How is restless legs syndrome (RLS) treated?

RLS is treated in different ways, depending on the intensity of the symptoms. In some cases, RLS is a temporary disorder that resolves when other conditions are treated. But in cases of genetic-based RLS or RLS due to persistent medical disorders, specific treatment is necessary.

Since iron deficiency is a reversible cause of RLS, many sleep specialists recommend over-the-counter iron tablets (ferrous sulfate). A simple blood test can measure iron stores in the body and help physicians determine who might benefit from iron therapy.

When RLS symptoms are frequent or severe, physicians prescribe medications to treat the disorder. The preferred treatments are dopamine agonists that replace dopamine, a neurotransmitter in the brain, known to be deficient in RLS. Also used to treat Parkinson's disease, these drugs control the urge to move and sensory symptoms in the legs as well as reduce involuntary leg jerks in sleep. Ropinirole (Requip®), pramipexole (Mirapex®) and the rotigotine patch (Neupro) are the FDA-approved dopamine agonists that are used for RLS.

Anti-seizure medications are also used to treat RLS symptoms by slowing or blocking pain signals from nerves in the legs. Examples include gabapentin enacarbil (Horizant®), gabapentin (Neurontin®) and pregabalin (Lyrica®). These drugs are particularly effective in patients with painful RLS due to neuropathy. Gabapentin enacarbil is the only medication in this class that is FDA-approved. However, the others may be effective.

Benzodiazepines are sometimes prescribed for RLS but are usually reserved for more severe cases due to their addictive potential and side effects including daytime drowsiness. Clonazepam (Klonopin®) falls into this category.

Opioids, commonly used to treat pain, are occasionally used to alleviate aching and uncomfortable sensations in the legs in more severe cases when other agents are not effective. These are controlled substances that require a special type of prescription. Examples include codeine, oxycodone, and morphine.

Talk to your healthcare provider about what type of treatment is best for you.

What can be done to control or decrease the symptoms of restless legs syndrome (RLS)?

If you have RLS, you may want to avoid caffeinated beverages, alcohol, and tobacco products, as these substances can worsen symptoms. Also, massaging the calves and legs may help the pain. Practicing good health and sleep habits may also help reduce your symptoms. Soaking in a warm bath can be helpful. Alternatively, cold compresses can be comforting to some patients. Magnesium supplements may also help. Reduce stress as much as possible.

Depending on the severity of your RLS symptoms, exercise may help reduce the discomfort. Beginning and ending each day with leg stretches may be helpful. Some people find that running in place for a short period of time, riding an exercise bike, or walking alleviates the symptoms of RLS. If your RLS is so severe that exercising or stretching the legs becomes painful, it is best for you to consult your doctor for alternative methods to control your symptoms.

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