Managing RLS and Parkinson's

[seamayo]

Good morning,
Wondering if anyone has RLS and Parkinson's and how they are being managed with medications. Concerned about use of Sinemet along with Neupro patch, particularly for augmentation. Husband has been on Sinemet 25 mg three times a day since October 2022, Rotigotine patch 4mg nightly for over 2 years, Gapabentin 1200 mg divided in two doses evening and bedtime since Oct 2022, Oxycodone hydrochloride/naloxone hydrochloride (Targin) 10mg/5mg 2 tablets at bedtime. He is being followed by neurologist specialising in movement disorders, awaiting iron infusion (last one was 2019). RLS rears its ugly head 2-4 times a week especially if husband is overtired. Interested to learn of other people with PD and RLS and how they manage. Thank you

[badnights]

Good morning,
Wondering if anyone has RLS and Parkinson's and how they are being managed with medications. Concerned about use of Sinemet along with Neupro patch, particularly for augmentation. Husband has been on Sinemet 25 mg three times a day since October 2022, Rotigotine patch 4mg nightly for over 2 years, Gapabentin 1200 mg divided in two doses evening and bedtime since Oct 2022, Oxycodone hydrochloride/naloxone hydrochloride (Targin) 10mg/5mg 2 tablets at bedtime. He is being followed by neurologist specialising in movement disorders, awaiting iron infusion (last one was 2019). RLS rears its ugly head 2-4 times a week especially if husband is overtired. Interested to learn of other people with PD and RLS and how they manage. Thank you

I don't know of anyone on the board who has both, but I'm not here that much anymore. I know, however, that a lot of people on medication for Parkinson's have WED/RLS as well*. Have you tried a Parkinson's forum?

There is no danger in taking the rotigotine as well as the Sinemet, as far as I know.

* "Several studies showed a high prevalence of RLS/WED in PD patients and several findings related to dopaminergic and iron alterations in both disorders" (from abstract of a paper on PubMed). But they don't know if the WED/RLS is caused by the dopamine medications that the PD patients use, or if the WED/RLS was there before and only expressed itself later. My suspicion is that the Sinemet causes WED/RLS augmentation in PD patients who are susceptible.

But it's no use him trying to stop the Sinemet, for the two reasons that he needs something fast-acting to relieve the PD symptoms, and he would still be taking rotigotine which also causes augmentation.

The gabapentin is hopefully helping his sleep and helping the WED in a small way; but more can't be expected from it, and he's on a pretty high dose already. That leaves opioids, but he's already taking 20 mg oxycodone. A physician might be willing to prescribe more, or switch him to methadone, which is very effective for WED, or buprenorphine, perhaps even more effective. It would make sense for him to see a WED/RLS specialist at one of the RLS Quality Care Centers, if you could get to one.

[Rustsmith]

At one of the RLS patient symposia, a question was asked of the expert panel of a link between RLS and Parkinsons. Dr WIlliam Ondo responded that in his 30 yrs of movement disorder practice, he had encountered numerous Parkinsons patients who later developed RLS but that he had never encountered an RLS patient who developed Parkinsons. He then asked the other members of the panel (which included Dr Earley and Dr Buchfuhrer) if their experience was any different, their reply was no.

As for combining Sinemet and Rotigatine, the rules for Parkinsons are different than they are for RLS. In Parkinsons, the dopamine producing cells in the brain slowly start to die off which produces a dopamine deficiency that needs to be replaced. In RLS, the current theory is that the dopamine receptor cells are blocked and that increasing dopamine levels forces the remaining receptors to work harder rather than clear the blocking mechanism, but that the added dopamine results in an imbalance in the types of dopamine, which is what is thought to cause augmentation.