How is restless legs syndrome treated?

This is the 4816th article of Da Yi Xiao Hu

Restless Legs Syndrome is a common sleep disorder in the neurology department's sleep clinic. Patients usually feel an inexplicable discomfort in their legs before going to bed. Rubbing their legs or getting out of bed and taking a walk can make them feel better. Long-term discomfort often affects sleep quality. Getting out of bed again and again can easily make people feel worried and anxious, and even cause sleep phobia. How to treat this symptom? Let's talk about specific treatment methods today.

1. Correct diagnosis is a prerequisite

The clinical manifestation of restless legs syndrome is a strong, almost irresistible desire to move the legs, which mostly occurs in the evening or at night, worsens when quiet or resting, and improves after activity. It seriously affects the patient's quality of life and can cause insomnia, depression and anxiety. The general diagnosis of patients who meet this typical clinical manifestation is not difficult, but some patients involve the thighs and other parts of the body, such as the upper limbs, head, and abdomen. In particular, discomfort in a single part other than the thigh, such as the abdomen and head, is prone to missed diagnosis and misdiagnosis.

The symptoms of restless legs syndrome have a characteristic diurnal variation pattern. Patients need to constantly move their lower limbs or get out of bed to walk. When they resume rest, the above discomfort will reappear, usually in a symmetrical pattern. Clinical leg discomfort often occurs in the evening or at night, with the peak of onset between midnight and early morning, and daytime symptoms are relatively mild. Therefore, in order to improve the accuracy of diagnosis, it is best to go to the neurology department's sleep specialty clinic for specialist diagnosis and treatment, and promptly find and discover common causes. If necessary, blood tests can be performed to see if there is iron deficiency, renal insufficiency, etc. Sleep monitoring and lower limb vascular ultrasound can also be done to further identify and confirm the diagnosis.

2. Non-drug treatment is the basis

First, we need to evaluate the potential risk factors that may aggravate the symptoms of restless legs syndrome and try to eliminate or reduce the impact of these secondary factors, that is, to find the cause. Avoid using drugs that may induce restless legs syndrome, such as phentolamine, nitroglycerin, sodium nitroprusside, metoclopramide, antipsychotics, antidepressants, antihistamines such as diphenhydramine, calcium channel blockers such as nifedipine, amlodipine, etc.

Secondly, you should maintain good sleep hygiene habits, such as taking a bath or doing simple activities before going to bed, avoiding sleep deprivation as much as possible, and avoiding or reducing the intake of substances containing stimulant ingredients such as caffeine, tea, energy drinks, nicotine, and alcohol. Many people like to drink strong tea before going to bed, drink strong coffee after getting up, or have a glass of wine before going to bed. These bad living habits will increase the frequency of restless legs syndrome. You must try to reduce the intake of these substances.

3. Drug treatment is the key

There are two common types of drug treatment:

1. Iron

If restless legs syndrome is caused by iron deficiency, iron treatment can be given. Commonly used oral iron supplements include ferrous succinate, ferrous sulfate, ferrous fumarate and polysaccharide iron complex. Intravenous iron preparations include sodium ferric gluconate, iron sucrose, carboxymaltose iron, low molecular weight dextran iron, isomaltose iron 1000 and superparamagnetic nano iron oxide.

2. Dopamine receptor agonists

(1) Pramipexole: Pramipexole is generally recommended as the first choice treatment for moderate to severe restless legs syndrome. It is usually started with a low dose (0.125 mg), once a day, 2-3 hours before bedtime. The dose can be adjusted every 4-7 days depending on the degree of symptom relief. The maximum dose generally does not exceed 0.75 mg.

(2) Ropinirole is generally used to improve clinical symptoms and enhance subjective sleep quality. The starting dose is 0.25 mg/d and the maximum dose is 4 mg/d.

(3) Rotigotine can generally improve and effectively reduce the severity of symptoms, with an initial dose of 1 mg/d and a maximum dose of 3 mg/d.

There are some other therapeutic drugs at present, but their recommendation levels and efficacy are not as good as the above-mentioned drugs, so they will not be introduced one by one.

Through these brief introductions to drug and non-drug treatments, do you have a clearer understanding of the diagnosis and treatment of restless legs syndrome? Of course, the most reliable way is to go to the neurology department's sleep specialty clinic to see a specialist for treatment!

Author: Jilin University Second Hospital

Department of NeurologyMan YuhongChief Physician