Anti-epileptics and Restless Legs

Earlier I wrote about antiepileptics in connection with restless legs. Anticonvulsants are an alternative to dopamine agonists.

A major drawback of dopamine agonists is that 50 to 80% of users experience augmentation. With augmentation, your complaints worsen and you need more and more of the medicine to have an effect.

Antiepileptics can also have unpleasant side effects. There are probably no medicines that are only beneficial for everyone.

In this blog I will once again discuss what antiepileptics are and what their effectiveness is for restless legs.

What are anti-epileptics

As the name implies, antiepileptics are originally intended to prevent epileptic seizures. They also work against (nerve) pain. This is because the medication makes brain cells less sensitive to stimuli.

There are different types of epilepsy. The right variant and dosage of the medicine is tailored to each person. Antiepileptic drugs should be built up gradually, starting with a low dose. This determines when they work.

Pregabalin and gabapentin are antiepileptic drugs that are often prescribed for pain. They are available as a tablet. It often takes several days or weeks for them to take effect. The slow increase has the additional advantage of reducing the risk of side effects.

Common side effects are dizziness, drowsiness, concentration problems, fatigue and double vision. They usually pass over time. You may not drive or otherwise participate in motorized traffic for at least the first two weeks after starting antiepileptics.

It is better not to use antiepileptics during pregnancy or while breastfeeding.

Restless legs

With RLS you usually don’t experience so much pain. Some peers, however, describe it that way. Antiepileptic drugs act on the signal transmission between nerve cells. The stimuli that cause the unpleasant feeling in restless legs are passed on less strongly by this medication.

I understand from fellow sufferers that it differs per person whether anti-epileptics work. They are usually used as a replacement for dopamine agonists such as ropinirole or pramipexole. Over time, this medication can cause augmentation.

Not everyone responds well to anticonvulsants. Side effects can be so intense that the benefits do not outweigh the disadvantages. For others, the effect in itself is insufficient to continue.

There is also a group for whom antiepileptics do work well. In this group, the RLS is therefore more manageable and the side effects are not too bad. Should this change over time, the reduction of antiepileptic drugs should take place gradually. Preferably under the supervision of an empathetic, knowledgeable doctor.

1 thought on “Anti-epileptics and Restless Legs”

  1. 16 AUG 2023
    Ben bezig over te stappen van 15 jaar (2008-2023) Pramipexol naar Pregabaline.
    Sinds 2018 klachten (langzaam groeiend naar extreme pijn bovenbenen, later bovenarmen erbij, weer later duizeligheid en hoofdpijn).

    Twee weken geleden op eigen houtje (gelezen in bijsluiter en ergens op internet dat dat kon) gestopt (Zat op MAX (3×0,18mg=0,54mg base));
    als sneeuw vvor de zon pijn, vermoeid, duizelig en hoofdpijn binnen dag weg; besloten EXIT Pramipexol.
    Rusteloze benen kwamen (zaoals te verwachten) terug. Van lieverlee toch maar weer Pramipexol gaan gebruiken’; met 1½ (1½x0,18 mg) boel weer onder ‘controle’
    GEEN rusteloze benen meer, wel weer pijn en vermoeidheid, maar duizeligheid en hoofdpijn waren weg (eigenlijk wel vreemd dat ik met ‘slechts’ 1½ tablet toch ook geen rusteloze benen meer had, terwijl daar 2 weken geleden 3 tebletten voor nodig waren?).
    Met neurologe/somnologe besloten Pregabaline te gaan gebruiken; stapsgewijs Pramipexol ‘eruit doseren’. Beginnen met 1 tablet Pregabaline (75 mg) aan dagdosering toevoegen en dan de komende dagen Pramipexol afbouwen (in kleine stapjes) tot 0.
    Deze eerste nacht al tóch weer rusteloze benen, duizelgheid en hoofdpijn. Te grote stappen in afbouwen Pramipexol, teken dat Pregabaline geen goed idee is, of met Pregabaline zich eerst maar ‘ns settle-n?

    Help, wat moet ik doen?

    Reply

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