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So what causes RLS? There are abundant theories, but no neat answers. Doctors who have studied it agree on one thing: The syndrome is complicated. It's even possible that some cases are related to metabolic, vascular or neurologic factors. Specialists have reported that RLS can be triggered, but not caused, by anemia, circulatory problems, diabetes, alcoholism, pregnancy, antidepressants, or diseases of the kidneys, nerves or muscles. Also mentioned, albeit less often, are caffeine, calcium channel blockers, folic acid deficiency, and iron deficiency. The condition tends to run in families, suggesting that susceptibility to it is genetic. Some researchers, like J. Steven Poceta, M.D., of the Scripps Clinic and Research Foundation in La Jolla, California, believe that "familial RLS cases are the worst. They tend to be more severe and less responsive to treatment." Lucky patients may experience remissions. As reported in a 1992 issue of the journal Sleep, "Sudden remissions, which may last for months or even years, are as difficult to explain as relapses, which also appear without any apparent reason." Prescription: difficult Prescribing treatment for RLS is usually a hit-or-miss proposition. A dozen different doctors, hearing a patient describe symptoms, might order a dozen different medications. Unfortunately the most commonly prescribed drugs have little or not effect: aspirin, ibuprofen and other pain-killers, sleeping pills, tranquilizers, muscle relaxants, antidepressants (some of which aggravate, or even cause symptoms), vitamin and mineral supplements, quinine, and allergy drugs. People have tried hypnosis, deep massage, acupuncture, thermal baths, meditation, and an alarming array of drugs. In desperation some turn to alcohol. The prescription drug of choice for people with severe RLS is Sinemet CR (a long-acting combination of L-dopa and carbidopa), normally used to treat Parkinson's disease. This does not imply any causal relationship between RLS and Parkinson's, but RLS often responds to medications that replace or simulate the neurotransmitter dopamine, the lack of which causes Parkinson's. Some doctors combine Sinemet with other dopamine-like drugs like Permax (pergolide) or Parlodel (bromocriptine) in an effort to avoid the daytime rebound Sinemet sometimes causes. Over the past year, more doctors have begun prescribing Permax alone. For mild cases, however, a physician might initially prescribe something in the benzodiazepine family, one of a group of medicines known as central nervous system depressants. The most favored benzodiazepine medication for RLS is Klonopin (clonazepam). A third category of drugs used for treatment is a combination of acetaminophen and narcotic analgesics, which include Tylenol III (codeine), Percocet (oxycodone), and Darvocet (propoxyphene). Some doctors hesitate to prescribe such drugs for fear patients will become addicted. But a study of their use for RLS, conducted by seven scientists for the journal Sleep, concluded as have other studies that they "can be successfully used long-term with little risk of addition." Some geriatricians, however, feel that older people should not use propoxyphene and warn that narcotics can cause side effects including constipation and difficulty urinating. Despite the myriad types of treatments, all the experts are in agreement on one point: A physician should monitor any medications taken for RLS. Every person reacts differently; a drug that creates no side effects in one patient could knock another for a loop. Further, older people tend to be more sensitive to all these drugs' side effects. Research continues Fortunately, more and more is being discovered about RLS and thanks not only to Guthrie and Wilson's work in the area but also to the proliferation of sleep- disorder centers. At the end of 1978 there were only three such centers in the U.S. accredited by the American Sleep Disorders Association. Ten years ago, at the end of 1984, there were 34. Today there are a whopping 258. And this year, for the first time, the scientific community afforded RLS major recognition when a two-hour symposium on the subject was a major part of the annual meeting of the Association of Professional Sleep Societies in Boston. The hunt continues for better treatment. Studies are also under way to determine whether or not circadian variability (biological rhythms) causes individuals to suffer more at night. Researchers are also delving into brain functions with PET (positron emission tomography) scanners to find out more about the role of neurotransmitters, dopamine in particular, on RLS. And specialists are looking for a genetic cause. If the * SLMR 2.1a * McLean Virginia USA Wed 02-01-95 6:10 pm --- * KMail 3.00y