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Restless Leg Syndrome

Discussion in 'General Issues and Discussion Forum' started by Cameron, May 19, 2005.

  1. Cameron

    Cameron Well-Known Member

    Members do not see these Ads. Sign Up.

    This is a syndrome most GPs regard as something you just have to put up with and unaware of Adartrel ® (Ropinirol) (GoldsmithKline) a dopaminagonist, which is already used for the treatment of the Parkinson illness. The drug has been used in the US and Europe and is now about to be introduced into the UK

    The syndrome of the jerky legs, also Restless Legs syndrome (RLS) is a sensitive motor neurological disturbance, which is frequently misjudged and underestimated, although 5 - 15% of the European population are affected by it. It causes unpleasant feelings, mostly within the range of the legs, whereby the sleep is impaired and is associated with behaviour disturbances such as fear, as well as depression in the long run.

    The complaints can begin at any age, although it is found frequently in the thirty something demographic. Many patients report acute symptoms to their podiatists but rarely mention the symptoms to their doctor until they are chronic. The illness is idiopathic and predominantly arises with a genetic predisposition. Research indicates RLS is caused by a disturbance in the dopamine metabolism and patients respond frequently to a dopamine type treatment.

    Interested to find what experience podiatrists have had with patients and restless leg syndrome?

    Hey, what do I know?
  2. Craig Payne

    Craig Payne Moderator

  3. admin

    admin Administrator Staff Member

  4. P Thompson

    P Thompson Member

    I am not a physician, but I do have restless leg syndrome, and additionally experienced cramping of toes and feet daily since childhood. In my case, the entire problem was solved within a couple of days by taking powdered magnesium. No one was more surprised than I. I take 1 tablespoon dissolved in hot water every evening, (in the morning as well during ski vacations or when I am over-tired) and have no symptoms. Been taking it for over 10 years now.

    I have no studies or medical evidence to prove it works for everyone, but it would be an inexpensive, non-drug solution to try.
    Last edited by a moderator: Jan 24, 2009
  5. Ian Linane

    Ian Linane Well-Known Member

    Apparently it is one of the conditions that can respond to medical acupuncture that podiatrists can use, although I have not treated it myself.

  6. NewsBot

    NewsBot The Admin that posts the news.

    Restless Legs Syndrome

    Reuters are reporting:
    Requip eases restless legs, study confirms
  7. emoclew

    emoclew Member

    A pt of mine seems to have minimised her RLS to a manageable point by following an extremely low salt,magnesium rich diet. I don't have exact details of the diet but I know she ordered the book over the internet. Whether it's placebo or not I'm not sure, but it seems to have helped.
  8. planger

    planger Member

    As a podiatrist who also experiences periodic bouts of RLS, I have had good results both for myself and patients treating with 100 - 300 mg gabapentin before bed. As a side note, although my symptoms became significant around age 36, I do recall a couple of instances of RLS as a child. A patient of mine had similar experience.
  9. John Spina

    John Spina Active Member

    I would do a blood test to R/O any kidney,endocrine or liver trouble.While usually benign....it is NOT always so.Monitor the situation.
  10. NewsBot

    NewsBot The Admin that posts the news.

    Restless Legs Syndrome

    Medscape have a new CME on Restless leg syndrome
    The Diagnosis and Management of Restless Legs Syndrome (free registraion required)
  11. One Foot In The Grave

    One Foot In The Grave Active Member

    A friend who was studying naturopathy told me about Magnesium deficiency & RLS ten years ago.
  12. P Thompson

    P Thompson Member

    Pretty amazing stuff. Apparently solves a myriad of problems, not just RLS, although a drug-free solution to RLS isn't a minor accomplishment. I buy the stuff in bulk :D :cool:
  13. NewsBot

    NewsBot The Admin that posts the news.

    Restless Legs Syndrome

    The BBC are reporting:
    Drug for Restless Legs Syndrome
  14. NewsBot

    NewsBot The Admin that posts the news.

    Editorial in todays BMJ
    Restless legs (only those with instituitional access can get the full article)
  15. METaylor

    METaylor Active Member

    Restless legs is only one of many symptoms of magnesium deficiency. the others are: fatigue, anxiety, insomnia, palpitations especially frequent ventricular ectopics, myocardial infarcts, hypertension, headaches and migraines etc. Magnesium is depleted by alcohol, exercise, sweating and excess calcium. Recommended intake is 250-300mg/day. average intake is 220mg/day so deficiency is not uncommon. Main dietary sources are greens (middle of chlorophyll molecule is magnesium), nuts and seeds, whole grains, which many people eat very little of. Usual supplemental dose is 300 - 600mg/day but much more is safe. To relieve restless legs use 200mg three times a day for 2-3 weeks, then reduce to 300mg/day with at least 200mg at bedtime as it is natures tranquillizer. It's cardiovascular benefits are due to its properties as natures calcium channel blocker.
  16. P Thompson

