Treatment options for restless legs syndrome

There is no cure for restless leg syndrome (RLS) but the symptoms can be treated. The aim of treatment is to relieve symptoms. Treatment includes lifestyle changes, supplements, treatment of associated conditions and medications.

Treatment of associated conditions: RLS can be caused due to other problems such as peripheral neuropathy or diabetes. Treatment of the underlying condition can improve the symptoms of RLS.

Lifestyle changes: Certain lifestyle changes such as decreased intake of caffeine, alcohol, and tobacco can improve the symptoms in case of mild to moderate RLS. People with RLS are advised to maintain a regular sleep pattern, do moderate exercises, massage the legs, take hot baths, or use heating pads or ice packs. These can improve sleep and symptoms of RLS.

Supplements: Iron, folate and magnesium supplements to correct deficiencies can decrease RLS symptoms.

Medications: Medications are usually helpful but they are recommended if supplements, lifestyle changes and treatment of any associated condition do not decrease the symptoms. There is no one single medication that is effective for all people with RLS. You may have to try different drugs before the one that is effective is found. Medications on regular use tend to lose their efficacy over time, and hence change of medication is needed periodically.

Some of the commonly prescribed drugs to treat RLS include:

• Dopaminergic agents (drugs which increase dopamine): These medications are mostly used to treat Parkinson's disease, but have been shown to improve symptoms of RLS. The medicine has to be taken at bedtime and is considered the initial treatment of choice. Pramipexole and ropinirole are the two drugs approved by the U.S. Food and Drug Administration for treatment of moderate to severe RLS. Levodopa plus carbidopa have also been reported to effective in RLS. But the drugs have several side effects and long term use of these medications can lead to worsening of the symptoms in many patients.
• Benzodiazepines: This group of medication (such as clonazepam and diazepam) is useful in people with mild or intermittent symptoms to obtain a more restful sleep. But long term use of the drug can lead to dependence and several other side effects.
• Opioids: These drugs (such as codeine, propoxyphene, or oxycodone) may be used to improve pain and relax people with more severe symptoms. Besides side effects such as dizziness, nausea, exacerbation of sleep apnoea, these drugs can cause dependence and addiction.
• Anticonvulsants: Gabapentin and pregabalin are anticonvulsants which can be effective in improving sensory disturbances such as creeping and crawling sensations and nerve pain.