4 replies to this topic

[bronxbomber]

Since I suspect that the taper is making my RLS worse, this for me is a topic that I have plenty of time to figure out. But I thought that I would ask the question today while I am packing my next 2 week supply of pills. It's not a high priority at this time, but I'm hoping that others might also be interested.

My RLS is pretty well controlled even during the taper. But it is impossible to fall asleep without my dosage of ropinarole (aka Requip). After I am completely free of C, I would like to investigate whether there is a natural alternative to Requip.

I wonder if anyone has researched this topic.

After my C taper, Requip will be my only remaining important prescription. It would be nice to be prescription-free, and to rely on my family doctor only for annual checkups. The way Healthcare is headed, a lot of us may be asking that question. Of course, if I break something or have a heart attack I will see the appropriate specialist. I am not suggesting that doctors are to be avoided.

Any thoughts about Restless Leg Syndrome?

[fishinghat]

Good morning BB.

 

There has been much research done on the causes of RLS. The causes vary but in the cases of those with depression/anxiety it is often due to low magnesium levels. It has been shown that people suffering from high stress release more magnesium in there urine and the magnesium drops in their tissue. I took gabapentin for years for rls until it was linked to pancreatic cancer at which time my dr discontinued its use. I had my blood checked and my magnesium was within normal range but near the bottom of the range. I started on 300 mg of magnesium a day and my RLS was resolved within two days. However, magnesium competes with calcium in the blood so I had to have my magnesium checked every 6 months. After a few years my magnesium started being elevated and the calcium

 

I may have some literature on it and if so I will post it. Be aware that there are other causes for RLS but this is the most common.

[fishinghat]

Restless Leg Syndrome

(Synopsis from PubMed)

Causes

Research and brain autopsies have implicated both dopaminergic system and iron insufficiency in the substantia nigra plays an important role in reward, addiction, and movement and is composed of dopaminergic neurons. This area is one of the primary areas for the production of dopamine. Iron is an essential cofactor for the formation of L-dopa, the precursor of dopamine and adrenaline.

Magnesium deficiency.
Magnesium deficiency showed important disorders of sleep organization, agitated sleep with frequent periods of nocturnal awakenings, increase of the durations and percentages of light sleep, a decrease of duration and percentage of deep sleep, a decrease of duration and percentage of REM sleep caused by magnesium deficiency with the disappearance in the REM sleep in some.

Iron Deficiency
The most commonly associated medical condition is iron deficiency (specifically blood ferritin below 50 µg/L), which accounts for just over 20% of all cases of RLS. Normal blood levels are 30-300 ng/mL for males and 15-200 ng/mL for females. Studies using cerebrospinal fluid, magnetic resonance imaging, ultrasound determination of iron and autopsy tissue have implicated a primary role for brain (substantia nigra) iron insufficiency in restless legs syndrome (RLS). Ferritin can deliver iron to multiple organs, including the brain. The data clearly show changes in iron status affect dopaminergic activity. The proposed etiology of RLS is the central dopaminergic dysfunction, based on the benefits of dopamine agonists and exacerbation of RLS symptoms by dopaminergic antagonists.

Iron is most available to the body when chelated to amino acids - iron in this form is ten to fifteen times more bioavailable than any other, and is also available for use as a common iron supplement. Often the amino acid chosen for this purpose is the cheapest and most common amino acid, glycine, leading to "iron glycinate" supplements. RDA for iron varies considerably based on age, gender, and source of dietary iron (heme-based iron has higher bioavailability).

Iron uptake is tightly regulated by the human body, which has no regulated physiological means of excreting iron. Only small amounts of iron are lost daily due to mucosal and skin epithelial cell sloughing, so control of iron levels is mostly by regulating uptake.[33] Regulation of iron uptake is impaired in some people as a result of a genetic defect that maps to the HLA-H gene region on chromosome 6. In these people, excessive iron intake can result in iron overload disorders, such as hemochromatosis. Many people have a genetic susceptibility to iron overload without realizing it or being aware of a family history of the problem. For this reason, it is advised that people do not take iron supplements unless they suffer from iron deficiency and have consulted a doctor. Hemochromatosis is estimated to cause disease in between 0.3 and 0.8% of Caucasians.[34]

Certain medications may worsen RLS in those who already have it, or cause it secondarily. These include: any antidepressants (SSRIs).

Genetics
More than 60% of cases of RLS are familial and are inherited in an autosomal dominant fashion with variable penetrance.
Six genetic loci found by linkage are currently known and are listed below.
12q,14q, 9p, 20p, 2p and 16p12.1.
Four genes, MEIS1, BTBD9, PTPRD and MAP2K5, were found to be associated to RLS.

Effects
Sleep - For 60%–80% of patients with RLS, sleep disturbance is their most distressing symptom. For example, impact on patients’ daytime cognitive abilities, patients report reduced concentration and attention, increased daytime sleepiness, and mood disturbance. Studies have indicated that the symptoms of RLS precede those of depression or anxiety, and others relate the severity of mood symptoms to the severity of RLS symptoms. For some patients, the effects on mental health may be so pronounced as to reach the diagnostic criteria for major depressive disorder or generalized anxiety disorder

Several studies have shown an association between the symptoms of RLS and worse mental health. The authors concluded that the presence of RLS symptoms “was probably the major determining factor for the anxiety and depression scores, with higher scores correlating with more severe RLS”.