    P Thompson Member

    The best source I've found for Magnesium is a water soluable powder from HERE
  17. TEW

    TEW Member

    An elderly patient of mine was suffering from night cramps in her legs. She started to take a supplement (from health shop) that was advertised to help with hair and skin strength. She took it to improve the appearance of her hair. Once she started taking the tablets the night cramps stopped. I can't remember the exact contents of the supplement but I do know there was a high percentage of magnesium and zinc. Does zinc also help with cramps or is it more likely that the magnesium was producing the desired results? Does anyone recommend supplements if people are suffering from night cramps?
  18. P Thompson

    P Thompson Member

    For me it's magnesium, no question. For night cramps especially.
  19. METaylor

    METaylor Active Member


    Absolutely agree - magnesium is the one for cramps and restless legs, but you need calcium as well for the cramps. 500mg calcium (as citrate not carbonate as its poorly absorbed) and 250mg magnesium. Good supplements will have that ratio. It's good to take half of the daily dose at bedtime so the calcium is there for the night-time parathyroid hormone. Check that they aren't coeliac - there are 8 undiagnosed for every one diagnosed, and oldest one diagnosed was in her 90s. Coeliac disease causes malabsorption of most minerals, and they usually present with vague complaints eg fatigue, anaemia, irritable bowel and osteoporosis. There's a very good blood test for it nowadays, called transglutaminase, that a GP can order. On the other hand, zinc is excellent for growing pains in children. 15-30mg daily should stop them within a month.
    Last edited: Oct 31, 2006
  20. NewsBot

    NewsBot The Admin that posts the news.

    Ivanhoe Medical News are reporting:
    Restless Leg Drug may Cause Compulsive Gambling
  21. NewsBot

    NewsBot The Admin that posts the news.

    Children get it as well

    Science Daily are reporting:
    Restless Legs Syndrome Affects Nearly Two Percent Of US And UK Children
  22. John Spina

    John Spina Active Member

    For such cases,a blood test can rule out systemic causes.Also try to limit caffeine intake.
  23. Cameron

    Cameron Well-Known Member


    Source: Nogrady B Pediatrics 2007; 120:253-66

    RESTLESS legs syndrome is under-diagnosed in children and could be an underlying cause of behavioural and sleep problems, experts say. A US survey of more than 10,000 families found 1.9% of children aged 8-11 years and 2% of children aged 12-17 years met the criteria for restless legs syndrome, but only 11% of these patients had been previously diagnosed with the condition. Sleep disturbances and a history of "growing pains" were significantly more common in children identified as having restless legs syndrome compared with controls, the data, published in Pediatrics (August), showed.

    "These population-based data suggest that restless legs syndrome is prevalent and troublesome in adolescents, occurring more commonly than epilepsy or diabetes," the authors wrote.

    Paediatric sleep physician Dr Arthur Teng said this was the first prevalence study to use proper diagnostic criteria, and showed the condition was being missed in many children. Restless legs syndrome could have many daytime presentations, including anxiety, attentional deficits, irritability, sleepiness and ADHD, said Dr Teng, head of the department of sleep medicine at Sydney Children's Hospital at Randwick. It was important to ask parents about their child's sleeping habits when they presented with these symptoms, he said.

    "Ask about their bedtime routine, what time do they go to bed, what time does the child go to sleep, during sleep what happens," he said.

    The study also identified a strong family association, with at least one biological parent reporting similar symptoms to the child in 70% of cases. While there were several pharmacological treatments available for adults with restless legs syndrome, Dr Teng said few of these were tested in, or suitable for, children. Iron supplements were one option in patients with ferritin levels less than 40µg/L, although evidence for their efficacy was "variable".

  24. Cameron

    Cameron Well-Known Member

  25. NewsBot

    NewsBot The Admin that posts the news.

    Science Daily are reporting:
    Restless Legs Syndrome Doubles Risk Of Stroke And Heart Disease, Study Shows
    Full story
  26. betafeet

    betafeet Active Member

    Restless Legs

    Thought you might find this article useful:

    "Treating restless legs

    2007 Aug 7

    GPs no longer have to search for a specialist neurologist for restless legs syndrome, because diagnosis and management can be achieved in general practice, says Dr Tony Brzezicki

    Restless legs syndrome (RLS) is a common but poorly understood condition and, until recently, management has been difficult. Recent advances in therapy now make the accurate identification of RLS important.

    It has long been recognised that RLS tends to run in families. At least three specific gene locations have been discovered, showing a strong genetic disposition to develop the syndrome.

    Iron metabolism and in particular ferritin levels within the substantia nigra are known to be important, but exactly why is uncertain. Dopamine pathways are also involved. However, the evidence for these pathways being the underlying cause of RLS is conflicting.

