Restless legs syndrome, also known as Ekbom syndrome, is the most commonly experienced sensorimotor disorder among the general population (Bassetti et al., 2011). The disorder afflicts approximately 2 to 10% of the general population and it is experienced as periodic limb movements in 80% of individuals with restless legs syndrome (Bassetti et al., 2011). The most prominent symptoms of the disorder are urges to move the legs as well as unpleasant sensations in the legs (Lee et al., 2011). The symptoms generally commence or become worse during inactivity and individuals with the disorder generally feel relief from symptoms after movement (Lee et al., 2011). Also, symptoms of the disorder are generally worse during the evening hours in comparison to the daytime. Furthermore, restless leg syndrome often results in sleep disturbances such as delayed sleep onset, multiple awakenings, and reduced sleep efficiency (Lee et al., 2011). The disorder is generally defined as primary, stemming from genetic or idiopathic causes, or secondary, resulting from other medical occurrences or neurological disorders (Mitchell, 2011). There are a few different treatment options available for the treatment of the disorder, including pharmacologic and non-pharmacologic interventions. The following discussion outlines treatment options for restless legs syndrome and their effectiveness in alleviating symptoms of the disorder.
The most commonly prescribed treatments for the symptoms associated with restless legs syndrome are dopaminergic medications (Bassetti et al., 2011). One of these dopaminergic agents commonly used for treatment is levodopa, a dopamine precursor, which has been demonstrated as effective in the reduction of restless legs syndrome symptoms when administered at bedtime (Bassetti et al., 2011). The effectiveness of another dopaminergic agent called pramipexole was investigated in a study conducted by Bassetti et al. (2011). This study sought to compare the effectiveness and safety of pramipexole, a dopamine agonist, with that of levodopa. The effectiveness of the treatments was assessed through measures of how frequent leg movements occurred while the subjects spent time in bed, rating scales for severity of restless legs syndrome in the day and night, as well as the SF-36 scale, Hospital Anxiety and Depression Scale, Epworth Sleepiness Scale, and Clinical Global Impression for measures of quality of life, mood, and daytime sleepiness (Bassetti et al., 2011).
Results of the study by Bassetti et al. (2011) indicated that levodopa and pramipexole are comparable in their effectiveness for the treatment of symptoms associated with restless legs syndrome, and both treatments were demonstrated to be well tolerated among participants in the study. Adverse drug reactions were observed among a large proportion of participants of the study, at rates of 59% and 61% respectively for pramipexole and levodopa (Bassetti et al., 2011). The adverse drug reactions included restless legs symptoms, dizziness, and nausea (Bassetti et al., 2011).
Another pharmacologic intervention used for the treatment of restless legs syndrome is gabapentin enacarbil, which is a non-dopaminergic agent (Lee et al., 2011). Researchers sought to investigate the effectiveness of this treatment in light of the fact that many dopaminergic medications used for the treatment of restless legs syndrome result in adverse side effects such as impulse control disorders and compulsive behaviors (Lee et al., 2011; Voon et al., 2011). A 12-week study investigating this agent yielded findings that indicated the medication was significantly effective in improving symptoms associated with restless legs syndrome and also reduced the occurrence of sleep disturbances (Lee et al., 2011). The dosages of gabapentin enacarbil used in the study were 600 mg and 1200 mg, both tolerated well by the participants (Lee et al., 2011). The negative aspects of this agent are that it may not be clinically effective with all individuals. This is due to the fact that plasma exposure to gabapectin differs between patients and its bioavailability decreases with increasing dose, necessitating frequent dosing (Lee et al., 2011).
Patients suffering from restless legs syndrome may also exhibit symptoms of depression (Bayard et al., 2011; Scholz et al., 2011). Patients experiencing severe symptoms are more likely to suffer from depression, and this comorbidity should be taken into account when devising a treatment plan (Scholz et al., 2011). Research has demonstrated that an antidepressant known as bupropion is effective in the treatment of symptoms of restless legs syndrome and is a good treatment choice for depressed individuals (Bayard et al., 2011).
Aside from drug interventions, there are alternative options for the treatment of symptoms associated with restless legs syndrome. Mitchell (2011) presented a review in which he outlined all of the possible non-pharmacologic interventions for the disorder, and remarked that these treatments may be more effective for the treatment of primary restless legs syndrome than for the secondary type of the disorder. The interventions suggested by the author included lifestyle adjustments, physical activity, pneumatic compression devices, massage, NIR light, complementary and alternative medicine, as well as placebo (Mitchell, 2011).
In regards to lifestyle adjustments, it has been demonstrated that sleep quality among individuals with restless legs syndrome may be improved by controlling sleep times as well as reducing the consumption of alcohol and caffeine (Mitchell, 2011). It was also suggested that certain mental activities like, card games, reading, and working on a computer may decrease symptoms of the disorder (Mitchell, 2011). These interventions would be easy to incorporate into the routines of individuals with restless legs syndrome and pose no risk of adverse effects.
Physical activity level has been demonstrated as a key factor in the occurrence of restless legs syndrome (Mitchell, 2011). In particular, lack of exercise is considered to be a significant risk factor and predictor of the disorder, and exercise was considered for a long time to be the only non-pharmacological intervention available for individuals with the disorder (Mitchell, 2011). Regular exercise programs incorporating aerobic and resistance training have been shown to result in significant decreases in the severity of symptoms associated with restless legs syndrome (Mitchell, 2011). The mechanisms by which physical activity is effective for the relief of symptoms is increased blood flow, release of dopamine, as well as the release of endorphins (Mitchell, 2011). Physical activity is an excellent treatment option since the overall benefits of the activity extend beyond the alleviation of restless legs syndrome symptoms, positively affecting health and well-being in general.
Another non-pharmacologic intervention is the use of pneumatic compression devices. These devices, such as vasodilators, act by increasing blood flow through the use of pulsed compression applied to the regions of the leg and thigh (Mitchell, 2011). This vascular compression relieves symptoms of restless leg syndrome through the subsequent release of endothelial mediators and enhanced lymphatic and venous drainage (Mitchell, 2011). This intervention may also prove to be a valuable option for many individuals considering its non-invasive nature.
Massage is another potentially effective treatment for restless legs syndrome. Research has demonstrated that massage twice per week for a period of three weeks effectively reduced symptoms associated with restless legs syndrome significantly (Mitchell, 2011). The techniques used were Swedish massage, friction to tendinous attachments, myofascial release, stretching, and pressure applied directly to lower extremity muscles and hips (Mitchell, 2011). However, the positive effects observed were temporary, as symptoms returned two weeks after the massages ended. The mechanisms postulated to be at work in the reduction of symptoms were increases in dopamine following massage, modulation of neural activity in the thalamus, as well as increases and improvements in blood circulation (Mitchell, 2011).
NIR light therapy has been used with some success in the treatment of restless legs syndrome (Mitchell, 2011). This therapy stimulates the generation of nitric oxide in the endothelium through mechanisms similar to that of exercise, and this results in increased blood flow thus delivering more oxygen to tissues. NIR light therapy has been demonstrated as effective in the prolonged decrease of restless legs syndrome symptoms up to two weeks following treatment (Mitchell, 2011).…