High-Dose Clonidine in a Case of Restless Legs Syndrome

Abstract

Spanish

French

OBJECTIVE:

To describe a patient with idiopathic restless legs syndrome (RLS).

CASE SUMMARY:

A 37-year-old man developed severe symptoms of RLS. Treatment using combinations of levodopa, opioids, benzodiazepines, and baclofen provided only partial benefit or resulted in intolerable adverse effects. Higher dosages of clonidine than previously reported in the literature (0.9 mg/d in divided doses) were needed to completely relieve his RLS symptoms. The only prominent adverse effect was dry mouth. The RLS symptoms returned after subsequent reductions in the dosage. After the dosage of clonidine was again increased, complete relief of the symptoms was achieved again. After several months, clonidine was tapered to zero and the patient entered a period of spontaneous remission. When his symptoms returned four months after clonidine had been discontinued, clonidine therapy was restarted.

DISCUSSION:

Clonidine alleviated RLS symptoms in 30 of 41 patients reported in the literature, indicating that the adrenergic nervous system may playa role in RLS.

CONCLUSIONS:

High-dose clonidine appears to be useful in treating RLS when other therapies fail. However, well-controlled, polysomnographic studies are needed.

Get full access to this article

View all access options for this article.

References

Walters

Hening

. Clinical presentation and neuropharmacology of restless legs syndrome. Clin Neuropharmacol 1987; 10: 225–37.

Banerji

Hurwitz

. Restless legs syndrome, with particular reference to its occurrence after gastric surgery. Br Med J 1970; 4: 774–5.

Gorman

Dyck

Pearson

. Symptom of restless legs. Arch Intern Med 1965; 15: 155–60.

Walters

Hening

Chokroverty

. Review and videotape recognition of idiopathic restless legs syndrome. Mov Disord 1991; 6: 105–10.

Walters

Hening

Chokroverty

. Frequent occurrence of myoclonus while awake and at rest, body rocking and marching in place in a subpopulation of patients with restless legs syndrome. Acta Neurol Scand 1988; 77: 418–21.

Harvey

. Cholesterol crystal microembolization: A cause of the restless leg syndrome. South Med J 1976; 69: 269–72.

Nordlander

. Therapy in restless legs. Acta Med Scand 1953; 145: 453–7.

Lutz

. Restless legs, anxiety and caffeinism. J Clin Psychiatry 1978; 39: 693–8.

Lugaresi

Cirignotta

Coccagna

Montagna

. Nocturnal myoclonus and restless legs syndrome. In: Fahn

Marsden

Van Woert

, eds. Myoclonus. New York: Raven Press; 1986: 295–307.

10.

Coleman

Pollak

Weitzman

. Periodic movements in sleep (nocturnal myoclonus): Relation to sleep disorders. Ann Neurol 1980; 8: 416–21.

11.

Walters

Hening

Rubenstein

Chokroverty

. A clinical and polysomnographic comparison of neuroleptic-induced akathisia and the idiopathic restless legs syndrome. Sleep 1991; 14: 339–45.

12.

Sandyk

Bernick

Lee

Stern

Iacono

Bamford

. L-dopa in uremic restless legs syndrome. Int J Neurosci 1987; 35: 233–5.

13.

Hening

Walters

Kavey

Gidro-Frank

Cote

Fahn

. Dyskinesias while awake and periodic movements in sleep in restless legs syndrome: Treatment with opioids. Neurology 1986; 36: 1363–6.

14.

Brodeur

Montplaisir

Godbout

Marinier

. Treatment of restless legs syndrome and periodic movements during sleep with l-dopa: A double-blind, controlled study. Neurology 1988; 38: 1845–8.

15.

Walters

Wagner

Hening

Grasing

Mills

Chokroverty

Successful treatment of idiopathic RLS in a randomized, double-blind trial of oxycodone versus placebo. Sleep 1993; 16: 327–32.

16.

Handwerker

Palmer

. Clonidine in the treatment of restless leg syndrome. N Engl J Med 1985; 313: 1228–9.

17.

Steiner

. Clonidine helps in restless legs syndrome (abstract). Neurology 1987; 37 (suppl 1):278.

18.

Bastani

Westervelt

. Letter. Am J Kidney Dis 1987; 4: 326–7.

19.

Ancoli-Israel

Seifert

Lemon

. Thermal biofeedback and periodic movements in sleep: Patients' subjective reports and a case study. Biofeedback Self Regul 1986; 11: 177–88.

20.

Ware

Blumoff

Pittard

. Peripheral vasoconstriction in patients with sleep related period leg movements. Sleep 1988; 11: 182–7.

21.

Watanabe

Ono

Naito

. Periodic leg movements during either epidural or spinal anesthesia in an elderly man without sleep related (nocturnal) myoclonus. Sleep 1990; 13: 262–6.

22.

Uchihara

Ichikawa

Furukawa

Tsukagoshi

. Myoclonus with burning sensation in legs that remits with sympathetic blockade. J Neurol Sci 1990; 100: 161–4.

23.

Langer

Cavero

Massingham

. Recent development in noradrenergic neurotransmission and its relevance to the mechanism of action of certain antihypertensive agents. Hypertension 1980; 2: 372–82.

24.

Ausserwinkler

Schmidt

. Erfolgreiche Behandlung des (restless legs)-Syndroms bei chronischer Niereninsuffizienz mit clonidin. Schweiz Med Wochenschr 1989; 119: 184–6.

25.

Bamford

Sandyk

. Failure of clonidine to ameliorate the symptoms of restless legs syndrome. Sleep 1987; 10: 398–9.

26.

Lechin

van der Dijs

Insausti

C L

Gomez

Villa

Lechin

Pharmacomanometric studies of colonic motility as a guide to the chemotherapy of schizophrenia. J Clin Pharmacol 1980; 20: 664–71.