Restless Leg Syndrome evidence based treatment

Restless Leg Syndrome evidence based treatment


If you have restless legs syndrome and want
to find out the best evidence based advice this video is for you! My name is Simon and I’m a Consultant in
Clinical Neurophysiology. I’m going to explain to you what we now
know about this common condition and how best to manage it. Restless Legs Syndrome (pause) or RLS, is
very common and affects at least 2% of the population. It is a clinical diagnosis which was redefined
in 2014 as matching 5 key criteria: 1. An urge to move the legs which is usually
accompanied by an unpleasant sensation in the legs. This is often described as a crawling sensation
under the skin. 2. It is worse during periods of rest or inactivity 3. There is at least partial relief by movement 4. Clear evening or night time emphasis 5. It is not solely explained by another medical
or behavioural condition When it comes to understanding and therefore
treating RLS – there are two major categories, Primary and Secondary. Let’s start with Secondary. This means that there is an identifiable process
driving the RLS and if so treatment is aimed at addressing the underlying cause as well
as managing symptoms. Causes can include any of the following: Peripheral
neuropathy in around 1/3rd. This may be a large fibre or more commonly
a small fibre neuropathy. You can see separate videos explaining these
and how they are tested by clicking on the i-cards above. Iron and to a much lesser extent magnesium
deficiency can be causes, raised urea levels from kidney failure, and Varicose Veins. Medications including a variety of anti-depressants
can also be a factor. Pregnancy is also well recognised but self-resolves
afterwards in the majority of cases. Primary RLS is when there is no identifiable
cause. It’s quite different in that it tends to
start at a much younger age and there is often a positive family history in around 2/3rds
of patients. Research is ongoing into a variety of potential
causative genes. To understand how treatment works and why
it can fail, we need to be clear on the underlying disease mechanisms. Current research has identified that multiple
regions of the brain dysfunction especially the Basal Ganglia which are important in initiating
and controlling movement. Many of the neural cells here rely on Dopamine
which needs Iron as part of it’s formation. Iron uptake by these cells is impaired for
reasons, as yet unknown. This leads to a relative fall in Dopamine
production. We can target either of these so patients
who are Iron deficient, and this can be from any cause of anaemia, can respond well to
Iron replacement. Medications that increase Dopamine levels
directly such as Levo-Dopa or act like Dopamine such as Ropinorole are also successfully used
as treatments for this condition. However, it’s not just these cells that
dysfunction. It is also important to recognise that the
brains natural internal Opioid system may also be depleted and this may be why the condition
is often responsive to Opioid medications. Many other structures which govern sensation,
emotion, cognition, behaviour and movements are also implicated. This likely explains why so many patients
have a multitude of other problems including high rates of depression (up to 30%), impulsivity
and problems with decision making. Sleep disturbances are also very common. Around 80% of RLS patients also have Periodic
leg movements in sleep which are associated with arousals and so further interrupt sleep
quality. This is a long term condition and whilst it
can wax and wane, treatment often needs to be provided for prolonged periods, even many
years. There is a significant issue with Dopamine
replacement therapy which is called Augmentation. This means that the treatment itself can in
fact worsen the condition with a risk of this happening of around 7% per year. Signs of this developing include worsening
intensity, spread of symptoms into other body regions such as the arms, shorter duration
between rest and symptoms and also earlier onset of symptoms into the daytime. Some medications are worse at doing this than
others, particularly Levo-Dopa. This is why it is no longer a first choice
treatment. The combined task force of the RLS-Foundation,
European RLS Studdy Group and the International RLS Study Group have produced their management
recommendations in 2016. You can find a link to the whole guidance
in the link below. But briefly 1. Non-dopamine medications such as Gabapentin
Enacarbil, also called Horizant, should be trialled first which should avoid the risk
of Augmentation. However, it is not yet universally licensed
as a first line medication. 2. When dopaminergic medications are utilised
these should be at the lowest possible doses e.g. Pramipexole, Ropinirol or Rotigotine
and the aim should be to reduce symptoms to the point where quality of life isn’t impaired
but not their complete eradication. 3. If augmentation does occur then anything exacerbating
factors should be addressed such as iron replacement if they have low Iron stores or avoidance
of medications that can exacerbate augmentation such as Anti-depressants and Anti-histamines
should be reduced or avoided and any lifestyle factors such as sleep deprivation addressed. 4. Other medications may need to be added at
this point such as Horizant or even switching. 5. Opioids such as Oxycodone do have a place
as treatment but are reserved for those with severe augmentation symptoms not responding
to all other means. I hope that you found this video useful, and
if so please do support this channel, by liking, subscribing and sharing. Thanks for your support!

