Restless Legs
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Iron: Supplements Can Help Restless Legs: Restless Legs Syndrome (RLS) is found in iron deficient conditions: 40% of people with anemia have RLS and about 30% of pregnant women. Some people with RLS do have normal iron levels. However, in an RLS post-mortem study, iron levels were often low in brain cells in the substantia nigra even when serum iron was normal. There were not enough receptors to bind to a protein called transferrin that brings iron to and from the cells. This abnormality could be a genetic defect. Measure blood levels of ferritin, since ferritin levels best correlate with the symptoms of RLS. People with low ferritin levels may benefit from a 325 mg daily dose of a ferrous sulfate iron supplement along with vitamin C to improve absorption. An enzyme that makes the brain chemical dopamine is an iron-requiring enzyme, so iron deficiency changes the balance in the dopamine system. Dopamine agonists reduce symptoms by replacing the insufficient amounts of dopamine that are thought to induce RLS.

Magnesium: Restless Legs Improved After Bedtime Magnesium: Periodic limb movements during sleep (PLMS) and restless legs syndrome (RLS) are often treated with dopaminergic drugs. Tolerance and rebound exacerbation are common. In an open polysomnographic study in 10 patients (mean age 57) with insomnia from PLMS (n = 4) or mild-to-moderate RLS (n = 6), magnesium 12.4 mmol (about 300 mg) was given in the evening over 4-6 weeks. PLMS associated with arousals (PLMS-A) decreased significantly (17 vs. 7 events per hour, p < 0.05). PLMS without arousal were also moderately reduced (PLMS per hour 33 vs. 21, p = 0.07). Sleep efficiency improved from 75% to 85% (p < 0.01) Magnesium therapy for periodic leg movements-related insomnia and restless legs syndrome: an open pilot study. Hornyak M, Voderholzer U, Hohagen F, Berger M, Riemann D. Albert-Ludwigs-University, Freiburg, Germany. Sleep. 1998 Aug 1;21(5):501-5. Ed: While this is a very poor study due to no placebo and no random assignment

Causes of Restless Legs: Periodic limb movement disorder (PLMD) and restless legs syndrome (RLS) are seen mostly as primary or hereditary diseases, but may occur in conjunction to other diseases such as uremia, polyneuropathy, Parkinson's disease, and deficiencies of iron and magnesium. Secondary periodic limb movement disorder and restless legs syndrome. Rijsman RM, De Weerd AW. The Hague, The Netherlands. Sleep Med Rev. 1999 Jun;3(2):147-58.

Restless Leg Syndrome: Pain Meds a Major Risk Factor Among Psychiatric Patients: Chronic pain syndromes were observed more often in RLS cases (women: 86.0% vs. 32.0%, men: 62.5% vs. 29.0%). 12% without RLS and 75.0% of RLS cases had a history of regular intake of analgesics prior to study enrolment. In a multivariate regression model the authors found RLS very strongly associated with the intake of analgesics (OR: 25.5, P<0.001), frequently having psychiatric co-morbidity (OR: 2.97, P=0.01) and an interaction between age and the intake of analgesics (OR: 2.6, P=0.03). Univ. Muenster. Non-opioid analgesics and the risk of restless leg syndrome-a spurious association? Berger K. Sleep Med. 2003 Jul;4(4):351-2

Dopamine Agonist: Ropinirole (Requip) Helped Restless Legs: Ropinirole is a dopamine agonist used for Parkinson's disease.  In a 22-patient DB PC crossover study of ropinirole (0.5 to 6.0 mg/day) for restless legs syndrome (RLS), the RLS Rating Scale score improved (p < 0.001) from a mean of 25 during placebo treatment to 13 during ropinirole treatment. Eight of the 22 patients had complete resolution of symptoms on ropinirole. Adverse events included nausea and dizziness. Ropinirole for restless legs syndrome: a placebo-controlled crossover trial. Adler CH, Hauser RA, Sethi K, Caviness JN, Marlor L, Anderson WM, Hentz JG. Mayo Clinic Scottsdale. Neurology. 2004 Apr 27;62(8):1405-7

Dopamine Agonist: Cabergoline Helped Restless Legs: The dopamine agonist cabergoline (CAB) 0.5 mg, 1 mg., or 2 mg/day was used in a DB PC study of 85 patients with restless legs syndrome (RLS). Symptoms during the night markedly improved with all CAB doses compared to placebo (placebo: -1.4, 0.5 mg CAB: -4.2 [p = 0.0082], 1.0 mg CAB: -4.0 [p = 0.0040], 2.0 mg CAB: -4.8 [p = 0.0026]). A stable, clinically relevant improvement was achieved in all efficacy measures throughout 1 year with a mean CAB dose of 2.2 mg per day. Under CAB therapy up to 1 year, 11 of 85 patients discontinued treatment due to a drug-related adverse event. Effective cabergoline treatment in idiopathic restless legs syndrome. Stiasny-Kolster K, Benes H, et al. Marburg , Germany . Neurology. 2004 Dec 28;63(12):2272-9

Restless Legs: Pergolide (Permax) Helped Restless Legs: In an industry-funded DB PC study of 100 patients with RLS, periodic limb movements during sleep improved with pergolide (mean -12.6 vs. -3.6; p = 0.004), but sleep efficiency did not improve significantly (+11.3% vs. +6.1%; p = 0.196). Efficacy of pergolide in treatment of restless legs syndrome: the PEARLS Study. Trenkwalder C, Hundemer HP, Lledo A, Swieca J, Polo O, Wetter TC, Ferini-Strambi L, de Groen H, Quail D, Brandenburg U; PEARLS Study Group. Goettingen, Germany.  Neurology. 2004 Apr 27;62(8):1391-7