By Ellen Feldman, MD

Altru Health System, Grand Forks, ND

Dr. Feldman reports no financial relationships relevant to this field of study.

SYNOPSIS: Medical evidence supports the use of physical activity and iron supplementation (for those with low serum ferritin) in patients presenting with restless legs syndrome.

SOURCE: Bega D, Malkani R. Alternative treatment for restless legs syndrome: An overview of the evidence for mind-body interventions, lifestyle interventions, and neutraceuticals. Sleep Med 2016;17:99-105.

Restless legs syndrome (RLS) is a neurologic disorder occurring in 10-40% of adults. An uncomfortable sensation to move limbs while at rest and relief from symptoms with movement is pathognomonic of RLS; treatment is not as clear-cut. Use of conventional agents, such as benzodiazepines, dopamine agonists, and anticonvulsants, often result in side effects and moderate efficacy. RLS disrupts sleep, increases daytime fatigue, and thereby affects quality of life; many patients turn to integrative medicine for answers.

Bega and Malkani summarized and analyzed clinical trials involving non-conventional treatments for RLS. Reliable data support the following:

  1. Increase physical activity to address RLS symptoms. The type and duration of activity and mechanism of action all need further study. Aerobic exercise with resistance training focused on lower limbs seems to be the most promising intervention in this category.
  2. Supplement with oral iron for patients suffering from RLS who present with low serum ferritin levels (< 40-50 ng/mL) with or without anemia. Additional studies are needed to identify iron formulations and optimal duration of treatment. Oral iron supplements (typically 325 mg ferrous sulfate two times per day with vitamin C) can cause constipation; more concerning is the risk of anaphylaxis with infused iron. Dietary intervention to increase serum ferritin levels is not well studied in the treatment of RLS.
  3. Consider supplementation with vitamins E, C, and D. Data are unclear if levels should be checked routinely in RLS. One study compared 400 mg vitamin E, 200 mg vitamin C, and a combination of the two with placebo in hemodialysis patients with RLS. Although results look impressive for each intervention arm, short duration of the study and a limited number of participants leave clinicians with few conclusive recommendations.

Preliminary but non-conclusive studies on the following interventions warrant further investigation: yoga, acupuncture, compression devices, light therapy, cognitive therapy, valerian, and Chinese herbs.

CONCLUSION

Well-designed, robust, randomized, controlled trials are needed to better understand the role of alternative treatments and integrative techniques in caring for patients suffering from RLS. The interventions currently supported by sufficient numbers of valid medical studies are physical activity (especially aerobic exercise with lower limb resistance training) and supplemental iron when serum ferritin is low. Several other interventions show promise; future studies should clarify the role of these non-pharmaceuticals in treatment of RLS.