A Promising New RLS Treatment: The 'Relaxis' Pad
Restless leg syndrome is a common cause of disordered sleep. Current therapy is most commonly pharmacologic agents which boost dopamine, but this week, a non-pharmacologic vibrating pad was given the green light by the FDA and will likely be available later this year.
For some, sleep is an enigma, a code to be broken every night. Often times, the process of code-breaking digs the hole even deeper. Poor sleep, in-turn, leads to fatigue, depression and/or chronic diseases like diabetes and high blood pressure. It's even been linked to increased accidental fatality and premature death in general.
As a doctor, detecting any identifiable cause of poor sleep is important, especially if it is treatable. One such cause is restless leg syndrome (RLS).
What is RLS?
Simply, restless leg syndrome is a condition of discomfort in the lower limbs often accompanied by a compulsion to move them. Often, this problem is more noticeable at night when settling into sleep.
Moving the legs by walking, shaking, jiggling or thrashing temporarily improves the perceived discomfort and need to move (much like an itch). Often times, the symptoms persist into sleep and disturb not only the sleep of the individual but also any one sharing the bed. This involuntary movement is known as periodic limb movement disorder (PLMD) and is considered a common aspect of RLS. Because the nights are so full of activity, daytime fatigue or tiredness is one of the most common resulting symptoms. RLS symptoms also include a creepy/crawly sensation described in the legs. Some also describe it as throbbing, painful or burning in sensation.
For some, the sensations are difficult to put into words and they exist thinking that they are the only one with this bizarre syndrome. Diagnosis in and of itself for these people is a relief.
Causes of RLS
Research up until recently had led to the belief that the root cause of RLS is found in the brain. This is mostly a conclusion based on the findings that the syndrome is caused by a deficiency of the neurohormone dopamine. Dopamine-boosting drugs, primarily used for Parkinson's Disease and thought to act solely on the brain proved to be effective in treating symptoms. Most recently, however, this month in fact, a study was published in the Journal of Neurology supporting the notion that the root of the problem may actually lie in the legs. In the study, RLS subjects were found to have low levels of oxygen in the tissues of their legs relative to healthy controls. Dopamine-boosting drugs caused normalizing of tissue oxygen levels correlating with relief of symptoms. (1) Thus, the notion of the brain deficiency of dopamine is being challenged by the possibility that a dopamine-mediated peripheral oxygen deficiency is behind RLS symptoms.
Before pharmaceutical products, the old stand-by treatment for RLS, or "Jimmy legs" as it was called, was tonic water. Back then, true tonic contained the chemical compound quinine. Quinine, also used in the past to treat malaria, was only marginally effective and prone to side effects/interactions. The staple for treatment of RLS currently are the dopamine-raising Parkinson's drugs. They have been shown to be effective and are relatively well-tolerated, though other drugs which are occasionally used include muscle relaxers, sedatives and pain medications. These drugs are marginally effective and carry an addictive potential.
This week the Food and Drug Administration (FDA) approved the first device to be used in the treatment of RLS. The device, called Relaxis, is a flat pad which provides vibrations as counter-stimulation to the legs. The goal of this counter-stimulation is to alleviate the need to move and allow for the initiation and maintenance of sleep. The pad reduces the counter-stimulation with time and eventually shuts off. In preliminary studies, the device was shown to improve sleep quality in patients with RLS. It is projected that Relaxis will be available with prescription in late 2014.