Introduction
Restless leg syndrome is a neurological disorder. It is not a behavior problem as it was thought of in the past by distraught parents and doctors. About 12 to 15 million Americans are suffering from this syndrome, where they have abnormal or unpleasant sensations under the skin and in the muscles of the lower legs, a burning, a feeling like insects are crawling or sharp knife-like pain. It is relieved somewhat by getting up and walking or running around, only to return very quickly when sitting down. Patients with this condition have also often sleep disturbances, which can be measured in the sleep laboratory.
Diagnosis
Sleep lab investigations are a good way to measure the severity of the restless leg syndrome condition and to evaulate the impact it has on the patient’s sleep hygiene. It is known that sleep deprivation makes the symptoms worse and a reintroduction of a regulated sleep/wake rhythm improves the symptoms.
Treatment
Recently there have been reports of a very beneficial effect of gabapentin, an anti-epileptic drug. Gabapentin(brand name: Neurontin) releases GABA in some parts of the brain and inhibits the NMDA pain receptors. This link describes the use of it in the pain of complex regional pain syndrome. Dr. Stephen Clarke, Clinical Assistant Professor in the Div. of Neurology of the University of BC/Vancouver/Canada, reviewed the use of gabapentin at a conference in Vancouver/BC in November 2004 (Ref. 3). Dr. Clarke said that the use of gabapentin in restless leg syndrome is particularly satisfying as the patients who tend to not respond to all of the other medications respond in a high percentage of cases and this leads to a more normal life for them. It is a very safe medication as outlined under the complex regional pain syndrome link and the symptoms can be titrated by increasing the dose of the medication.
Restless Leg Syndrome
In 2006 a transdermal treatment with the dopamine agonist rotigotine (brand name Neupro®) used for Parkinson’s disease, was found to be useful for treating restless leg syndrome. You can read more details about this in this blog.
References:
1. Ruddy: Kelley’s Textbook of Rheumatology, 6th ed., 2001, W. B. Saunders Company
2. The 50th Annual St. Paul’s Hospital Continuing Medical Education Conference for Primary Physicians, Nov. 16 – 19, 2004
3. The 50th Annual St. Paul’s Hospital Continuing Medical Education Conference for Primary Physicians, Nov. 16 – 19, 2004
