Treating Restless Legs Syndrome (RLS)

Whether you're grappling with primary or secondary restless legs syndrome (RLS), understanding the various management strategies available is essential for effectively addressing this condition. From lifestyle adjustments to medical interventions, finding the right combination of treatments can significantly mitigate the impact of RLS. But before we talk about how to alleviate the symptoms that come with RLS, let’s understand how RLS develops. 

Factors Contributing to RLS 

Two key factors play a prominent role in the development of RLS: brain iron deficiency and abnormalities in dopamine signalling. Iron deficiency in the brain disrupts the production and regulation of dopamine, a neurotransmitter crucial for motor control and movement. This deficiency impairs the function of dopamine receptors, leading to dysregulation of neuronal pathways involved in motor activity. Additionally, abnormalities in dopamine signalling pathways contribute to the sensory symptoms experienced in RLS, such as discomfort in the legs that prompts the urge to move. The interplay between iron deficiency and dopamine dysfunction highlights the importance of addressing both factors in RLS management and treatment.

Common RLS Treatments 

Common treatments for RLS encompass a variety of pharmaceutical options targeting different aspects of the condition. Dopaminergic drugs, including pramipexole, ropinirole, and rotigotine, are USFDA-approved medications that act on dopamine receptors in the brain, effectively alleviating symptoms of moderate to severe RLS by restoring dopamine balance. In some cases, carbidopa/levodopa (Sinemet), primarily used for Parkinson's Disease, may be prescribed to manage RLS. Benzodiazepines, although not directly addressing the underlying cause of RLS, can aid in improving sleep quality by inducing sedation; however, they may lead to daytime drowsiness as a side effect. Additionally, pain relievers and anticonvulsant or anti-seizure drugs like carbamazepine (Tegretol), gabapentin (Neurontin), gabapentin enacarbil (Horizant), and pregabalin (Lyrica) may be considered for RLS treatment. 

RLS Treatment Limitations

Despite the effectiveness of common medications in managing RLS, there are notable limitations to their long-term use. The recommendations developed by the International Restless Legs Syndrome Study Group (IRLSSG) provide valuable insights into the duration of effectiveness for various medications used in RLS treatment. While pregabalin demonstrates effectiveness for up to a year, dopamine agonists such as ropinirole, pramipexole, and rotigotine show efficacy for only up to six months. Gabapentin enacarbil, levodopa, and rotigotine exhibit probable effectiveness for durations ranging between one and five years. However, medications like pergolide and cabergoline have been sidelined due to safety concerns. Additionally, despite the potential of combination therapy with dopamine agonists, anticonvulsants, and opiates to provide relief for many patients, a subset may either not respond adequately or experience significant side effects, such as poor impulse control or augmentation (defined as the worsening of RLS symptoms). 

Alternative Treatments for RLS

A recent study revealed that patients with RLS exhibit heightened excitability in nerve cells within their legs. This finding suggests a novel approach to understanding the neurological basis of RLS and offers promising avenues for future research and treatment development. It argues that while dopaminergic agents are currently the mainstay treatment for RLS, modulating the excitability of neurons could offer greater therapeutic benefits once safe medications become more widely available.

CBD and RLS

Emerging research indicates a potential relationship between CBD (cannabidiol) and RLS symptoms. Early studies suggest that CBD may effectively reduce the frequency of abnormal nerve firings that underlie the involuntary muscle twitching characteristic of RLS. Many patients have reported positive experiences with CBD in alleviating RLS symptoms, yet these findings predominantly rely on self-reported accounts. As such, further rigorous research is necessary to substantiate CBD's efficacy as a viable treatment option for RLS. While these preliminary findings are promising, additional clinical trials are needed to fully understand the therapeutic potential of CBD in managing RLS and to establish evidence-based guidelines for its use.

Let’s understand how CBD might alleviate RLS via the Endocannabinoid System (ECS). The ECS comprises various receptors, including cannabinoid type 1 (CB1R) and type 2 (CB2R) receptors, as well as endogenous cannabinoid ligands such as anandamide and 2-AG. CB1 receptors are distributed throughout the nervous system and are believed to play a role in inducing a sense of painlessness by inhibiting neurotransmitter release and neuronal excitability. Additionally, cannabinoids like CBD have been found to help reduce anxiety and modulate dopamine synthesis. These interactions within the endocannabinoid system contribute to CBD's potential effectiveness in managing RLS symptoms by influencing neurotransmitter activity and neuronal excitability. 

Further, CBD has shown potential in improving the quality of life for RLS patients by alleviating symptoms such as involuntary muscle movements, discomfort, and restlessness. Additionally, CBD's ability to improve sleep quality is particularly beneficial for RLS sufferers, who often experience disruptions in their sleep patterns. Research suggests that CBD can effectively reduce anxiety, a common co-occurring symptom in RLS patients, thus promoting a sense of calm and relaxation.

The Ayurvedic Perspective 

According to Ayurveda, RLS doesn't have a specific disease name, but its symptoms align with imbalances in the Vata dosha. In Ayurvedic principles, all movements in the body are governed by Vata dosha, and RLS symptoms, such as jerking or shaking movements, correlate with increased Vata. The affected site, in RLS is considered to be Vaatika, mainly affecting the hip and lower limbs. Ayurveda also considers factors like dhaatu kshaya, which refers to degeneration, and aavarana, or obstruction to channels in the body, as contributing factors to RLS. Thus, from an Ayurvedic perspective, managing RLS involves balancing Vata dosha and addressing factors like degeneration and obstruction to restore harmony and alleviate symptoms.

Addressing RLS necessitates a comprehensive understanding of its multifaceted nature and the diverse treatment options available. From conventional pharmacological interventions to emerging alternatives like CBD, the aim is to alleviate symptoms and enhance quality of life for those affected. Recent insights into nerve cell excitability and the potential benefits of CBD suggest promising avenues for future treatment development. Moreover, considering RLS from an Ayurvedic perspective provides additional insights into its management, emphasizing the importance of restoring balance within the body's natural systems. Our full-spectrum cannabinoid medications - Shunyata - incorporates modern pharmacology with approaches of Ayurveda in clinical management to help give you lasting symptom relief.