Treating RLS

[ViewsAskew]

Jackie Bainbridge, PharmD, gave a talk at the Chicago Regional RLS Foundation meeting. Here are some of her comments.

Per evaluating if it's RLS, she said you should also look at general history of sleep, secondary causes (CBC, Fe, ferritin, RF, BUN, Cr, hgb, A1C, folate, Mg, TSH, and B12). That's a long list, but a good one to take to your doctor. Even if you think it's primary RLS, testing for all of the above is important.

She was asked if statins would worsen RLS. Here is what was said. Statins can cause myalgia (pain) and any pain can worsen RLS. In a study, there was no increase in RLS in those taking statins. She also commented that if you have pain when taking a statin, CoQ10 could clear up the cramps IF your doctor has said there is no other problem causing it. First, though see your doctor if you have pain.

In talking about dopaminergics, it was said that taking them TWO FULL hours before the onset of symptoms was very important. They said Requip was 6 hours duration, Mirapex 8. It was also said it was very important to stay on the same dose each day and not to alternate because you wanted to keep the dopamine receptors at the same level. That was a reason they suggested you should take Mirapex or Requip every day. Sinemet is not associate with the same receptor (D2), so it can be taken as needed.

Per augmentation, they think it may be that there is receptor remodeling or a change in the receptor very likely.

Someone asked about ADD drugs and how they might work with RLS. Picchietti and Bainbridge both answered. The gist is that you can't give these at bedtime because they are stimulants. Studies have shown that stimulants do help RLS (all stimulants increase dopamine), but since the majority of us need something at bedtime, these won't work. It also could be that any cognitive alerting helps (as we know from when we get involved in anything). The other problem is that they are controlled substances so are just as hard to get as some of the opioids. \

This was also when a question about magnesium came up. It was said that a study from Germany shows that people with RLS have normal levels. Picchietti said that people with kidney problems should not take magnesium. He also said a blinded study showed no evidence that calcium or magnesium helped RLS.

[Aiken]

He also said a blinded study showed no evidence that calcium or magnesium helped RLS.

I have trouble with this line. He said earlier that taking care of pain and cramps caused by statins can ease RLS troubles that are exacerbated by them. In people who already have cramps for other reasons, calcium is pretty well established in its ability to reduce or eliminate them, and so it most certainly can help with RLS in the right cases.

[ctravel12]

Ann thanks for sharing this information. I do have kidney problems and will be doing a 24 hr urine test in Sept along with b/w. I will be seeing my dr in October and will mention this as I do take magnesium (one tablet in the afternoon).

I am also still taking mirapex but lowered my dosage (.125mg) and will discuss this with my neurologist who I will be seeing next month. Still having problems with the med and will see if he can give me something else.

[ViewsAskew]

Aiken, no question that it can help cramping and the pain associated (calcium). It doesn't help RLS. Now, in those people who have painful RLS, I imagine this gets a bit blurred. The study, I presume, was looking at the restlessness and sensations that make you move, not with pain. But, I don't know as I haven't seen the studies, so I am just guessing.

He also said he HIGHLY recommends that adults take calcium...but for other reasons, not for RLS.

[Aiken]

Well, it doesn't directly help RLS, but since RLS is often exacerbated by pain, even unassociated pain, I'd think using calcium to reduce the pain of cramps should indirectly reduce the RLS by removing one of its triggers.

On the other hand, if their point is that it doesn't directly help RLS, then they're probably right.

[ViewsAskew]

Yes, their point was that is doesn't directly help RLS. And, if you are someone who doesn't have painful RLS, it won't help you at all. If you do have painful RLS and it reduces other pain that makes the RLS pain worse, I would think it would help.