News Review From Harvard Medical School -- Study: Drugs Reduce Restless-Leg Symptoms
Some medicines can reduce symptoms in 60% of people with restless legs syndrome, a review of prior research finds. People with restless legs syndrome feel a need to move their legs, partly to relieve discomfort in the legs. The new study combined results of 29 prior studies. They looked at results of drug treatment in people with moderate or severe restless legs syndrome. People took various drugs. Two groups of drugs produced the best results. Medicines in one group are known as dopamine agonists. They include carbidopa/levodopa (Sinemet), pramipexole (Mirapex) and ropinirole (Requip). The other group of drugs includes gabapentin (Neurontin and generics), pregabalin (Lyrica) and carbamazepine (Tegretol and generics). Both types of drugs improved symptoms by at least half in about 61% of patients. About 40% of those who got placebo (fake) pills reported similar relief. Both medicines have side effects. Some people stop taking them because of these effects, an expert told HealthDay News. The journal JAMA Internal Medicine published the study online. HealthDay wrote about it March 4.
By Lori Wiviott Tishler, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
I vividly remember the first time I heard about restless legs syndrome. I was a junior medical student, working in primary care. My teacher brought up the diagnosis, and I laughed. I thought that she'd made up the name! During many years as a primary care doctor, I've learned that the condition is no joke.
Restless legs syndrome impacts up to 7% of American adults. What is it? Basically, restless legs syndrome is the urge to move your legs, especially to relieve uncomfortable feelings in the legs. For most, it's worse during periods of rest, so restless legs can often disturb sleep.
Some people have only mild symptoms that don't bother them often. Others have more severe symptoms that affect their sleep and their entire quality of life.
This study was a meta-analysis. That means that the authors reviewed many good-quality studies and combined the results. They wanted to help determine whether prescription medicines improve symptoms of restless legs syndrome.
Here's what the study found:
- People responded best to a class of medicines called dopamine agonists.
- People also did well with a second class of medicines that include gabapentin.
- Common side effects with both medicines included nausea, sleepiness and dizziness.
The study had several drawbacks. First, the research monitored only people with severe symptoms and only for a short time, three months. The study had little racial and ethnic diversity. Restless legs syndrome is usually a lasting condition. Such a short-term study doesn't tell us much about whether these treatments help in the long term. It also doesn't address treatment for mild symptoms.
In the end, I find this study to be generally helpful. It gives me a good sense of which medicines to try first for patients and how to counsel them about side effects.
What Changes Can I Make Now?
Sleep disorders are very common. They include restless legs syndrome, sleep apnea, insomnia and many others. Fortunately, many of these conditions are very treatable, so talk to your doctor. He or she may treat you directly, or suggest seeing a specialist in sleep medicine.
If you have discomfort and feel a need to move your legs while you are seated or sleeping, you might have restless legs syndrome. If you're not sure, ask your sleep partner if you kick during the night. You might also notice that your bed is more rumpled than average.
The condition is more common in people with low levels of iron, with kidney disease and in pregnant women. Your doctor might evaluate you for anemia and kidney function.
For all of us, following rules of good sleep hygiene can be extremely helpful in getting a good night's sleep. These tips might help:
- Follow a regular sleep schedule.
- Sleep in comfortable clothes in a comfortable bed.
- Eliminate any sources of noise or bright lights that could prevent or disrupt sleep.
- Cut down on beverages containing caffeine during the day. The stimulating effects of caffeine can last for many hours.
- Find more suggestions for good sleep.
What Can I Expect Looking to the Future?
Restless legs syndrome is common. So I hope that we can see more studies that look at mild restless legs syndrome as well as how people do if they take medicines for longer periods of time.