Ask an Expert: Parkinson's & restless leg syndrome

Parkinson's Disease

Parkinson's & restless leg syndrome
12/15/2006

Question:

Got RLS in 1998 followed by peripheral neuropathy in 1999. Present treatment is Limbitrol DS. My current neurologist says Amitrip/CDP (generic) assists the nerves in recovering or assists the communication between them. Second opinion neurologist does not believe this and recommends Lyrica. He also says PN does not lead to Parkinsons but RLS may. My father got Parkinsons late in life. How do I distinguish risks from RLS from PN?

Answer:

The majority of cases of restless legs syndrome (RLS) are idiopathic (no identifiable cause). However, there are certain medical conditions that can predispose someone to developing RLS.
Some of the more common conditions that increase risk of RLS include:

pregnancy
osteoarthritis
varicose veins
diabetes
iron deficiency anemia
fibromyalgia
rheumatoid arthritis
peripheral neuropathy
kidney disease
and Parkinson's disease

People with Parkinson's disease (PD) can often experience symptoms of restless leg syndrome, but there is no evidence to suggest that RLS causes PD. With regards to peripheral neuropathy, the symptoms of RLS may be an early manifestation prior to finding the actual etiology of the peripheral neuropathy.
In addition, certain medications can cause or exacerbate symptoms of RLS. These include certain anti-nausea, anti-seizure, antipsychotic, and cold/allergy drugs. Other agents that can also aggravate symptoms of RLS include caffeine, alcohol, and tobacco. Often, the elimination of these such agents may help alleviate RLS symptoms.
There are a far greater number of potential risks and causes for peripheral neuropathy. Given the multitude of causes, a person experiencing symptoms of peripheral neuropathy should seek medical attention for an individualized evaluation. There is no evidence to support that peripheral neuropathy causes or leads to Parkinson's disease. However, as discussed above peripheral neuropathy can increase risk of developing symptoms of RLS. Some of the more common causes of peripheral neuropathy include:

Systemic or metabolic disorders:

Diabetes (diabetic neuropathy)
Vitamin deficiencies (vitamin B12)
Excessive alcohol use (alcoholic neuropathy)
Kidney disease (Uremia)
Cancer

Infectious or inflammatory conditions:

HIV or AIDS
Hepatitis
Diptheria
Guillain-Barre syndrome
Leprosy
Lyme disease
Polyarteritis nodosa
Rheumatoid arthritis
Sarcoidosis
Sjogren syndrome
Syphilis
Lupus
Amyloidosis

Exposure to toxic compounds:

Sniffing glue or other toxic compounds
Nitrous oxide
Industrial agents -- especially solvents
Heavy metals (lead, arsenic, mercury, etc.)

Prolonged exposure to certain medications:

Heart or blood pressure medications:

Amiodarone
Hydralazine
Perhexiline

Cholesterol lowering mediations:

Lovastatin
Indapamid
Gemfibrozil

Cancer fighting medications:

Vincristine
Cisplatin

Medications to fight infections:

Metronidazole
Nitrofurantoin
Thalidomide
Isoniazid
Dapsone
Zidovudine
Didanosine
Stavudine
Zalcitabine
Ritonavir
Amprenavir

Other medications:

Phenytoin
Disulfiram

Decreased oxygen and blood flow

Trauma or prolonged exposure to cold temperature

Hopefully, this answer helps you identify certain risks associated with both peripheral neuropathy and RLS.

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Response by:

Punit Agrawal, DO
Assistant Professor of Neurology
College of Medicine
The Ohio State University