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Tweaking the Treatment for Restless Legs

(Topix) Last Super Bowl, a TV commercial lauded the power of Requip , the first drug approved to treat restless leg syndrome, a condition whose signature feature is creepy-crawly leg sensations that interfere with ...Comment

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Doc,
I have had severe RLS and PLM for as long as I can remember. Once I found a sleep disorder clinic I went through many drugs, alone and in combination to allow me to even lay down at night.:(
Before Requip was FDA approved for RLS my doc put me on it in combination with Klonipin. Requip alone has an extremely good outcome for many. :)
What a miracle!!!!!!!!! I take my meds one hour prior to bedtime and off I go to dreamland. I still move my legs a lot but there is no pain or waking up because of it.
Thank God for modern medicine. Standing up to sleep is something that some animals do........... not humans. :Zzzz:
Judy

simple old magnesium

can help many with cramping/twitching or restless legs.

Potent dopamine agonists? YIKES...upset your whole system!
Many side effects, etc.

See my magnesium thread in Vitamin forum for details.;)

I have RLS.
Actually that article is quite interesting from my point of view. Apart from the fact that it references some of Roger Kurlan's work, I find it interesting for a few other reasons. Kurlan is a member of the Tourette Syndrome Association Medical Advisory Board. The acticle referenced speaks about 2 patients who found that they developed tolerance or declining response to the medications and suggestions about improving that. (as an aside, I see that Kurlan has also written a paper regarding "dopamine phobia" in patients who have Parkinson's Disease.)

I've personally never taken any pharmaceutical medications for my RLS although I can assure you that I've been tempted at times when I've wanted to jump of a cliff to stop the edginess and restlessness, and I mean that quite seriouslly. Because it sounds like a fairly painless syndrome because of the name, it's actually something quite dreadful and I have much empathy for anyone who has this problem.

I have a few minor motor tics. One major observation that I've found over the years since my childhood has been that my RLS is much worse at the times when I have no tics, and visa versa. Obviously related to dopamine dysregulation, but I'd hate to think what would happen if I started using a dopamine agonist for RLS or even a dopamine antagonist for the tics, although that wouldn't happen.

I have also noticed in the past few years though, that some doctors have treated patients who have debilitating tics with some low dose dopamine agonists although it isn't that common a practice.

Quote:

J Gen Intern Med. 2006 Dec;21(12):C1-4.
Medication tolerance and augmentation in restless legs syndrome: the need for drug class rotation.

* Kurlan R,
* Richard IH,
* Deeley C.

Movement Disorders Unit, Department of Neurology, University of Rochester School of Medicine, Rochester, NY, USA.

Restless legs syndrome (RLS) is a common condition characterized by an unpleasant urge to move the legs that usually occurs at night and may interfere with sleep. The medications used most commonly to treat RLS include dopaminergic drugs (levodopa, dopamine agonists), benzodiazepines, and narcotic analgesics. We report the cases of 2 patients with RLS who illustrate the problems of tolerance (declining response over time) and augmentation (a worsening of symptoms due to ongoing treatment) that can complicate the pharmacotherapy of RLS. We discuss the optimal management of RLS and propose strategies to overcome tolerance and augmentation such as a rotational approach among agents from different classes.

PMID: 17105517 [PubMed - indexed for MEDLINE]

Quote:

The truth is, some of the most common, most effective drugs, including ropinirole and pramipexole, which was recently approved to treat restless leg syndrome, may only work effectively for each person for a limited time," Kurlan said. "After that, this class of drugs � albeit the most-popular, effective, and the only one approved by the Food and Drug Administration for restless leg syndrome� has a regrettable tendency to turn traitor. The medicine can actually begin to worsen symptoms."

""Ultimately, there is hope for those who suffer from restless leg syndrome," Richard said. "But until there�s an effective drug we can use long term without interruption, for many patients hope lies in a merry-go-round of medications, not a single drug. Patients and physicians must be braced for this.
from Eurekalert

http://www.eurekalert.org/pub_releas...-ttt122006.php

hubby has both rls and plmd. ( periodic limb movement disorder)
our dr gave him an rx for requip. he didn't fill it.

my dad who has pd had horrible horrible experiences with it. :( it might work for some, but i can't reccomend it.

Hi Curious! still going here. ;)

http://www.blackwell-synergy.com/lin....00368.x/full/

Journal of Sleep Research
Volume 12 Issue 4 Page 343 - December 2003
doi:10.1046/j.0962-1105.2003.00368.x
Volume 12 Issue 4

Letter to the Editor
A preliminary look at the percentage of patients with Restless Legs Syndrome who also have Parkinson Disease, Essential Tremor or Tourette Syndrome in a single practice

Arthur S. Walters, Cheryl LeBrocq, Vandna Passi, Shivani Patel, Philip A. Hanna, Barry Cohen4 and Mary Wagner
_______

Lipinski, J. F., Sallee, F. R., Jackson, C. and Sethuraman, G. Dopamine agonist treatment of Tourette disorder in children: results of an open-label trial of pergolide. Mov. Disord., 1997, 12: 402–407.
_______

http://www.ncbi.nlm.nih.gov/entrez/q...02&query_hl=18
Mov Disord. 2004 Sep;19(9):1084-7.
Restless legs in Tourette syndrome.

Lesperance P, Djerroud N, Diaz Anzaldua A, Rouleau GA, Chouinard S, Richer F; Montreal Tourette Study Group.

Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada.
_________

plenty more I have, but much of it is ADHD and/or TS with RLS stuff so not particularly related to original topic.

Anyone interested though might also look into the work of Drs. AS Walters and D Picchietti in PubMed. Also worth looking into the ferritin studies.

ty sweety for doing so much awesome research!!!!!

( how is the weather? send me some of your heat! it is gonna be a cold christmas here in texas! )

It's all old stuff I've saved. That's why I freaked when I lost my bookmarks when I downloaded the new Firefox 2.0. lol 10 years of hard reading and poof all gone in a second. Got them all back thank goodness!!!
It has been hot here, curious, but not as hot as usual. I just slept for 4 hours today... in the middle of the day. It's xmas eve tomorrow here and I had so much to do. (5.30pm now 23rd) We will get storms apparently on xmas day. Usually I cook hot dinner in the steaming humidty and sometimes heat in the high 90's and sometimes over 100. This year it's fairly mild so far but I'm over cooking hot turkey and dinners like that in the heat. I wish I could send some warm air up and over for you. My bones ache in the cold, so it would be so miserable.

[btw. I think it's appalling that companies can advertise medications on tv there. Can't here]

Quote:

Originally Posted by Curious (Post 52507)

Curious,
I am sorry that the medication didn't work for your dad. It is no fun to live with the pain and discomfort. There are many meds out there and sometimes they need to be in combination. I hope he finds relief.
I don't know what I would do if I had to go back to the sleepless nights.
Judy

Have a Merry Christmas Curious!!!!!!!!!

http://bestsmileys.com/christmas3/18.gif