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Suggest Treatment For Restless Leg Syndrome Despite Taking Neupro Transdermal Patches

Posted on Tue, 8 Sep 2015

Question: I just started on Neupro transdermal patches 8mg/24 hrs. with gabapentin 300-600 mg at night for breakthrough symptoms and still have severe symptoms in the daytime and when I go to bed. I have taken everything else offered for Restless Leg Syndrome. Is there anything else that can be done?

Answered by Dr. Olsi Taka (56 minutes later)

Brief Answer:
Read below.

Detailed Answer:
I read your question carefully and I understand the distress you are in.

Judging by the number of drugs you seem to be on, yours seems to be a resistant case of restless legs syndrome (RLS). The choice of drugs you have been taking is correct, they all are first line drugs for RLS. I supposed you have been tested for iron deficiency as it commonly is associated with RLS and should be treated.

So if Neupro and Gabapentin remain ineffective, less common 2nd choice options will have to be explored. Such options may include Clonidin, a medication usually used for hypertension, but its central nervous system effect has proven beneficial in some RLS patients. Opioids may improve symptoms as well, especially pain.
Baclofen, a drug used to relieve muscle spasms may reduce intensity of the symptoms. An antidepressant called Bupropion is also being considered, but its use and benefit in RLS is yet not proven, further studies are needed.

Non medication measures may include exercise early in the day, hot baths, stretching, avoiding alcohol, smoking, caffeine.

I remain at your disposal for further questions.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Olsi Taka (6 hours later)

Thank you. That at least gives me hope for relief.

Answered by Dr. Olsi Taka (2 minutes later)

Brief Answer:
You're welcome

Detailed Answer:
Hopefully some of those suggestions might be of help.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Olsi Taka (10 hours later)

I have been seeing a pulmonologist for treatment. Would it be better to see a neurologist?

Answered by Dr. Olsi Taka (4 minutes later)

Brief Answer:
Yes

Detailed Answer:
For restless legs syndrome treatment?...well yes, pulmonology is far from being a specialty which deals with that diagnosis, definitely a neurologist is the most qualified specialist for that diagnosis.

I am not saying I find something wrong in your treatment, if the diagnosis is correct as I said the choices made till now are first choices, but since you are not improving it would be advisable to consult a neurologist, both to confirm the diagnosis as well as for further treatment.

I hope to have been of help

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Olsi Taka (1 hour later)

Thank you. I originally ended up with a pulmonologist by referral fron a neurologist for sleep apnea to see if that contributed to My RLS. I do have sleep apnea and use a C-Pap machine, but no much improvement to RLS. However, the pulmonologist and neurologist were on the same page and the neurologist left the practice, so have continued with the pulmonologist. I have a referral to a neurologist and am hoping that she will accept me.
I appreciate your recommendations.

Answered by Dr. Olsi Taka (3 hours later)

Brief Answer:
Thank you and good luck.

Detailed Answer:
Thank you for that added info, now that you explained the reason for being followed by a pulmonologist I am less perplexed. The fact that the diagnosis was made by a neurologist is reassuring. Hopefully the new neurologist will be able to better help you.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar