife which makes daytime usage and high dosage not useful. I use O.25-1.5 mg. evening or HS. Opioids, although effective, are used only when patients' dysesthesias accompanying the urge to move were actually pain and restricted use to codeine or darvon. Patients were afraid(inapropriately) of "addiction" and I was afraid of addiction or misappropration from the strong opioids. Carbidopa/levodopa is good and I have three teenagers tolerating it well. I could go on, but tha would be a superblog
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