My husband has suffered from severe restless legs in his sleep + tingling arms for 6 years. After many investigations (blood and sleep clinic) and therapies (diet, fascia therapy, physio, …) and grandma tricks such as extra sports, stretching exercises, no alcohol, … only SIFROL helps. Take small doses daily to still be able to sleep. Unfortunately, this SIFROL also has side effects such as panic attacks, nightmares and drowsiness (which makes driving a car at night out of the question). My husband is now 41 years young and would like to continue without medication. Hopefully we can find an answer this way? Regards, Marieke
Answer
Restless legs can indeed be very annoying and a plague for sleep. They typically come on in the evening or at night, but can also break through during the day. Despite the name restless legs, the arms can also be affected. It is an unpleasant feeling that is difficult to describe, sometimes there are also some cramps and these sensations get better with movement. So there is often also a feeling of restlessness.
The causes are unknown. Sometimes it occurs during pregnancy, or sometimes as a result of iron deficiency. Strangely enough, these phenomena usually respond well to anti-parkinsonian drugs with a dopaminergic activity. Mind you, it’s not because there are restless legs that someone will get Parkinson’s disease. However, the two can sometimes go together.
The most commonly used antiparkinsonian drug is Sifrol, which is a low dose of pramipexole. As a rule, people take it before going to sleep, but in many cases it is necessary to take two to three intakes, eg around 6 pm when people often sit down after work and then before going to sleep. Unfortunately, this sometimes has side effects of drowsiness, nausea,… Other dopaminergic drugs can be tried, but often have similar side effects. Caution should be exercised when using Prolopa or Sinemet as they increase the risk of rapid daytime breakthrough.
If dopaminergic agents are not tolerated, other products should be sought. Then people often switch to the use of drugs that come from the pain treatment. That seems strange and a bit scary, but sometimes these help wonderfully. One can then try with codeine eg in a low dose. Recently, Oxycodone/naloxone (Targinact) has been widely used. In very severe cases, one must sometimes successfully resort to stronger painkillers.
Sometimes other drugs are used, such as sedatives (eg clonazepam) or anticonvulsants such as gabapentin and pregabalin.
Non-drug options are very limited in terms of evidence. There has been some research on the use of vibrating pads on the legs, but I am not aware of their use. So it usually comes down to the fact that people with these annoying problems have to make the choice whether or not they want to take medication, because there are few other options.
It should still be mentioned: avoiding alcohol, coffee, nicotine is recommended, especially in the late afternoon and evening.
Prof.Dr.P.Santens
Neurology UZ Gent
Answered by
Prof Patrick Santens
Neurology and neuroscience. Neurodegenerative diseases such as Parkinson’s, Alzheimer’s. Cognitive and movement disorders.
http://www.ugent.be
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