Side Effect: Restless Leg Syndrome

What is Restless Leg Syndrome?

Restless leg syndrome is a condition where patients feel an uncontrollable urge to move their legs. Usually this is paired with uncomfortable sensations like tingling. The sensations typically occur at night or when resting, leading to difficulty falling or staying asleep.

What does Restless Leg Syndrome look like?

Restless leg syndrome can present in different ways, but most common symptoms include:

• Strong, uncontrollable urge to move legs to relieve comfort
• Sensations often described as crawling, creeping, tingling or itching deep within the legs
• Symptoms worsen at rest, especially particularly during periods of inactivity like sitting or lying down
• Moving the legs helps relieve discomfort, but the relief is short-lived

Patients may constantly adjust their leg position, shake the legs, or walk around to help alleviate symptoms temporarily. These movements help temporarily, but the symptoms often return when the legs are still again. Restless leg syndrome can significantly disrupt sleep, leading to fatigue and daytime drowsiness.

Who gets Restless Leg Syndrome?

Patients with cancer are at risk of getting restless leg syndrome because of several factors. Certain chemotherapies, iron deficiency from cancer or chemotherapy, or radiation treatment can contribute to its development. Restless leg syndrome can occur in all ages, but it is most common in middle-aged, older, and female adults. Additionally, some medicines or substances can increase risk or worsen symptoms including caffeine, nicotine, or alcohol.

How to prevent Restless Leg Syndrome

Preventing restless leg syndrome in patients with cancer might include ensuring adequate iron levels, managing medications that could be contributing, and promoting healthy sleep habits. Below are some tips to help prevent restless leg syndrome in patients with cancer:

• Maintain a healthy lifestyle with regular exercise, a balanced diet, and adequate sleep; avoid irritators like caffeine, nicotine, and alcohol close to bedtime
• Manage stress with medication, deep breathing exercises, engaging in relaxing activities
• Establish a bedtime routine like taking a warm bath, stretching
• Check current medications as certain medicines can make restless leg syndrome worse, some examples are listed below (including cancer regimens):
  
  • Selective serotonin reuptake inhibitors (SSRIs): fluoxetine (Prozac®), sertraline (Zoloft®)
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs): venlafaxine (Effexor®), duloxetine (Cymbalta®)
  • Tricyclic antidepressants (TCAs): amitriptyline (Elavil®)
  • Dopamine antagonists: metoclopramide (Reglan®)
  • Calcium channel blockers: nifedipine (Procardia®), diltiazem (Cardizem®)
  • Chemotherapy agents
    
    • Oral agents: capecitabine (Xeloda®), temozolomide (Temodar®)
    • IV agents: vincristine (Oncovin®), paclitaxel (Taxol®), cisplatin (Platinol®), carboplatin (Paraplatin®)
• Address underlying conditions that can worsen restless leg syndrome such iron deficiency, peripheral neuropathy (tingling in fingers and toes), kidney failure

How to treat Restless Leg Syndrome

Treatment of restless leg syndrome in patients with cancer involves a variety of approaches that focus on the cause rather than curing the condition. Some of the most common methods, techniques, and medications are:

• Lifestyle changes such as regular sleep schedule, avoiding caffeine and alcohol before bed
• Medications
  
  • Dopamine agonists:pramipexole (Mirapex®), ropinirole (Requip®), and rotigotine (Neupro®)
  • Neuropathy medicines: gabapentin (Neurontin®), pregabalin (Lyrica®)
  • Anti-seizure medications: levetiracetam (Keppra®),
  • Iron supplements (oral or intravenous)
  • Benzodiazeines:clonazepam (Klonopin®)
  • Low dose opioids (for severe cases only as a last resort):methadone (Dolophine®), oxycodone (OxyIR®)
• Compression socks
• Physical therapy
• Acupuncture, yoga, massages, and stretching
• Heat or cold therapy to the legs
• Managing underlying conditions:
  
  • Peripheral neuropathy
  • Kidney damage
  • Iron deficiency