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I have been diagnosed with restless legs and prescribed

I have been diagnosed...

I have been diagnosed with restless legs and prescribed sinemet 100/25 six times a day. Even with this dosage I am exhausted from the leg attacks I have during the day and night. I am not comfortable with this diagnosis.

Doctor's Assistant: What seems to make the symptoms worse or better? Have you noticed any swelling?

I do not have swelling. My spine and hips are deteiorating so I have a hard time to walk and can only stand on spot for about ten minutes at a time.

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

High blood pressure,reflux,minimal diabetes- controlled by diet, austro arthritis, some other bone disorders that I can't spell == one I take Risedronate once a week for and the other Is diagnosed by having 18 out of 22 sore spots on your body. I'm tired all the time even though I take a large amount of vitamins suggested by my doctor.

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Answered in 1 minute by:
3/27/2018
drphophalia
Category: Neurology
Satisfied Customers: 38,757
Experience: Regularly deal with musculoskeletal neurology, spinal issues, bowel and bladder dysfunctions etc.
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Welcome to Just Answer.
Answers here are for education and information.
I will respond shortly with an answer, or further information request.

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What is your age and gender?

What did MRI of the spine, nerve conduction velocity study (NCV) and electromyography (EMG) show?

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Customer reply replied 3 months ago
I am a 71 year old female. I had an MRI of my spine some years ago to check the deterioration of my spine from austio arthritis but if so not believe that I have had a NCV or EMG. I am from New Brunswick Canada and our health system is broken. I have been waiting for two years for an appointment with a neurologist and I don't really think I will get one. When I have a leg attack it is usually on the right or the left = not usually on both sides at once. It seems lately, before an attack comes, I get a mild headache and my left arm twitches and jerks. My walking has become very impeded. I now can only walk about fifty feet and I have to sit and rest. I do not get more than four hours of sleep a night and sometimes I have a chance to sleep for about an hour during the day. My life is ruled by my legs.

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Restless Leg Syndrome can develop as a result of certain conditions, particularly iron deficiency and peripheral neuropathy. Other causes of RLS are folate or magnesium deficiency, amyloidosis, diabetes mellitus, lumbosacral radiculopathy, or vitamin B-12 deficiency. Following investigations are advised;

1) A complete iron panel including iron levels, ferritin, transferrin saturation, and total iron binding capacity.
2) BUN,
3) creatinine,
4) magnesium,
5) thyroid-stimulating hormone (TSH),
6) vitamin B-12, and folate.

7) NCV and EMG

8) MRI of spine

These investigation results will help to treat the primary problem so symptoms are benefited.

Following measures usually are helpful;

1) Avoidance of caffeine, alcohol, or nicotine (if one takes them).
2) Exercise before the bed time
3) Medications
a) Pramipexole (Mirapex)
b) Ropinirole hydrochloride (Requip).

Following treatment approaches are recommended, if present medications are not helping:

1) Change to gabapentin

2) Adding a second medicine like gabapentin, a benzodiazepines, or an opioid

3) Change to a high potency opioid or tramadol

In addition to above non pharmacologic therapy comprises of the following components:

1) Iron replacement therapy

2) Mental alerting activities such as video games or crossword puzzles, may reduce symptoms at times of boredom.

Wishing you a speedy recovery.

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Customer reply replied 3 months ago
I have cut out caffeine about seven months ago and alcohol thirty five years ago. I still smoke. I have taken Mirapex and gabapentin and replaced it with the sinemet 100/25 six times a day. I also take oxycodone which is prescribed four time a day but I do not find it helps so I don't usually take the oxycodone. Since I came off the Fentenyl patch 75mcg two years ago, the oxys are very mild. I do cross word puzzles and read a lot. I am not usually bored but frustrated that I cannot do things that I've done all my life. I question the restless leg diagnosis because of the prescribed six Sinemet a day. Also I have all the symptoms of pure HSP (hereditary spastic paraplegia) especially since my legs get weaker and weaker and my standing and walking get worse by the week.

I agree with you, that your diagnosis of RLS may not be right. This need further thorough investigative work up.

A concomitant neuropathy may be looked into, also.

Following investigations should be done by your primary care physician or a neurologist;

1) Electromyography/nerve conduction studies (EMG/NCS)

2) MRI of the spine and brain

3) blood glucose, glucose tolerance test and glycosylated hemoglobin

4) serum B12 level with methylmalonic acid (with or without homocysteine),

5) serum protein electrophoresis

6) Anti-nuclear antibody

7) Lyme testing

8) Rheumatoid factor

9) Sjogren's syndrome testing (Anti-Ro, Anti-La Antibodies)

Skin and nerve biopsy may be recommended after the results of these investigations.

This should give the diagnosis and guidelines for the management.

Following are the causes of neuropathy;

1) Diabetes

2) An underactive thyroid gland

3) Excessive use of alcohol

4) Thiamine deficiency

5) Vitamin B 12 deficiency (pernicious anemia)

6) Vitamin B 6 (pyridoxine) taken in excessive amounts

7) Drugs, medications, herbs

8) Autoimmune diseases

9) Heavy metals such as lead and mercury.

It is privilege assisting you.

drphophalia
Category: Neurology
Satisfied Customers: 38,757
Experience: Regularly deal with musculoskeletal neurology, spinal issues, bowel and bladder dysfunctions etc.
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