100 Replies to “Restless Leg Syndrome evidence based treatment”

  1. I take all these vitamins, and nothing helps my rls. Most videos on here saying potassium, magnesium I'm taking it and nothing. What about a muscle relaxer?

  2. For what it's worth, here's what's made a huge difference for me… 🙂

    I've been a long time sufferer of RLS and after 12 years of research and personal trial and error, I found that toxicity… caused by drugs and the highly compromised stuff we tend to call food now… is definitely what led to a compromised digestive system and subsequently my RLS.

    Once I had it, it took me several year's to notice that what I was eating, was definitely effecting it. The liver, which removes toxins from the body, also makes the bile (which helps break down our food) that's then stored and concentrated in the gallbladder. The bile from the gallbladder works in conjunction with the digestive enzymes from the pancreas, to break down our food. When the liver gets overloaded with toxins, it has more difficulty making bile. The concentrated bile in the gallbladder also starts to thicken, turn into "sludge" and (many people believe) gallstones. This in turn effects the pancreas, which also becomes blocked and can't function correctly and that's definitely not a good thing because it can begin to basically dissolve itself with its own digestive enzymes if it gets blocked.
    A compromised gallbladder can lead to neck pain on the right side, since there is a nerve that goes from the gallbladder to the neck and when the gallbladder us swollen, it'll press on that nerve. In my experience, I also developed pain in the left side of my neck (even a lump actually) and experienced pain in the middle of my back. I also had pain, that lovely "knife in the shoulder blade" feeling as well. I went round and round with doctors, specialist and treatments to try and figure out what all my intense neck, back and shoulder pain was being caused by for years. Each doctor scratching their head, referring me to another one, or just deciding that it must be arthritis…. ie: inflammation.
    I also began to develop food sensitivities, which were also signs of a compromised digestive system. In fact my digestion finally got so bad… and my RLS along with it… that I couldn't eat without pain, so I went on a 3 day water fast. ….and within 3 days, almost all my pain went away, I cut my RLS in half and I began sleeping like a baby. The swelling around my eyes, my face in general (jowls, under chin, etc.) lessened dramatically. All the bloating around my middle (which I thought had been fat), went almost entirely away. In fact, I went down a whole pants size in that 3 days. There was a big improvement in my cognitive function and clarity. All my "menopause" symptoms evaporated. The list went on and on. In the end I realised that all these numerous, "different" physical symptoms, we're all being caused by the same thing. Toxicity and a compromised digestive system.

    The other things that made noticeable differences over the years, more than others, included liquid diets (soups, smoothies, juices) and taking potassium citrate powder (a high dose) and magnesium citrate powder. Of course, those were good because they also help reset your bodies digestive system and are excellent for your pancreas and gallbladder. One of the ironies of being put on medication for RLS, is that this also backs up and adds dramatically to the toxicity of your liver/gallbladder/pancreas. Bad fats, bad sugar's, stress and nonorganic diets are pretty much the majority of the others.

    Other interesting things to note… a high percentage of people with IBS, another "digestive disorder", also have RLS…. surprise. More women than men have RLS. Also twice as many women also have gallbladder issues as men. Another digestive correlation. The list goes on. Personally, after years of research, I'm convinced that toxicity (which trust me, is pretty much all of us these days!) leads to digestive issues, which causes inflammation all over the body. Since inflammation is the cause of almost every "disease" out there, it doesn't take a rocket scientist to realise what the cause of all these diseases are.