Diagnosis

Serum ferritin levels are measured in patients as part of the iron studies workup for anemia and for restless legs syndrome. The ferritin levels measured have a direct correlation with the total amount of iron stored in the body including cases of anemia of chronic disease.
Normal blood levels are 30-300 ng/mL for males and 15-200 ng/mL for females.

Treatment
Patients with RLS and prominent anxiety symptoms may require treatment with an anxiolytic in addition to dopaminergic therapy for the RLS symptoms. The benzodiazepines have been used in the treatment of RLS. Their efficacy depends mostly on reducing insomnia, rather than managing the motor and sensory symptoms of RLS. These drugs may be useful in the management of RLS and anxiety, though there are concerns about the long-term use of these agents and patients require monitoring for dependency and declining efficacy.

Iron supplements - People with RLS should have their ferritin levels tested; ferritin levels should be at least 50 µg for those with RLS. Oral iron supplements, taken under a doctor's care, can increase ferritin levels. For some people, increasing ferritin will eliminate or reduce RLS symptoms. A ferritin level of 50 µg is not sufficient for some sufferers and increasing the level to 80 µg may greatly reduce symptoms. However, at least 40% of people will not notice any improvement. It is dangerous to take iron supplements without first having ferritin levels tested, as many people with RLS do not have low ferritin and taking iron when it is not called for can cause iron overload disorder, potentially a very dangerous condition.
RDA – 8 mg/day; UL 45 mg/day One used 200 mg ferrous sulfate 3 times per day, which equals 73.5 mg iron 3 times per day or 225 mg/day. An additional study used 7 mg of iron/day. They used iron succinylate or bisglycinate. During my 7 day test I used 22 mg/day.

Clonidine - Patients subjectively reported improvement in leg sensations and motor restlessness while receiving clonidine (0.05 mg/day). Sleep onset occurred faster with clonidine (12 minutes) compared with placebo (30 minutes) and baseline (47 minutes). Adverse findings with clonidine treatment included decreased REM sleep in the clonidine group (4%) compared with placebo (16%) and baseline (16%) and increased REM delay in the clonidine group (195 minutes) compared to the placebo (70 minutes) and baseline groups (89 minutes) There was a nonstatistical trend toward an increase in stage 3 and 4 sleep and a decrease in motor activity. Clonidine may be an effective treatment for RLS patients who don't have large numbers of sleep-disrupting periodic limb movements but have delayed sleep onset due to leg sensations.
An additional double-blind study was conducted in 20 patients with renal failure and symptoms of restless legs. 10 patients were treated with 0.075 mg clonidine twice daily and 10 received placebo. Three days after starting therapy. the clonidine-treated group complete relief of symptoms was noted in 9 out of 10 patients.

Gabapentin - Gabapentin, an analog of gamma-aminobutyric acid, was compared with L-dopa in a small, open-label study involving patients with RLS secondary to renal disease. After 4 weeks, both treatments improved the symptoms of RLS. Gabapentin produced significant improvements compared with baseline on three of the eight SF-36 domains. Gabapentin produced adverse events of malaise (feeling bad) and somnolence (drowsiness); but resulted in no patient withdrawal.

Magnesium/Calcium– RDA 400 mg/day Serum levels should be between .7 and 1 mmoles/L. Studies used 400 – 800 mg/day. (avg. 600 mg/day; 6 tablets)
Studies recommend using 600 to 1,000 mg calcium with the magnesium. (800 mg/day avg.)
Amino acid chelated magnesium is the easiest to absorb and has little to no effect on the stomach.

Folic Acid – Recommended to be taken, no medical research to back this. Use folic acid at 4 – 10 mg/day. Currently using 0.4 mg/day.

[TryinginFL]

I also suffer with RLS and have for about 30 yrs...Taking Ropinirole as it seems to work quite well..  Had been taking Carbidopa-Levodopa, but after years it finally pooped out.

 

Some nights (even after having taken my med, I will wake up in the middle of the night) I seem to have RLS all over my body - it is horrible to say the least.  At this point, I have to take another dose and stay up for about 45 minutes as it takes that long to go into effect.  

 

Getting old sure isn't for the faint of heart....

[bronxbomber]

Hi Trying, thanks for chiming in. I too have been taking ropinarole for a long time, and never try to get to sleep without it.

However, a friend of mine recently had her ropinarole stop working, and she had to move to a more powerful and costly drug.

I am wondering whether its cause is vitamin/mineral deficiency. I will be getting a blood test fairly soon, and I'll pay close attention to my magnesium and iron levels, as well as to anything else that may contribute to RLS.

This is a problem which I will work after my C taper is successfully completed. I have a couple of months to go. So I shall continue to research it until after my annual physical in October.