Each week we will aim to bring out a concise email that provides 4-5 key pieces of information addressing a specific issue in clinical therapeutics.
This week: Restless Legs Syndrome
Caroline Holdstock, Regional Pharmacist Manager, Ward MM
Restless Legs Syndrome (RLS) is a disorder of the nervous system, that causes an urge to move the legs. Those affected often complain of limb (usually leg) discomfort at rest, then have an uncontrollable urge to move the leg. It is a common cause of insomnia, usually occurring in the evening or early hours of the morning, and so is also classed as a sleep disorder.
- Many symptoms are described including: creeping, crawling, burning, electric current and others. Symptoms occur after lying or sitting quietly and are intensified the more relaxed the person is. Movement only temporarily controls the symptoms.
- Conditions predisposing a person to RLS including iron deficiency, pregnancy, uraemia, Parkinson’s Disease, diabetes and peripheral neuropathy. RLS may also be idiopathic. Some medications may contribute such as lithium, clomipramine and venlafaxine, and sedating antihistamines, as will the consumption of alcohol, caffeine and nicotine.
- There is no cure for RLS. Initially good sleep hygiene practices, avoidance of aggravating substances and treating the underlying cause may be enough. Non-pharmacological therapy such as stretching, hot or cold baths, massage, hot or cold packs or electrical stimulation of the feet before bed may help.
- Symptoms occurring more than 3 times a week generally require treatment, usually with medications that increase dopamine transmission in the CNS. Starting with as required levodopa with benserazide or carbidopa, more severe symptoms may require dopamine agonists or oxycodone. If these are not tolerated benzodiazepines or anticonvulsants could be tried. Anticholinergics may have a deleterious effect on symptoms. If painful sensory symptoms are present anticonvulsants may be useful. Doses of dopamine agonists will be much lower than those used for Parkinson’s Disease.
Please consider these issues when preparing or interpreting RMMR reports or education sessions. Contributions of content or suggested topics are welcome and should be sent directly to firstname.lastname@example.org.