Restless legs syndrome (RLS) does what it says on the can. Victims need to only sit or lie down for a few seconds before creepy-crawly sensations literally drive them up the wall. The discomfort is as insatiable as the urge to move is uncontrollable. It is, literally again, a nightmare; a frantic evening quickly followed by a frenetic night.
Neurologists rarely struggle to make the diagnosis of RLS. And with the efforts of support groups such as the RLS foundation, patients are now well-informed about the diagnosis. To the chagrin of the neurologists, patients often come with a list of medications they have tried, and failed.
The list of RLS risk factors is quite long. Some of these are modifiable, and the ‘must-exclude’ condition here, iron deficiency, requires checking the level of ferritin in blood. Other modifiable risk factors are quite diverse such as obesity, migraine, and even, surprisingly, myasthenia gravis (MG). Most RLS risk factors, such as peripheral neuropathy and Parkinson’s disease (PD), are unfortunately irreversible; in these cases some form of treatment is required.
But what really works in RLS? And what is the evidence? To the rescue come the latest Practice guideline summary: Treatment of restless legs syndrome in adults, published in the journal Neurology. Below, in summary, are the interventions that work in RLS.
Strong evidence (Level A)
- Pramipexole
- Rotigotine
- Cabergoline (but beware of cardiac risks)
- Gabapentin enacarbil
Moderate evidence (level B)
- Ropinirole
- Pregabalin
- Ferric carboxymaltose
- Pneumatic compression
Weak evidence (level C)
- Levodopa
- Oxycodone/naloxone (prolonged release)
- Near-infrared spectroscopy
- Transcranial magnetic stimulation (TMS)
- Vibrating pads (to improve subjective sleep)
Add-on treatments in haemodialysed patients
- Vitamin C
- Vitamin E
Enough to guarantee a well-deserved nighttime sleep!
You may wish to look at another set of RLS guidelines also recently published in the journal Sleep titled Guidelines for the first-line treatment of restless legs syndrome/Willis–Ekbom disease, prevention and treatment of dopaminergic augmentation: a combined task force of the IRLSSG, EURLSSG, and the RLS-foundation.
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