Medications, restless legs

Restless-legs syndrome treatment involves suppression of abnormal sensations and leg movements and consolidation of sleep. Dopaminergic and sedative-hypnotic medications are prescribed commonly. 

Restless-legs syndrome occurs in 5% to 15% of the population, making it a common sleep disorder.11,12 The prevalence of RLS increases with age and in various medical conditions such as end-stage renal disease (ESRD), pregnancy, and iron deficiency.13 RLS appears to be more common in women than in men and has a genetic link. The majority of RLS patients (63% to 92%) report a positive family history.14... 

TABLE 38-3. Frequently Used Medications for Restless-Legs Syndrome49... 

Insomnia secondary to a general medical condition, especially with pain- or sleep-disordered breathing Circadian rhythm disturbance Periodic limb movement disorder Restless legs syndrome... 

Restless legs syndrome is a disorder characterized by restlessness of the legs during sleep. It also is treated with medication such as clonazepam, levodopa, per-golide, or bromocripfine. 

A sleep disorder that is not endogenous or due to a medical condition or substance-related condition is categorized as not otherwise specified. Restless leg syndrome and periodic limb movements are two sleep disturbances that do not meet criteria for any of the other sleep disorders. 

Pain is a ubiquitous consequence of a wide range of injuries, surgeries, and medical conditions as diverse as cancer, low-back pain, and restless leg syndrome (Ahmedzai et al. 2012 Cloutier et al. 2013 Trenkwalder et al. 2013). Both acute and chronic pain can be extremely debiUtating clinical conditions, and there is a constant need for analgesics in medical practice. 

Discontinuation of dopamine agonist therapy may cause dopamine agonist withdrawal syndrome, a severe, stereotyped cluster of physical and psychological symptoms that temporally correlate with dopamine agonist withdrawal and are refractory to levodopa and other neuropsychiatric medications. The withdrawal syndrome has only been reported in Parkinson s disease. Thus, it has been xmclear whether the withdrawal syndrome is specific to Parkinson s disease. A case in a patient with restless legs syndrome is presented for the first time. 

The original 1989 Prozac label, under the heading Adverse Reactions of the Nervous System, mentions akathisia as infrequent. However, in the September 1989 issue of the Journal of Clinical Psychiatry, Joseph Lipinski et al. from McLean Hospital and Harvard Medical School described five cases of Prozac-induced akathisia, which they believed occurred fairly frequently. They estimated the rate of akathisia in Prozac patients at between 9.7% and 25%. They stated that their cases were indistinguishable from neuroleptic-induced akathisia. In a case example, 5 days after starting Prozac, one woman reported severe anxiety and restlessness. She paced the floor throughout the day, found sleep at night difficult because of the restlessness, and constantly shifted her legs when seated. ... 

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