If you don't cruise around this site on a regular basis there's a new document available via the Announcements page called An Algorithm for the Management of Restless Legs Syndrome written by the Mayo Clinic. The direct link is http://www.mayo.edu/proceedings/2004/jul/7907crc.pdf Interesting stuff...
Heron
Algorithm for Managing RLS
Heron,
You are totally on the ball!! You couldn't have posted this at a better time for me. Thank you. It's very user friendly, to the point and short enough to go over with my doc (who's not really a doc) this Friday. Thanks again!
You are totally on the ball!! You couldn't have posted this at a better time for me. Thank you. It's very user friendly, to the point and short enough to go over with my doc (who's not really a doc) this Friday. Thanks again!
Sole
"If you ever drop your keys into a river of molten lava, let'em go, because, man, they're gone."
"If you ever drop your keys into a river of molten lava, let'em go, because, man, they're gone."
Congratulations!
Excellent find, Heron! The link listed on the RLS web site does not work (expired) but your link does!
Jumpy Owl
I do not want to steal your show
Heron, but I thought I summarize that Mayo article and post it here for convenience. I really like that work and I added a little.
An Algorithm for the Management of RLS
By M.H. Silber et al. Mayo Clin. Proc. 79(7):916-922, 2004
INTRODUCTION:
Characteristic symptoms: Limb discomfort and urge to move legs which occurs at rest. Symptoms are relieved by movement and are worst in the evening and night.
Associated afflictions: RLS is usually associated with involuntary contraction of leg (muscles) during sleep known as periodic limb movements (PLM). (BTW the reverse is not true).
Severity: ranges from annoying and infrequent to distressing and daily.
Secondary adverse events: Often RLS is a cause of onset or maintenance insomnia.
Prevalence: 5-15% of population.
Pathophysiology: RLS is familial (50%), or idiopathic or related to acquired conditions (iron deficiency/renal failure).
Regulatory status: FDA has not yet approved any medication for the treatment of RLS, so all the drugs discussed here are off label.
Classification of RLS based on severity:
The article distinguishes between three types of RLS:
Intermittent RLS
RLS that is troublesome enough to require treatment but does not necessitate require daily therapy
Daily RLS
RLS that is frequent and troublesome to necessitate daily therapy
Refractory RLS
Daily RLS that is treated with a dopamine agonist with one or more of the following outcomes:
o Inadequate initial response despite adequate doses
o Response that has become inadequate with time despite increasing doses
o Intolerable adverse effect
o Augmentation that is not controllable with additional earlier doses of the drug
TREATMENTS:
INTERMITTENT RLS
Nonpharmacological therapy
• Determine ferritin level and administer iron replacement
• Mental alerting acitivties to reduce boredom
• Abstinence from caffeine, nicotine, and alcohol
• Consider if the use of antidepressants, neuroleptic agents, dopamine-blocking emetics or sedating antihistamines may be contributing and if they can be discontinued.
DAILY RLS
Nonpharmacological therapy
It is the same as for intermittent RLS
Medications
• Dopamine agonists (pramipexole/Mirapex or ropinorole/Requip)
• Gabapentin/Neurontin (anticonvulsive)
• Low potency opioids (propoxyphene/codein, or opioid agonists,
such as tramadol/Ultram
REFRACTORY RLS
Medications
• Change to gabapentin/Neurontine from dopamine agonist
• Change to a different agonist
• Add a second agent such as gabapentin, benzodiazepine, or an opioid
• Change to high potency opioid or tramadol
ALTERNATIVE, INVESTIGATIVE, OR POTENTIAL FUTURE THERAPIES
The management of RLS continues to evolve as new drugs become available and older ones are prescribed less frequently.
Carbamazepine/Tegretol (an anticonvulsive) and clonidine/Catapres (antihypertensive medications) have been successful in clinical trials but are not commonly used in clinical practice..
Among potential new dopamine antagonists Cabergoline/Dostinex (it is also a amtihyperproclactinemic) is of interest because of its long half life of 65 hours, which may result in less augmentation.
Magnesium (ions) has been reported to be effective. In addition to oral iron supplements, treatment of RLS by intravenous iron infusion is presently being investigated in patients with both low and normal ferritin concentration. Such use dates back over 50 years.
Jumpy Owl
Time To Bump
With so many new folks on the boards these days, it's time to once again bump this up. Please take the time to read about treatment options for RLS.
Heron
Algorithm for the Management of Restless Legs Syndrome
Heron
Algorithm for the Management of Restless Legs Syndrome
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t
mayo link
Thanks Heron, for the link to the mayo article on RLS. It was very informative. I have some RLS going on, but what concerns me more is I have burning, sparking, crawling nerves all over my body. This has been going on for about 11 months. Interestingly, I was evaluated at Mayo in Phoenix, by a neurologist (among other doctors) and no one could figure out why my nerves were doing what they were doing. My ferritin level at that time was 5.9, and no one said anything to me. (I had been on iron supplements for 4 months by then...it just wasn't doing any good.) So, now I know that iron plays a role in RLS, and I'm working to get my ferritin level over 50. I can only hope and pray that the rest of my nervous system will get better too. If anyone out there has what I've described, please write back. Good luck to all of you.....t
Dear Guest:
The role of ferritin RLS is quite complex. It is believed but by no means certain that the plasma ferritin level somehow directly reflect the iron stores in the brain cells.
When someone has such a low iron level in the blood plasma, one should wonder why. Under the best circumstances it is hard to influence that level by oral intake of iron in various forms. It is believed that the intestinal absorption of iron improves at low ferritin level but quite poor at normal levels to protect against too high levels which can be deadly.
But again there must be a reason why yours is so low. It is possible that only intravenous iron supplementation could help. This is a method much in vogue 50 years ago and is being resurrected again.
No idea why you have that overreaction on the part of the nerves.
When someone has such a low iron level in the blood plasma, one should wonder why. Under the best circumstances it is hard to influence that level by oral intake of iron in various forms. It is believed that the intestinal absorption of iron improves at low ferritin level but quite poor at normal levels to protect against too high levels which can be deadly.
But again there must be a reason why yours is so low. It is possible that only intravenous iron supplementation could help. This is a method much in vogue 50 years ago and is being resurrected again.
No idea why you have that overreaction on the part of the nerves.
Jumpy Owl