Definition
"RLS" is a complex neurological disorder, typical of sleep: the affected patient perceives the constant desire to move the lower limbs to find relief and comfort. The RLS syndrome is a sleep disorder because the symptoms occur mainly during rest, and are attenuated by movement.
Causes
The precise cause of restless legs syndrome is not known; probably the disease is transmitted genetically through an autosomal dominant mechanism. Risk factors: amyloidosis, rheumatoid arthritis, celiac disease, diabetes, folate deficiency, Lyme disease, kidney disease, Parkinson's disease, uremia.
Symptoms
The symptoms that accompany the restless legs syndrome are rather difficult to define: nocturnal contractions of the legs, motor restlessness, uncontrolled movements of the legs, need to move the lower limbs, itching / tickling, tingling in the legs.
Information on drugs for the treatment of restless legs syndrome is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Medicines for the Treatment of Restless Legs Syndrome.
drugs
Pharmacological treatment for patients suffering from mild forms of restless legs syndrome may not be necessary: in fact, the symptoms that accompany the disorder may be mild and sporadic, sometimes almost imperceptible.
Different discourse must be addressed for patients suffering from medium or severe forms of restless legs syndrome. Let us briefly recall that the primary form of RLS cannot be cured at the root because it is genetically transmitted, therefore not related to any precise and identifiable cause: in similar situations, pharmacological treatment is purely symptomatic.
The secondary form of the syndrome can instead be treated after identifying the cause that has been placed at the origins. In such circumstances, it is right to report two different therapeutic approaches:
- Symptoms are frequent, and occur in the subject at least 3 nights a week → medications to alleviate symptoms must be taken continuously.
- The symptoms of restless legs syndrome are sporadic, and present spontaneous remissions lasting for weeks or months. However, the symptoms - when they occur - create discomfort for the patient → in this case, the irregular intake of specific drugs is justified.
In addition to the administration of drugs, it is advisable to implement simple measures:
- Follow relaxation courses, yoga stretching
- Practicing sleep hygiene
- Avoid heavy and fat-rich meals, especially before bed
For further information: read the article on remedies for restless legs syndrome.
Martial therapy (administration of drugs containing iron)
Indicated to treat restless legs syndrome due to severe iron deficiency. Particularly indicated is ferrous sulphate (eg Ferrograd): iron supplementation should be continued as long as serum ferritin levels exceed 20-50 mcg / L. To promote mineral absorption, the drug can be combined with a vitamin C supplement.
Folic acid and vitamin B12
Folic acid and vitamin B12 supplementation is particularly useful for reducing the symptoms of restless legs syndrome in pregnant women.
Let us briefly recall that pregnant women should always supplement their diet with folic acid supplementation, which is essential for protecting the unborn child from spina bifida. Pregnant women should take higher amounts of vitamin B9 if they have a predisposition to restless leg syndrome.
The dosage must be carefully determined by the doctor.
Dopaminergic agonists (dopamine agonist drugs) : drugs mimic the effects of dopamine, stimulating neurons to react. Dopaminergic agonists are the first choice drugs for the treatment of restless legs syndrome.
Let us briefly recall that dopamine is a messenger substance contained within brain districts, useful for controlling movement and coordination. Even in restless legs syndrome, dopamine appears to play a leading role: neurological disorder may depend on alterations in the functioning of dopamine.
- Rotigotine (eg Leganto, Neupro): available as a trans-dermal release patch of 1, 2, 3, 4, 6 or 8 mg, rotigotine is indicated for the treatment of moderate or severe restless legs syndrome entity, especially when the disorder is apparently not related to any specific cause. Apply the patch once a day, approximately always at the same time, on dry, clean and healthy skin. It is recommended to apply it at the level of the abdomen, thighs, shoulders, hips or on the upper part of the arm. After 24 hours, the patch should be removed, and replaced with a new one to be applied at a different point. Do not exceed 3mg / 24 hours.
- Pramipexole (eg Sifrol, mirapexin, pramipexole accord, pramipexole teva, oprymea). The drug is available in immediate release tablets. For restless legs syndrome, it is recommended to take 0.088 mg (1 tablet) for immediate release once a day. If necessary, increase the dose every 4-7 days, up to a maximum of 0.54 mg. The drug is also used in therapy for the treatment of Parkinson's disease
- Carbidopa + levodopa ( Levodopa / Carbidopa / Entacapone Orion): even the combination of several active ingredients such as carbidopa and levodopa can significantly improve the symptoms of RLS. In general, the suggested posology for restless legs syndrome is 25-100 mg / day, to be taken before the onset of symptoms (before going to bed for a night's rest). However, the dosage must be carefully established by the doctor.
- Ropinirole (eg Requip): for restless legs syndrome, take 0.25 mg of oral drug once a day, 1-3 hours before bedtime. After 2 days, if necessary increase the dose to 0.5 mg / day. If necessary, the dosage can be progressively increased from week to week, up to a maximum of 4 mg per day. Consult your doctor.
Long-term therapy can induce serious side effects: hallucinations, hypotension, water retention and drowsiness; Possible obsessive-compulsive behaviors such as hypersexuality, gambling and compulsive eating behavior are also possible.
Benzodiazepines : although effective, these drugs exert their therapeutic activity exclusively on sleep disorders, not interacting with the root cause.
- Clonazepam (eg Rivotril): the drug is used in therapy for restless legs syndrome; it acts by raising the threshold of awakening reactions, thus countering frequent awakenings. The dosage must be carefully determined by the doctor (generally ranging from 0.5 to 2 mg, to be taken before bedtime). Clonazepam, due to its pharmacokinetic profile, is the most widely used benzodiazepine ever for restless leg syndrome.
Opiates
Second choice drugs for the treatment of restless legs syndrome. They are used in therapy when previous medications are not effective in reducing symptoms.
- Tramadol (eg Tralenil, Tramadol, Fortradol)
- Oxycodone (eg Oxycontin, Targin): in general, the recommended dosage is 15 mg, to be taken before going to bed
The dosage of the reported drugs must be established by the doctor based on the severity of the disorder.
Drugs can be addictive.
Antiepileptic drugs
For restless legs syndrome, antiepileptic drugs should be used at low doses.
- Gabapentin (eg. Gabapentin, Apentin, Gabexine, Neurontin): the drug (also used for the treatment of convulsions) should be taken orally, once a day, at a dose of 600 mg. Taken at 5.00 am, the drug excellently exercises its therapeutic action in reducing motor symptoms. Let us remember, in fact, that restless legs syndrome seems to follow very specific circadian rhythms.
