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Suggest Treatment For Restless Legs Syndrome
Question: I am being treated for restless legs syndrome. I was on requip for about 12 months when symptoms started to return. Doseage was increased, but after 6-8 months symptoms returned. I then went on gabapentin, 300mg tablets, 3 tablets 3 times a day. Again symptoms went away for about 18. I'm now on pramipexole .125mg at bedtime, with instructions to take up to 4 if needed. I have also tried iron and magnesium, massage therapy and acupuncture.
My symptoms occur more during the day rather than at night. It happens anytime whenever I sit down for more than 15-30 minutes. It starts with a tingling sensation and progresses to jerking, feeling of something crawling inside my legs. Symptoms occur primarily in the left leg. Some times the jerking is so bad my back hurts. I have also kicked myself so hard by accident to cause bruising.
In 2008 I went through chemotherapy for breast cancer. Due to heart issues from the first 2 treatments I was given a different course of treatment, which caused severe neuropathy and was the beginning of my RLS problems. After completing chemo the neuropathy went away, but the RLS continued and is getting worse. After chemo I was on estrogen blockers for 5 years. During that time I suffered from severe muscle and joint pain so my oncologist prescribed Vicodin. This also helped my RLS symptoms. With the new regulations on the use of opioids I no longer take Vicodin. My doctor doesn't seems to have any idea where to go now. In the meantime when the jerking, creepy feelings, and pain get so bad I think I'm going crazy. I have another appointment in 3 weeks and I'm wondering if I should try a new doctor or is there anything out there that works. I'm tired of feeling like a zombie during the day. I just want to feel normal.
My symptoms occur more during the day rather than at night. It happens anytime whenever I sit down for more than 15-30 minutes. It starts with a tingling sensation and progresses to jerking, feeling of something crawling inside my legs. Symptoms occur primarily in the left leg. Some times the jerking is so bad my back hurts. I have also kicked myself so hard by accident to cause bruising.
In 2008 I went through chemotherapy for breast cancer. Due to heart issues from the first 2 treatments I was given a different course of treatment, which caused severe neuropathy and was the beginning of my RLS problems. After completing chemo the neuropathy went away, but the RLS continued and is getting worse. After chemo I was on estrogen blockers for 5 years. During that time I suffered from severe muscle and joint pain so my oncologist prescribed Vicodin. This also helped my RLS symptoms. With the new regulations on the use of opioids I no longer take Vicodin. My doctor doesn't seems to have any idea where to go now. In the meantime when the jerking, creepy feelings, and pain get so bad I think I'm going crazy. I have another appointment in 3 weeks and I'm wondering if I should try a new doctor or is there anything out there that works. I'm tired of feeling like a zombie during the day. I just want to feel normal.
Brief Answer:
RLS treatment options
Detailed Answer:
Hi XXXX, thanks for asking from HCM.
I can understand your concern. As you are a proven case of severe restless leg syndrome (RLS), I will tell you the treatment options which you can try after discussing it with your doctor
: Preventive therapy - Avoid substances or foods that may increase the problem like alcohol, caffeine, and nicotine. This may help relieve your symptoms.
: Any underlying medical conditions, such as anemia, diabetes, nutritional deficiencies, kidney disease, thyroid disease, varicose veins. You have not told me about neuropathy. You can take dietary supplements to correct vitamin or mineral deficiency which might treat neuropathy. Take B12, folic acid, Pyridoxine, Pentothanic acid, Biotin, vitamin E and vitamin D3 supplements. It will treat nerves, bone and muscles
: You may also benefit from physiotherapy such as stretching, taking hot or cold baths, whirlpool baths, applying hot or cold packs to the affected area, limb massage or vibratory or electrical stimulation of the feet and toes before bedtime. Exercise and relaxation techniques also may be helpful. All these methods divert attention towards superficial sensation and prevent perception of restlessness. I use these methods in my patients with lot of success. There are no side effects.
: Start Yoga and meditation - After regular practice, I thick you will be able to control your symptoms. Start it under supervision.
: Keep in mind that drugs used to treat primary RLS do not cure the condition, but only relieve symptoms. After some relief, you can take them only during symptomatic episode and not on regular basis.