    Traditionally, dopaminergic drugs such as levodopa have been key therapeutic options. Now dopamine agonists are recommended as first-line treatments.
    RLS to a lesser or greater degree afflicts up to 10% of the population [1].

    Symptoms can vary with time, but tend to become more severe with age. As the onset is often insidious, many patients who become severely affected do not seek treatment, feeling there is nothing that can be done for them. Fortunately, this is no longer true.

    The effect on people’s lives can be devastating. Sleep is disturbed or becomes almost impossible, meaning partners often move to separate bedrooms. Sufferers’ work is affected because of lack of sleep and poor concentration.
    As keeping still becomes a nightmare for RLS patients, travel in cars and planes is not possible. Similarly, they avoid going to the theatre, cinema or other such events.


    Patients often become stressed, tired all the time and start to withdraw. It is certainly worthwhile enquiring about the symptoms of RLS in people who present with tiredness, insomnia and failure to cope. Patients can be mislabeled as suffering from depression, stress or ME syndrome.

    To diagnose RLS, patients need to satisfy the International Restless Legs Syndrome Study Group’s four simple criteria:

    ● A need to move the legs, usually accompanied or caused by uncomfortable sensations in the legs;
    ● The need to move and unpleasant sensations being exclusively present or worse during periods of rest or inactivity;
    ● The need to move and unpleasant sensations being partially or totally relieved by movement, as long as the movement continues;
    ● The need to move or unpleasant sensations being generally worse in the evening or night, showing a strong circadian rhythm.
    RLS can also occur as a secondary condition. The most common causes are:
    ● Iron-deficient anaemia;
    ● Pregnancy;
    ● End-stage renal disease.

    It is therefore sensible to exclude iron deficiency by doing a ferritin test before firmly diagnosing RLS, to exclude a treatable secondary cause. RLS is also common in diabetes mellitus and can be mistaken for an autonomic neuropathy, which will be unresponsive to the usual treatments. So diagnosis is straightforward:

    ● Patient satisfies the four criteria;
    ● Ferritin is normal;
    ● Simple neurological examination is normal;
    ● There is no underlying cause for the RLS.


    Dopamine agonists
    The treatments of choice are dopamine agonists. Two are licensed in the UK for the treatment of moderate to severe primary RLS: pramipexole and ropinirole. The Scottish Medicines Consortium, however, backs pramipexole in moderate to severe RLS, but ropinirole only in severe RLS [2,3].

    The treatment algorithm for RLS is relatively simple. The first licensed medicine in the UK was pramipexole. Treatment is started with a single evening dose of 0.125mg (equivalent to 0.088mg base dose), and then slowly titrated upwards depending on response, every four to seven days, provided no
    adverse side-effects occur.

    The maximum daily dose of pramipexole is 0.75mg (equivalent to 0.54mg base dose) [4]. However, a good response is usually obtained at lower dose levels, 0.25mg (equivalent to 0.18mg base dose) being the usual dose. The most common side-effect of dopamine agonists is nausea.

    The most frequently used treatment group in RLS has been dopaminergic agents (levodopa). Treatment is given as a single dose, usually at night. The drugs are very effective, but many patients develop one of two significant side-effects:

    ● Rebound – symptoms start appearing in the morning, in the afternoon or in the evening due to ongoing use of treatment;
    ● Augmentation – symptoms start appearing in the upper limbs.
    These side-effects have been difficult to manage. Dosing schedules tend to become increasingly complex and the treatment regimens can become hard to manage.

    For this reason RLS has become a tertiary care disease. This should no longer be a problem for the future. The early use of dopamine agonists will hopefully mean augmentation and rebound become a rare phenomenon.


    Anti-epileptics such as gabapentin can help if the RLS is particularly painful.
    Clonazepam and zopiclone can be helpful if insomnia persists. Many patients are treated with drugs for insomnia or depression. However, fluoxetine and amitryptyline make RLS worse.

    Non-drug interventions

    Interventions that can help with RLS include:
    Walking and stretching;
    Hot or cold baths;
    Relaxation and yoga;
    Massaging the affected limbs;
    Taking part in distracting activities, such as discussions or exercise;
    Reducing caffeine and alcohol intake.

    Referral to secondary or tertiary care is now only necessary if the diagnosis is in doubt or treatment fails, as augmentation or rebound can be very difficult to manage. The clear diagnostic criteria and good treatments now available make RLS a straightforward and satisfying condition to treat in primary care.

