Restless Leg Syndrome

05/06/2010

People with Parkinson’s can have nighttime discomfort in their legs for several reasons. Muscle pain, especially in the calf muscles, is thought to be related to muscle stiffness. Muscle contraction, called dystonia, can lead to toe flexion—or a pulling sensation in the foot or leg muscles.

What is restless leg syndrome (RLS)?
RLS is a sensation of restlessness and discomfort in the legs that worsens when sitting, lying, or resting and improves with movement, such as walking. Some patients describe the sensation as a creeping, crawling, gnawing, or boring sensation, or an urge to move.

People with this condition commonly experience trouble falling asleep.

What causes RLS?
RLS is present in up to 10 percent of the population but may be slightly more common in Parkinson’s. The cause of RLS is not clear, but it may be related to an alteration in brain chemistry and dopamine changes in an area of the brain called the diencephalospinal region. Studies suggest a possible genetic link in some people.

Other conditions such as peripheral neuropathy, kidney disease, pregnancy, and iron deficiency can worsen RLS.

Blood tests for iron deficiency and other metabolic conditions are available.

Certain medicines can worsen RLS.

Antihistamines like Benadryl (an ingredient in Tylenol PM, which is often used for sleep) and certain antidepressants can worsen RLS in Parkinson’s.

How is it treated?
Medicines that replace dopamine can treat RLS.

Two dopamine agonists, ropinirole and pramipexole, are approved for treatment of RLS. Carbidopa/L-dopa is also helpful. These medicines can be used throughout the day to treat the movement symptoms of Parkinson’s or taken at night for RLS.

Other helpful medicines include benzodiazepine drugs such as clonazepam, though its use may be limited because of its sedative effects.

Opioid medications such propoxyphene, codeine, and oxycodone can be tried in more severe cases. Side effects from opioids can include dependency, constipation, and itching.

In some cases the antispasticity medicine baclofen and the antiseizure medicine gabapentin are effective in addressing RLS.

RLS can significantly affect sleep, especially the ability to fall asleep.

Nonmedical treatments help?
Lifestyle changes can reduce the severity of RLS and improve sleep. It is recommended that RLS sufferers avoid caffeine, alcohol, and over-stimulation during the evening hours.

Occupational therapist Kay Ballen, OTR/L, offers a few suggestions to improve your nighttime sleep. She recommends developing a sleep ritual that helps you unwind an hour or so before going to bed. Try gentle stretching or a warm bath to help you unwind, relieve minor aching from muscle tightness or stiffness, and alleviate RLS.

A recent study showed that pressurized compression stockings reduce RLS suffering shewn used at night.

Neuropsychologist Martha Glisky, Ph.D., notes that sleep deprivation from RLS can make patients feel irritable, stressed, and depressed. She offers tips to help people deal with the daytime effects of sleep problems from RLS.

Reduce stress by simplifying your life when possible, she says, and find time for relaxation and pleasurable activities.

She recommends avoiding multitasking after a poor night’s sleep and choosing activities that aren’t too demanding. In addition, give yourself extra time to complete activities if you have had poor sleep the night before, Glisky recommends.

Simple changes in medicine or medicine timing can also make a difference. Most importantly, talk to your provider about options for treating RLS.

Learn more about sleep and how to improve yours in the accompanying articles.

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