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Night Walker: Restless Legs Syndrome

Do creepy-crawly feelings in your legs have you walking the night away? You may have restless legs syndrome.
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Restless Legs Syndrome: New Treatments Bring Relief

In 2005, the FDA approved Requip (ropinirole) for the treatment of moderate-to-severe restless legs syndrome. Requip is the first FDA-approved medication for RLS. In 2006, Mirapex (pramipexole) was also approved. Neupro (rotigotine) was approved in 2012.

These drugs act like dopamine. They attach to nerves and change the way they "talk" to each other. In clinical trials, these medicines relieved symptoms of restless legs syndrome in about 75% of people. Both drugs also prevented relapses during long-term use.

Many other medicines have been shown to help people with restless legs syndrome. Physicians often use combinations of medicines to get RLS under control.

Dopamine-like Medicines

These medicines act like dopamine, similar to those mentioned above. Dopamine-like medicines in general work the best in reducing restless legs syndrome symptoms. They include:

  • Bromocriptine
  • Levodopa
  • Pergolide

Nausea is the most common side effect of dopamine-like medicines. Another potential problem: taken frequently, these drugs can actually worsen symptoms of restless legs syndrome. Called "augmentation," this problem is more common with levodopa than with newer medicines.

Other Medicines for Restless Legs Syndrome

Several other kinds of medicines have shown benefit for RLS. They act in different ways to "calm down" nerve activity:

  • Anti-seizure medicines, such as gabapentin (Neurontin, Horizant)
  • Opiate pain medicines, such as hydrocodone, propoxyphene, or tramadol
  • "Sedative-hypnotics," such as clonazepam or zolpidem.

Restless legs syndrome often relapses, even after an effective treatment is started. "What's very interesting and strange about treating [RLS] is it's a constantly changing landscape," says Bell. "What works for you may not work for someone else, and what works for you now may not work for you a year from now."

Walt Kolakowski, 60, understands this well. Over 30 years, he tried multiple treatments for his restless legs syndrome. For Walt, dopamine-like medicines worked -- but caused too many side effects. He experienced the classic symptoms and progression of severe restless legs syndrome. Today, his symptoms are "somewhat controlled" with gabapentin and hydrocodone.

Fortunately, most people with restless legs syndrome do very well, says Buchfuhrer. For many, he says, the new dopamine-like drugs are "a godsend." In his experience, "95% of people can get free of restless legs symptoms 95% of the time" using some combination of treatments. Goodbye night walking, goodbye "creepy-crawlies." After finding a regimen that works, he adds, "they're the happiest patients -- it's my favorite disease to treat."

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Reviewed on May 20, 2008
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