    1. Phillips B, Young T et al. Arch Intern Med 2000; 160: 2137-41.
    2. Scottish Medicines Consortium submission ( www.tinyurl.com/ 2kbhog). 3. Scottish Medicines Consortium submission ( www.tinyurl.com/ 3car33). 4. Boehringer Ingelheim Ltd ( www.tinyurl.com/36hb6f ).
    Dr Brzezicki is a GP practising in Croydon


    ● The patient’s legs jump or twitch, often uncontrollably, at rest and especially at night
    ● Pain similar to neuropathic pain can be experienced, which presents like electric shocks, crawly sensations in the legs, fizzing under the skin, heat or cold
    ● All symptoms worsen towards the evening and are improved with exercise
    ● For some, staying still for any length of time becomes intolerable
    ● This combination of sleep, movement and neuropathic pain disorder is unique to RLS and symptoms tend to worsen with time

    Doctor Portal

    Accessed 30th May 2008"
  27. NewsBot

    NewsBot The Admin that posts the news.

    The latest Australian Prescriber has a full text article on Restless Legs Syndrome:
  28. NewsBot

    NewsBot The Admin that posts the news.

    This device has just been granted a patent:
    Device to alleviate the symptoms of restless leg syndrome, restless arms syndrome, and foot and leg cramps
    Link to patent
  29. Geoff Boldero

    Geoff Boldero Welcome New Poster

    Restless legs syndrome

    Good to see someone not automatically diving for a pharmaceutical for a quick fix of a symptom. So often these problems are symptomatic of a lack some essential nutrient and never because the body is lacking a toxic drug. Good tip thank you
    Geoff Boldero
    Last edited by a moderator: Jan 24, 2009
  30. NewsBot

    NewsBot The Admin that posts the news.

    Review article in latest BMJ:
    Restless legs syndrome
    BMJ 2012; 344 doi: 10.1136/bmj.e3056 (Published 24 May 2012)
  31. NewsBot

    NewsBot The Admin that posts the news.

    Press Release:
    Flies with Restless Legs Syndrome point to a genetic cause
    Sleep Fragmentation and Motor Restlessness in a Drosophila Model of Restless Legs Syndrome
    Amanda Freeman, Elaine Pranski, R. Daniel Miller, Sara Radmard, Doug Bernhard, H.A. Jinnah, Ranjita Betarbet, David B. Rye, Subhabrata Sanyal
    Current Biology 31 May
  32. NewsBot

    NewsBot The Admin that posts the news.

    Prospective Study of Restless Legs Syndrome and Coronary Heart Disease Among Women
    Yanping Li, Arthur S. Walters, Stephanie E. Chiuve, Eric B. Rimm, John W. Winkelman, and Xiang Gao
    Circulation 2012; first published on September 11 2012
  33. NewsBot

    NewsBot The Admin that posts the news.

    Here is a press release on this study from Heartwire:
    Restless legs linked to CHD: New prospective data
  34. NewsBot

    NewsBot The Admin that posts the news.

    Restless legs syndrome in Iranian patients with multiple sclerosis
    Shahnaz Miri, Mohammad Rohani, Mohammad Ali Sahraian, Babak Zamani, Gholam Ali Shahidi, Amin Sabet, Maziar Moradi-Lakeh and Mohammad Bodaghabadi
    Neurological Sciences; 2012
  35. NewsBot

    NewsBot The Admin that posts the news.

    No association between neuropathy and restless legs in Parkinson's disease
    Y. A. Rajabally, J. Martey
    Acta Neurologica Scandinavica (Early View)
  36. NewsBot

    NewsBot The Admin that posts the news.

    Long-term use of pramipexole in the management of restless legs syndrome
    Melissa C. Lipford, Michael H. Silberemail
    Sleep Medicine (Article in Press)
  37. NewsBot

    NewsBot The Admin that posts the news.

    A phase II, open-label, non-comparative study of Botulinum toxin in Restless Legs Syndrome
    Imad Ghorayebemail et al
    Sleep Medicine (Online first)
  38. Lab Guy

    Lab Guy Well-Known Member

    Thanks for the tip. I have had RLS for about 5 years. Been taking oral Magnesium for about 4 months and symptoms abated after about 1 week. I am very happy. People drink bottle water and many brands devoid of minerals.

  39. NewsBot

    NewsBot The Admin that posts the news.

    Uremic Versus Idiopathic Restless Legs Syndrome: Impact on Aspects Related to Quality of Life
    Gkizlis, Vasileios; Giannaki, Christoforos D.; Karatzaferi, Christina; Hadjigeorgiou, Georgios M.; Mihas, Costantinos; Koutedakis, Yiannis; Stefanidis, Ioannis; Sakkas, Giorgos K.
    ASAIO Journal: 12 October 2012
  40. NewsBot

    NewsBot The Admin that posts the news.

    Intravenous Iron Given prior to Pregnancy for Restless Legs Syndrome is Associated with Remission of Symptoms.
    Picchietti DL, Wang VC, Picchietti MA.
    J Clin Sleep Med. 2012 Oct 15;8(5):585-6. doi: 10.5664/jcsm.2168.

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