Restless Leg Syndrome
Sep 16, 2014
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Im not as good as I once was, but Im as good once as I ever was. Im not sure if those words by Toby Keith apply to me anymore. I had a team of cyclists with me during the MS Bike ride from Dauphin to Clear Lake and back. I had trained more for this MS Riding Mountain Challenge than I ever had before. I felt ready. However, I had trouble keeping up to one team member, Emily, my 12 year old daughter. This was Emilys first MS Bike ride and she often left me in the dust. After the MS Bike Tour, I went out to play Monday Night Hockey. I thought all that cycling would help my skating. Nope. Younger guys were still skating circles around me, and cycling didnt give me magic hockey skills that I never had before. On my anniversary, I had to call my wife to kill a big spider in the shower. I dont like spiders. Emily said, You really arent the man of the house, are you Dad? I told her I hadnt been for years. I had the uncomfortable feeling I couldnt even see my lost machismo in the rear view mirror anymore.
Another uncomfortable feeling is Restless Leg Syndrome. Recently, I had a patient come in the pharmacy and tell me her doctor was going to cure her Restless Leg Syndrome with iron pills. I had never heard of that treatment for RLS before, so I was excited to look it up.
Restless Leg Syndrome (RLS) is also known as Ekbom Syndrome or Willis-Ekbom disease. RLS gives you the strong urge to move your legs and often unpleasant feelings in the legs like pulling, itching, tingling or aching. When a person with RLS moves their legs, their symptoms get better, but only for a short time. Usually the urge to move happens when the person is inactive. Often the urge to move happens at night. That means RLS often disturbs people's sleep. It has been reported that up to 1 in 15 of us will suffer from RLS.
There is no cure for RLS. The causes of Restless Leg Syndrome aren't all known either. However levels of iron and dopamine in the brain seem to be involved. As early as 1953, Nils Nordlander recognized that treating patients with iron injections could reduce or eliminate RLS symptoms. He even recognized that iron stores in the tissues could be low even though blood levels of iron were normal. More recent studies with spinal taps and MRI's have confirmed that the brain can be low in iron even when the rest of the body has normal iron levels. Dopamine is a brain chemical that is involved in many systems from the reward system to Parkinson's Disease to Schizophrenia. Even though we know we can make RLS symptoms better when we use drugs that act like dopamine and we can cause RLS symptoms if we block dopamine from doing its job, exactly how dopamine is involved in RLS isnt completely clear. It seems there might be lots of dopamine production in the RLS brain, but not enough receptors to respond to the dopamine signal.
Most drugs we use to treat RLS act like dopamine in the brain. Pramipexole and ropinirole are considered first line treatments. They are relatively expensive. They have side effects like nausea, dizziness, sleepiness and in rare cases compulsive behavior like gambling. Levodopa is a much less expensive treatment, but it has a larger chance of causing augmentation. Augmentation is when after being on the RLS treatment for several months the symptoms start getting worse again. Worsening symptoms include symptoms happening earlier in the day than before and symptoms happening just before the next medication dose is due.
Can iron cure RLS? Iron it isn't a miracle cure for everyone with RLS but in some cases if the RLS patient also has low iron, it can at least reduce symptom severity. Your doctor should do blood tests to see if your serum ferritin levels are actually low. If you just take iron on your own, you could get iron overload, and that can be dangerous. If your ferritin is low, your doctor may recommend oral iron tablets. Depending on the type of iron, you may have to take it 1 to 3 times per day. If you take your iron with vitamin C, the iron may be absorbed better. Any time a text book talks about taking iron tablets, they will say iron should be taken on an empty stomach, an hour before meals. That is because iron is absorbed best on an empty stomach. However, iron tablets bother a lot of peoples stomachs. My compromise with many patients is to tell them to take their iron with the least amount of food possible. And people shouldn't take their iron pills and their calcium pills together. Those two minerals will stop each other from getting properly absorbed. Your doctor will check your ferritin levels again in 3-4 months to see if it is normal. If not, they may decide to try injectable iron.
Iron isnt a magic cure all for RLS, but it is an interesting and inexpensive avenue of treatment that you can certainly discuss with your doctor. And this morning I got to rescue my family from a raging inferno. Okay Kraft Dinner. Eric was trying to cook his single serving KD in the microwave. He forgot to put the water in with the noodles. First there was a funny burning smell. Then smoke started pouring out of the microwave. I took the smoking mess out of the microwave, poured some water over it in the sink and put it out on the deck. Crisis averted. Maybe I can enjoy Toby Keiths song again.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
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Johns Hopkins Restless Leg Syndrome Center: http://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/restless-legs-syndrome/what-is-rls/
Restless Legs Syndrom Foundation: www.rls.org
American Academy of Sleep Medicine: www.aasmnet.org