Tuesday, September 13, 2011

Restless legs syndrome (RLS) has received much attention in the past year, particularly after the FDA approved ropinirole (Requip) for treatment of moderate to severe RLS. The clinically practical definition of moderate to severe RLS is the presence of symptoms that occur nightly and are severe enough to interfere with sleep quality. Most people who seek medical treatment of RLS would be classified as having moderate to severe RLS. RLS affects about 10% of the population in the West, yet it remains largely undiagnosed.

The sensation or urge to move is usually felt deep within the legs and is always unpleasant but usually not painful. RLS symptoms typically involve both legs, although one side may predominate, or they may alternate. Terms used by patients to describe the sensations vary and are dependent on educational level. Examples include "creepy crawlies," "need to move," "tingling," "restless," "cramping," "pulling," "painful," "electric," "tension," "discomfort," and "itching."
The underlying cause of primary RLS remains unknown, but current thought implicates dopamine and faulty iron metabolism. Iron may also represent a primary factor in the development of RLS, as suggested by recent research. However, the method by which dopamine and iron interact to generate the circadian pattern in the occurrence of RLS symptoms remains unknown. Secondary causes of RLS are associated with some drugs, end-stage renal disease, fibromyalgia, iron deficiency, discontinuation of opiates, pregnancy, use of spinal anesthesia, and uremia.

Non-drug approaches for treating RLS include avoiding alcohol and caffeine within several hours of bedtime, stretching, hot or cold baths, and massage of the affected limbs.

Historically, L-dopa, a drug commonly used to treat Parkinson Disease has been the mainstay for RLS therapy. However, L-dopa is no longer the preferred drug due to its extremely short duration of action and other problems.

Clinicians are now becoming more aware of RLS, and the disorder has even captured the attention of drug manufacturers. Drugs under investigation for RLS include the dopamine agonists pramipexole and rotigotine (transdermal delivery system), and XP13512, a gabapentin prodrug. With the heightened awareness of RLS in the medical community, pharmacists will become increasingly exposed to RLS patients and should be knowledgeable about the symptoms and treatment options. This will allow them to more confidently educate and advise patients on the proper use of medications.

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