    Anyway, I hope this information helps others to connect the dots if their experiencing these same issues to. 🙂

  3. Hey Doctor, I've been haunted by RLS several times a month since I was four years old. I've tried about everything without luck. Until an opioid was prescribed for nerve pain after a major accident many years ago that left me with a spine and Traumatic Brain Injury. Now due to the Opioid Crisis and the Government threatening Doctors enough for them to cut their patients prescriptions off cold turkey even after they were prescribed for many years. This just happened to me. Now the weekly RLS fits have turned into a full on 24/7 assault! Sadly, now it also impacts my scrotum, which makes no sense to me. It's impossible to find a Doctor who will take me serious without profiling me as some sort of drug addict looking to get high. I'm not looking to be medicated, I simply want to fix the problem. I have never in my life taken any kind of illegal drug, nor have I ever abused a prescription medication. Because of the actions of drug addicts, this Opioid Crisis Response Act has caused an awful lot of innocent people to become Collateral Damage! This is wrong on many levels! Any ideas?

  4. Hey doc, my dad has been suffering from rls symptoms from a very age but it has progressed a lot in hirecent years. Most doctors don't even take this seriously and prescribe pain meds. Could magnesium or potassium supplements have a positive effect?

  5. Thank you for your advice. I have RLS it's a pain in the but. I cannot sleep properly. I take sleeping pills. That is the only thing that helps me.. I have tried vegies. I take magnesium x2 daily. Eat a banana everyday. Nothing works. Yes I am a diabetic. However I had this issue when I was young I use to tie my knees with scarves. My best solution is cold air water..fan..ice pack..
    Or a warm close to hot shower just let the hot water finish on you its very relaxing… I listen to music from youtube I do anything to distract myself. I even get up do exercise and dance the feeling off..I have realized its hereditary my daughter,son Auntie and sister have have rls. RLS gets so bad it effects all my joints…I walk around like a stiff mummy wrapped in plaster. You never know when it will strike.. it does not only happen at night in bed..car bus drives plane..
    If the sleeping tablets are not working I drink beer..???? people are saying to put a bar of soap under the sheets.. lmao this did not work for me

  6. Should you be recommending opiods to treat RSL considering the high risk of addiction and that RSL is one of the many distressing symptoms of opioid withdrawal.

  7. I am now 51,have needed to move my legs and feet,nearly every night,since,i was a tiny child,feels like an uncomfortable,dry,sometimes slightly hot ,yucky feeling,don,t know why,is not fixed,often have to get up to walk around,its really annoying,even after having it all these years.

  8. I was prescribed amatryptiline for my rls. It does work but sometimes I need to increase the dose. I also take Tramadol for arthritis in my knee! Taking turmeric helped with the arthritis so much I reduced my tramadol intake. Worst rls ever, even in the day! So unfortunately, I had to increase the tramadol!!!!

  9. Ive had it for years, im 45 have had it from 18, ive been taking pramepexole for it, i was mentally tortured for years untill my doctor put me on it, works perfect, those tablets are my life line, if you suffer and havnt tried this please ask your doctor about pramepexole.

  10. Interesting that it’s cause may be related to dopamine. I developed RLS after taking Abilify, an atypical antipsychotic, for several years. My psychiatrist said it’s a potential side effect. Even though I’ve been off all medication for several years, I still have the RLS.
    As a kid, I had a hard time sitting still, I was a fidgety kid, but I had no problems sleeping.
    I’m very very reluctant to take prescription medications for it as whatever side effects and long term effects are probably undesirable.
    I had been getting some relief from taking magnesium glycinate snd taurine, but it doesn’t seem to be helping anymore.
    I eat a whole foods plant based diet, so I think I get plenty of potassium. Tried ACV, but that didn’t help.

  11. Best thing (works for me anyway) is when it starts, lay down on your back on a bed and lift (exercise) the affected leg (s) high, some 50 times, until the leg is exhausted. It does the trick. For me anyway. For years now (after years of terrible evening discomfort and consequent irritation)

  12. I'm 43. I got my resless leg syndrome at 27 years old at the same time I got something called EMS or electro magnetic sensitivity. This was caused by holding a cell phone to my head while talking for long periods of time. I've tried all the suppliments, diet changes, leg hitting and working out and found very little relief. Tried something called clonidine with no luck. The only thing that has worked is half a lortab 10 before bed.. I sleep for 3 hours, wake up with restless legs, take another half, sleep for another 2 or 3 hours.. I usually have to take 3 halves every night to be normal.. Without lortabs I get anywhere from zero to 3 hours of really bad sleep.. And in that case I have to take hot baths during the night to get about 30 mins of sleep each time.. Its absolute torture.

