Restless legs and Parkinson’s: the link thickens

When you smell freshly baked cookies or get a good hug from a friend, the “feel-good” chemical, dopamine, is released in your brain.

Without dopamine, you wouldn’t take much pleasure from those wonderful sensory experiences.

But dopamine is more than just our “feel-good” chemical. It regulates all of our voluntary movements.

Without dopamine, you couldn’t pick up a pencil or walk across the room without stumbling.

It’s no surprise then that the rigidity and tremors of Parkinson’s disease (PD) are associated with a malfunction in the brain’s dopaminergic system.

But there’s another, more benign neurological condition with a dopamine connection that, if left untreated, might just be the gateway to Parkinson’s disease.

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Untreated restless legs may increase Parkinson’s risk

It starts with a throbbing, itching or uncomfortable sensation in the legs and an overwhelming need to move them. Shifting the legs temporarily relieves the discomfort, but the symptoms soon return.

And the symptoms often come at the worst possible time — at night, when you’re trying to sleep. But sleep isn’t the only concerning thing about restless legs syndrome (RLS).

RLS is a common condition affecting up to 10% of Americans, with women and older adults most affected. But it also commonly plagues people with PD. Both conditions are associated with dysfunction in the brain’s dopaminergic system, and researchers have long suspected a link.

And now, researchers from the Korea University Ansan Hospital, Pohang Stroke and Spine Hospital, and the National Health Insurance Service Ilsan Hospital, Republic of Korea, have clarified that the link between RLS and PD is much more than an overlap of symptoms.

Their research spanned 15 years and followed 9,919 individuals with RLS, comparing them with an equal number of participants without the condition, making up a control group.

During the study, 1.6% of RLS patients developed PD, compared with 1.0% of controls, confirming a heightened risk. But when analyzed by treatment status, there was a striking divergence…

Patients with untreated RLS showed the highest PD incidence — 2.1% — and earlier disease onset. In contrast, the patients treated with dopamine-agonist (DA) therapy showed a markedly lower incidence of PD (0.5%) and a delayed onset compared with controls.

According to the lead researcher, Prof. Jong Hun Kim from the Department of Neurology, Korea University Ansan Hospital, “This dual pattern underscores the importance of recognizing and managing restless legs syndrome early. Monitoring and treating RLS may not only improve sleep quality but could also influence long-term neurological health.”

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Help for restless legs and more

Prof. Jong Hun Kim’s team also suggests that other factors, such as sleep disruption, iron deficiency, and immune or metabolic pathways, may contribute to the association between RLS and PD.

They also note that the protective trend observed with DA therapy could reflect neuroprotective mechanisms or improved identification of genuine RLS cases that are distinct from early-stage PD.

Lifestyle changes and activities may provide some relief from RLS. These include:

• Avoiding or decreasing the use of alcohol, nicotine and caffeine.
• Maintaining a regular sleep schedule.
• Exercising moderately and consistently.
• Massaging the legs or taking a warm bath.
• Applying a heating pad or ice pack.
• Using foot wraps specially designed for people with RLS, or vibration pads on the back of the legs.

A few studies have associated low vitamin D levels with the condition. One led researchers to conclude that “The serum VitD level is generally lower in patients with RLS than in healthy people, and lower serum VitD level is associated with more severe symptoms of RLS, worse quality of sleep and worse depression.”

But if RLS symptoms are consistent despite these efforts, your doctor may want you to consider medication, including:

• Anti-seizure medications: Gabapentin, enacarbil or pregabalin for moderate to severe RLS.
• Iron supplements.
• Opioids: For severe RLS cases that don’t respond to other treatments.
• Benzodiazepines: To treat anxiety, insomnia, or muscle spasms.
• Dopaminergic agents, like those used in this study. Be aware that they do have side effects that require careful management, especially in older adults with heart issues, so discuss with a doctor.

Sources:

Restless Legs Syndrome Linked to Parkinson’s Risk—Dopamine Treatment May Be Protective — Korea University College of Medicine

Korea University study finds restless legs syndrome linked to Parkinson’s risk—dopamine treatment may be protective — Eureka Alert

Risk of Parkinson Disease Among Patients With Restless Leg Syndrome — JAMA Network Open

Restless Leg Syndrome — National Institute of Neurological Disorders and Stroke