1) Dopamine agonists: These are most often the first medicines used to treat RLS which you are already taking. These drugs, including pramipexole, rotigotine, and ropinirole act like the neurotransmitter dopamine in the brain.
Side effects include daytime sleepiness, nausea, and lightheadedness.
2) Dopaminergic agents: These drugs, including a combination of levodopa and carbidopa -- increase the level of dopamine in the brain and may improve leg sensations in RLS.
Side effects can also include nausea, vomiting, hallucinations, and involuntary movements (dyskinesias).
3) Benzodiazepines: Benzodiazepines, such as alprazolam, clonazepam and temazepam are sedatives. They do not so much relieve symptoms but help you sleep through the symptoms.
4) Opiates: Opiates are very addictive. They are usually used only when other drugs don't work. Hydrocodone is one example. You can get it after prescription. As you had worsening of symptoms. You can ask your doctor to prescribe it.
5) GABA agonists - These agents such as gabapentin and Pregabaline may help relieve the symptoms of RLS as well as any chronic pain or nerve pain. So in your case, these medication may take care of neuropathy pain.
6) Alpha2 agonists: Clonidine.
You can discuss all these options with your doctor and get the treatment which will relieve your symptoms.
Hope it will help you. Thanks. Take care.
If any doubt, do let me know.
RLS treatment options
Detailed Answer:
Hi XXXX, thanks for asking from HCM.
I can understand your concern. As you are a proven case of severe restless leg syndrome (RLS), I will tell you the treatment options which you can try after discussing it with your doctor
: Preventive therapy - Avoid substances or foods that may increase the problem like alcohol, caffeine, and nicotine. This may help relieve your symptoms.
: Any underlying medical conditions, such as anemia, diabetes, nutritional deficiencies, kidney disease, thyroid disease, varicose veins. You have not told me about neuropathy. You can take dietary supplements to correct vitamin or mineral deficiency which might treat neuropathy. Take B12, folic acid, Pyridoxine, Pentothanic acid, Biotin, vitamin E and vitamin D3 supplements. It will treat nerves, bone and muscles
: You may also benefit from physiotherapy such as stretching, taking hot or cold baths, whirlpool baths, applying hot or cold packs to the affected area, limb massage or vibratory or electrical stimulation of the feet and toes before bedtime. Exercise and relaxation techniques also may be helpful. All these methods divert attention towards superficial sensation and prevent perception of restlessness. I use these methods in my patients with lot of success. There are no side effects.
: Start Yoga and meditation - After regular practice, I thick you will be able to control your symptoms. Start it under supervision.
: Keep in mind that drugs used to treat primary RLS do not cure the condition, but only relieve symptoms. After some relief, you can take them only during symptomatic episode and not on regular basis.
1) Dopamine agonists: These are most often the first medicines used to treat RLS which you are already taking. These drugs, including pramipexole, rotigotine, and ropinirole act like the neurotransmitter dopamine in the brain.
Side effects include daytime sleepiness, nausea, and lightheadedness.
2) Dopaminergic agents: These drugs, including a combination of levodopa and carbidopa -- increase the level of dopamine in the brain and may improve leg sensations in RLS.
Side effects can also include nausea, vomiting, hallucinations, and involuntary movements (dyskinesias).
3) Benzodiazepines: Benzodiazepines, such as alprazolam, clonazepam and temazepam are sedatives. They do not so much relieve symptoms but help you sleep through the symptoms.
4) Opiates: Opiates are very addictive. They are usually used only when other drugs don't work. Hydrocodone is one example. You can get it after prescription. As you had worsening of symptoms. You can ask your doctor to prescribe it.
5) GABA agonists - These agents such as gabapentin and Pregabaline may help relieve the symptoms of RLS as well as any chronic pain or nerve pain. So in your case, these medication may take care of neuropathy pain.
6) Alpha2 agonists: Clonidine.
You can discuss all these options with your doctor and get the treatment which will relieve your symptoms.
Hope it will help you. Thanks. Take care.
If any doubt, do let me know.
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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