  13. I am 49 years old and have had this all my life! I have never known what is was until recently! My father had it,(he is deceased now), myself and my youngest daughter have it so I believe it is genetic?

  14. Had this since childhood. Didn’t even know it was a condition until recently,just thought it was me.
    Doing leg lifts, pacing, massaging and slightly pinching my legs, or running freezing cold water over them are all things that help me personally. It is very annoying, especially when you are so exhausted ? but your legs will not let you rest. However, it is such a normal part of my life because I can never remember a time I didn’t have it.

  15. Hello, I'm Klaus (74). I'm taking 0,9 mg pramipexole and pregabalin 75 mg daily for peripheral neuropathy (sensitivity). That basically solved daily attacks of RLS and cramps in unexpected moments. Now RLS seems to be worsening, with me waking up after an hour or two without getting any more sleep. The curious thing is that the assumption of a teaspoon tip of plain salt (as in the case of cramps) in half a glass of water gives immediate relief! The other night I had to take it twice, though. Do you know whether salt is used by others as a remedy, or can you explain the positive effect? Just to be sure, I'll now try a glass of water only, which would make me feel stupid if it worked.

  16. I get this in my legs and sometimes arms I find doing push ups or jumping just some sort of exorcise helps but you have to go in hard or it won't work

  17. I have restleg syndrome, im 18 and a dancer. My grandmother has had restleg sijce she was a teenager and her mother had it as well. My mother has it as well but she it only affects her a couple times a month. Mine affects me 5-6 nights out of the week

  18. My RLS has gotten so irritating to the point where the only way to calm it down is by punching thee area. It makes the muscle go crazy and it dies down a little. I lose so much sleep, it’s crazy. I even take sleeping pills and when I’m dozing off, my legs wake me right up and I stay in bed moving for a good two hours. It’s not fun at all

  19. Sir i started this when i am diagnosed with anxiety and depression I also have jelly legs can this be the reason.

  20. I have depression and insomnia so that’s probably why I have this too.
    It’s just weird because my legs feel like they’re in pain but I’m not feeling it and I just can’t stop moving them around. Sometimes I just cry it’s so bad

  21. It usually only happens to me when I’m sitting still which is usually in school. Never really at night tho. What do I do?

  22. I have this and it is bloody annoying, this sounds stupid but im not joking, exercise helps (at least for me) my rls hugely.

  23. Sitting here for hours now, can’t even stop moving my legs as they’re just aching

  24. i think i have this but tbh it isnt that bad, kinda makes me want to go run outside which i wouldnt do normally if i didnt feel restless so it gives me that motivation to stay in shape lol

  25. Fantastic video. I love my Sertraline because it has helped me so much with pppd but my restless foot causes me so much discomfort.

  26. ANY drugs, antidepressants or even opioids won't cure RLS. They act on receptors in brain only to alleviate the Symptoms. The cause of this neurological condition is to do with how we process our internal conflicts and how we generally cope with stressors. The neurotransmitter Dopamine is so important because it's involved in the neuro pathways and it's responsible for reward motivated behaviour. If you have experienced any type of addiction in your life; substance or behaviour the pathways for RLS responses are already activated. To resolve the CONFLICT (or conflicts) which is psychologically in nature but translates into our biochemistry and neurology is to look closely at our lives. I am writing from experience 🙂

  27. I had this feeling in my legs for ages, now I have it in my hand/arms and it feels disgusting. The only way I can get to sleep is if I continuously rub my hand on my sheet until I eventually pass out

  28. I’m lying in bed now and for the first time ever I feel an urge to move my feet. No matter what position I’m in, it doesn’t go away. I try to lay still but then I get a prickling sensation in my feet. Ugh it’s 3 am. I think I have gotten this from my dad because he always complains over that he has restless legs/feet?

