Clinical ReviewComplementary and alternative therapies for restless legs syndrome: An evidence-based systematic review
Introduction
Restless legs syndrome (RLS) is defined as an irresistible urge to move the legs. It is usually accompanied by paresthesia and dysesthesia, and the symptoms can be partly or totally relieved by physical activity [1], [2], ∗[3], [4], [5], ∗[6], ∗[7]. Patients with RLS describe the sensory discomfort using terms such as pain, tingling, creeping, burning, bugs, electricity, or nervousness [8]. It varies in symptom frequency, severity, and duration. The effects of RLS on the ability to function range from minor annoyance to negative effects on work, social activities, and emotional well-being [9]. However, sleep disruption induced by RLS and daytime fatigue are the most common reasons for seeking medical advice [10].
Bothersome RLS affects 2%–4% of adults in Europe and North America at least twice weekly and is more common among women [11], [12]. RLS is associated with female gender, pregnancy, elderly age, poor health, lower socioeconomic status, and positive family history [13], [14], [15], [16], [17], [18]. It can occur in an idiopathic form or secondary to other conditions such as renal failure, iron deficiency, pregnancy, or particular medications [19]. The pathophysiology of RLS is still unclear, although it is believed to result from iron deficiency and dopamine imbalance in the central nervous system [20].
Therapies for RLS can be divided into pharmacological and non-pharmacological treatments. Three dopamine agonists (ropinirole, pramipexole, and rotigotine) and one calcium channel alpha-2delta receptor ligand (gabapentin enacarbil) are currently approved by the Food and Drug Administration for pharmacological treatment of moderate to severe RLS [9]. Various clinical trials [1], [2], ∗[3], [4], [5], ∗[6], ∗[7] that have examined the efficacy of physiotherapy in the non-pharmacological treatment of RLS have demonstrated that it can alleviate the clinical symptoms. However, no systematic review has been published addressing the effectiveness and safety of non-pharmacological treatment for the relief of RLS symptoms. Hence, this systematic review was conducted to evaluate the efficacy and safety of complementary and alternative therapies for RLS, based on scientific evidence.
Section snippets
Data sources and search strategy
A systematic search of the PubMed, Embase, Cochrane, and Web of Science databases using the search terms ‘restless leg*’or ‘RLS’ was conducted in August 2016 to identify available data sources for complementary and alternative therapies for RLS. Only papers in English were included in the review. Further relevant trials were obtained by manually searching the conference abstracts and reference lists of all identified related publications to avoid omitting relevant randomized controlled trials
Results
The initial database search identified 1849 papers. Of these, only 18 studies met our inclusion criteria and were included in this systematic review. Twelve trials focused on primary RLS and the other six on secondary RLS.
Complementary and alternative therapies for primary RLS involved aerobic exercise training (n = 1), electrical stimulation (n = 3), vibratory stimulation (n = 1), enhanced external counter pulsation (EECP) (n = 1), pneumatic compression devices (PCDs) (n = 1), light
Discussion and conclusion
The results of this systematic review revealed that the severity of primary RLS symptoms can be significantly ameliorated by complementary and alternative options such as exercise training, tsDCS, PCDs, light therapy, rTMS, and acupuncture. With regard to secondary RLS, the application of intradialytic exercise training has consistently been shown to be highly efficacious in the reduction of uremic RLS symptom severity, and ELA has been proven to alleviate or relieve RLS symptoms in patients
Conflicts of interest
The authors have no conflicts of interest to disclose.
Acknowledgments
This work was supported by the National Key Clinical Specialties Construction Program of China for Neurology [The First Affiliated Hospital of Chongqing Medical University; grant no. (2014)27], as well as natural science foundation project of Chongqing science and technology commission (ID: cstc 2016jcy jA0423)
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