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Is there any certain treatment for restless leg syndrome?!
my father is 52 and it's really bothering him when he wanna go to sleep (anytime of day or night). He has the most severe form of this syndrome. He tried different tablets like different Sedative and Barbital drugs. These days, he is taking "Methadone". I was wondering if there is any certain treatment for this rare syndrome.

  • Certain? No, but my dad has this. I'll ask him what he's taking, it seems to have been working decently the past few years. – JohnP Aug 23 '15 at 17:59
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Restless Legs Syndrome (a.k.a. Willis-Ekbom Disease) is not rare! What it is is woefully under-diagnosed. Not that you asked, but, although estimates of prevalence vary widely depending on the criteria used, 5-8% of people in Europe/U.S have clinically significant RLS/WED, with women affected about twice as often as men.

Now to what you did ask: treatment of RLS/WED. In most situations, there is no curative treatment. However, there are excellent (mostly pharmacologic) treatments available to suppress symptoms. A few words about the various treatments by class:

  1. Iron. For reasons that are not fully understood, even sub-clinical (i.e. otherwise non-problematic) iron deficiency is associated with an increased prevalence of RLS/WED, and treatment with iron has been repeatedly shown to be helpful in that population. Recommendations vary, but most people would agree that iron supplementation should be provided to raise ferritin >20 μg/L, with some advocating cut-offs as high as 50 μg/L. Transferrin saturation should also be > 16% - 20%. Occasionally, RLS symptoms completely resolve with treatment of iron deficiency.

  2. Dopaminergic agents. L-dopa (the therapeutic ingredient in Sinemet) has long been known to be effective treatment for RLS/WED. Unfortunately, it tends to promote “augmentation”, where the drug ends up causing an iatrogenic worsening of symptoms over time, necessitating a change in treatment The newer dopamine agonists - pramipexole and ropinirole - have a lower (although still existent and commonly problematic during long-term treatment) incidence of augmentation. These are the medications most people start with for treating RLS. Nearly all patients who are correctly diagnosed will have at least partial improvement in RLS/WED symptoms with introduction of dopamine agonists.

  3. Alpha-2-delta agents. This is a class of anti-epileptic drugs that has been increasingly used for treatment of RLS in recent years. The advantage of these drugs over dopaminergic agents is mostly that they are much less likely to cause augmentation. (Some would say that augmentation is exclusively a dopaminergic phenomenon, but this is debated.) The most commonly used drugs in the U.S. in this category are gabapentin and pregabalin. A landmark study in 2014 published in the New England Journal indicated that pregabalin is at least as effective as pramipexole, with a much lower incidence of augmentation. These drugs may become first-line agents in the future.

  4. Opiods. You mentioned a family member on methadone for RLS/WED. This medication in particular is remarkably effective for RLS. There was also a recent study demonstrating the efficacy of oxycodone. Opioids have many side effects for long term usage (some of the more problematic: respiratory depression, potential for overdose, abuse potential, constipation). However, particularly for patients who have been suffering from RLS for many years and experienced augmentation with dopaminergic agents, opioids are at times appropriate and generally provide substantial relief.

Please see the most recent practice parameters from the American Association of Sleep Medicine and a recent meta-analysis of treatment options for further information.

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