  29. People who have never had RLS cannot imagine how horrible it is. I've had my left foot smashed off and reattached and I would rather go through that ordeal again rather than suffer from RLS. God only knows how many have died due to the consequences of RLS. When the prickly feeling it's just a matter of a few seconds before it explodes with an uncontrolled leg jerk that sends shockwaves over the whole left side of my body. I get it in the right leg sometimes but usually, it's the left that I get the worst of it. The only thing that stops it is Oxycodone 10-325. I've been taking Oxycodone, Morphine Sulfate and Tinazadine for the last 7 years for the pain in my left foot, left hip replacement, and back pain. I get a bonus taking the Oxy for my foot as it helps the RLS. But if it ever starts, it's a good two to six hours for even Oxy to stop it.

  30. Lot of ppl here asking is RLS caused by depression and insomnia !
    I am sure depression brings it on, the only thing worked for me was hypnotherapy 5 yrs ago!
    It took 5 weeks and 6 sessions at £70 and a 400 mile round trip and I started falling asleep at bedtime sleeping through until morning !
    I stopped the hypno and it took 5 weeks b for RLS returned !
    Anyway it worked which gave me the idea it was defo stress that brought it on, she said “we need to get the Adrenalin down” So the hypnotist just calmed my head down and RLS stopped !

  31. I usaully get it when I don’t get much sleep the night before and it’s always my right leg. It’s more annoying than painful! ?

  32. i havent slept in ages; nothing works. its more and more pain every single night, and i never get used to it. all night i just cry because it hurts so so so much. i dont know what to do

  33. I’m pretty sure I have it and when it hurts I move and then when I stop it gets worse and then there’s just a cycle and then it’ll just stop

  34. When I’m in bed it Like…Hurts/aches but not always,I have noticed a couple of times,if it hurts can It mean I’m growing? I’m scared

  35. I think I have rls, sometimes I get this tingleing sensation to move my legs. It happens to me either in class, or at night :/

  36. Forget medications to treat this, you only end up with more side effects. Use good supplements like iron, and Magnesium flakes (better than epsom salts) in a foot bath, as the body absorbs it better that taking a supplement. Go to a naturopath. As soon as you get your vitamin and minerals to a sufficient level and have your gut working right to supply your body with all it needs to function and replace cells, you will heal. It's how we are designed. If you cut yourself, what happens, it heals. All of your symptoms will eventually dissipate. The body is designed to heal given what it needs. I have just been working really hard these last few weeks and forgot my magnesium spray and supplements. I have become low and the restless leg syndrome came back. It's like black and white now. I know to keep myself healthy and I have managed to conquer RLS, anxiety, depression, bipolar, a tumor, low energy, all sorts.

  37. I’m only 14 and I’m really struggling to sleep with this 🙁 I have school tomorrow as well, I don’t know what to do!!

  38. M like shaking my legs even while watching dis vedio..Nd I enjoy shaking my legs even if someone stops me I couldn't stop myself

  39. I’m 14 and my legs sometimes get REALLY restless i don’t know about anything about it and some people call it a Syndrome? But i recently started skateboarding and it has been helping me ALOT for some reason

  40. i started taking vikodin and i noticed it worked great, but now they are so hi priced and i progressed to 3 a day now. i feel trapped, how do you say no to sleep. plus the f ing withdraw. any suggestions please

  41. I’m on Paxil and Gabapentin used to work on my restless legs, but lately my RLS is horrible. Maybe I need to take some iron and magnesium.

  42. My calf muscles are always sore and kinda itchy feeling like how it feels after a sunburn. Very annoying and uncomfortable. Gets better when I stand. Worse when sitting or lying down. Same during day as at night.

  43. I am more curious as I do get it but quite rare and I think more when I was a kid.When I do get it I want to stamp my feet to shake it off,not sure it works probably not.

  44. What do you suggest when it starts in the spine and stiffens to the extremities arms, legs to toes and fingers feeling like an electric shock?

