Treatment for Willis-Ekbom Disease (WED)

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How to ease the awful urge to move

No matter what medical condition you have experienced, you will have undoubtedly discovered that there is an array of medical opinions, and even more medications, available to treat it. It can be a frustrating and expensive process trying to find a doctor that understands your condition as well as an effective drug. The treatment of WED is no different. Most practitioners will advise certain lifestyle changes to reduce the symptoms before prescribing medication. These changes include the usual suspects:

1) regular, moderate exercise to improve physical and mental health as well as maintain a healthy weight and

2) a healthy, balanced diet rich in vitamins (such as vitamin C and E) and minerals (such as folate and iron).

If lifestyle change does not bring relief then the next option is prescription medication. There are many forms of treatment available for Willis-Ekbom disease (AKA Restless Leg Syndrome). Before beginning any of these medications it is necessary to rule out underlying conditions that may be masquerading as WED/RLS such as Parkinson's disease, diabetes and rheumatoid arthritis. Additionally, WED/RLS can be caused by common chronic medications like anti-histamines, anti-depressants and anti-convulsants. If the guilty medication is stopped, then the WED/RLS symptoms should disappear. If the symptoms persist, despite lifestyle changes and ceasing chronic medications, then the greatest challenge is finding a prescription medication that works and keeps on working.

Augmentation is the term used to describe how the body gets used to chronic medication. Initially, a medication may be effective for 12 hours, however, after a three month period, it may only be effective for six hours. This results in taking higher and higher doses of the same medication to get satisfactory results. The higher the dose, the more likely there will be negative side effects such as excessive daytime sleepiness (EDS).

The International Restless Legs Syndrome Study Group (IRLSSG) set up a Task Force to review 61 research studies that looked at the effectiveness of medication in relieving the symptoms associated with WED/RLS. In January 2013, these results were published in the Journal of Sleep Medicine under the title: The long-term treatment of restless legs syndrome/Willis-Ekbom disease: evidence-based guidelines and clinical consensus best practice guidance: a report from the International Restless Leg Syndrome Study Group.

Here is a brief summary of the results but for the full report see the published journal article.

  • Pregabalin has been shown to be effective for up to one year
  • Pramipexole, ropinirole and rotigotine have been shown to be effective for up to 6 months of treatment
  • Other drugs that have been shown to have probable effectiveness from 1 - 5 years include: gabapentin; enacarbil; pramiexole and ropinrole; levadopa and rotigotine.
  • Other pharmacologic therapies have insufficient evidence to support their long-term use in treating RLS/WED.

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