  45. I need advice from anyone else who has restless legs or has knowledge about these things. eating makes my RLS worse. anyone else? let's chat because it has morphed into a kind of eating disorder of mine where i feel anxious about eating when i know i won't be able to run/ walk afterwards. It resembles exercise bulimia a little bit, and honestly, the sensation i feel in my legs during a restless episode feels like..an extra layer of skin/ fat on my legs that i can only get rid of by walking/running. this is such a strange thing that ive been struggling with for a few months and idk what to do, as i have become very irritable and depressed as a result. it has honestly contributed to the body dysmorphia i feel about my body, as the sensation draws attention to my legs and always has me second-guessing my diet and exercise. any advice?

  46. I have been suffering this condition for years. My general practitioners over the years have just dismissed it. A doctor put me onto Benztropine Mesylate (Benztrop) several years ago and I have used it on and off with mixed success. My RLS has already moved into my arms (RAS). The location varies each time. It can be one leg, a leg and an arm together or even both arms together. I can be just a little bit tired and napping, even in the day and it begins. The only time it stops is after about 24 hours of being awake and collapsing from exhaustion, about 6-7am.

    It is intense and even on the highest dose sleeping medications including Benzodiazapine it prevents me from sleeping.
    If I deliberately try to fight it then eventually my affected limb will jolt like an electric shock and the sensation is extremely uncomfortable, because it has built up to an extreme level. I stand in hot showers for an hour at a time as it helps relieve it. Multiple showers at night.

    Electric bill is high because of it. I am then extremely exhausted in the day and more susceptible to falling ill from lowered immune system. I stop taking my anti-depressant at times to try to put the RLS back into remission. But that then causes a relapse of depression. It is a vicious Catch 22 scenario.

    I have multiple conditions, so have been taking medications for various ailments and disease for many years. My RLS began when on high doses of meds. RLS is up there with the worst. I would rather be in severe pain than RLS. It drives me insane.

  47. Excuse me sir. Earlier everyday nearly 400=ml of codeiene and triprolide mixed syrup I am take ing sir. But past 4=days I did took any codeiene syrup sir and I am take ing valporate 500 everyday sir along that I took alprazolam0.5 mg 2=tablets sir at night but later night my both legs are getting like electric shock sir like I am rideing cycle sir please help to over come please sir

  48. RESTLESS LEG SYNDROME

    Thank you!

    I have trued to cope with RLS since 19 yrs old – I am now 72 and finally have reasonable control with the help and bravery of my physician. Through out the years I have used hot or cold water soaks on the legs, didn't work. Plain ASA or Tylenol didn't touch it even when taking 2 to 3 times recommended dose at night time. Then ASA with codeine, only burned my stomach. AC&C with 8 mgm codeine helped only sporadically. Not necessary the choice for long term use as it is hard on liver. Over the 40s and 50s I added alcohol to the mix, usually 3 to 4 tabs with 4 to 5 oz of alcohol. (I don't even like booze, but at 3 am pacing the floor and desperate I would do anything to settle. I had used requipe it did help a bit. .

    Then at 65 yrs I had decompression of R L5S1. I was on hydromorphone 3 mgm for post op pain. NO RLS! Over the last 5 years my doctor and I have worked out reasonable treatment , hydromorphone 3 mgm up to 5 caps per day and Dilaudid 1 mgm max 4 per day. It works!

    Now that I am controlled the medical association and government have joined forces with public opinion that opioids are evil because the addicted were dying of overdoses. 4000 per year compared to 1.5 million chronic pain suffers. This is political and PR medicine. I have written to the medical association and government about my views. My doctor has told me his colleagues think I'm on to much! We discussed his role as a physician; that is, I need him to care for me and as the rest of the practice has not assessed me they have no business interfering with our relationship. I am dependent on him to stand up for my care. I do have a major fear of being cut off. I shall likely euphonize myself. I do not get any buzz from these drugs only pain control, I have no signs of over medication as the opioids are being consumed by the pain receptors.

    Addiction is NOT an issue but pain is and that is the focus of my care.

    My physician is gold!

  49. I've had tje urge to move my legs at bedtime like last 10 years ago since this time. I thought i just prefer my bedsheets to be silk or anything smooth so that i can move around. Now im in medical course, realizing ive been suffering and its worst now coz of my lifestyle. ?

  50. This started when i was going through stressful moment. One morning i wake up with numbness on my legs. Can this be caused by anxiety.

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