Gabapentin also known as "Neurontin" is a well-known medication used for various nerve disorders [1] (such as neuropathy and nerve pain) and also for RLS; or Restless Legs Syndrome [2]. Comparative studies seem to indicate that Gabapentin is at least as effective as dopamine agonists in treating Restless legs but some studies do not affirm the same findings [3].
However, in many medical publications, other factors in choosing the right medication are not always included. Rather those very factors are kept separate in isolated studies. This article aims to fairly analyze the data from many national sources and to make a patient-friendly conclusion that outlines the most important considerations.
AN OVERVIEW OF RESTLESS LEGS SYNDROME
Restless Legs Syndrome or RLS is a condition which causes uncomfortable sensations in the legs, described as an "unusual sensation leading to the urge to move the legs". Some describe it as a mild pinch, a tickle in the muscle, a feeling like a nerve is spasming and others describe an electrical sensation [4]. In any case, the condition is frustrating and it disrupts sleep and sleep quality [5].
Imagine being woken up multiple times at night by of all things, YOUR LEG. But a nerve somewhere in there that just won't be quiet, or your brain perhaps playing a dysfunctional rather than, cooperative role when you are trying to go to sleep!
That is what restless legs sufferers deal with.
This condition has been described since 1685 [6]. Doctors early on didn't actually officially give it a name until 1944 [7] where Dr.Ekbom (Karl-Axel Ekbom) gave a thorough clinical description along with his findings.
Since then, much more research has been done.
Many studies have found that the condition seems to occur after different forms of surgery [8] as well as other forms of trauma [9] and conditions which may cause neurodegeneration; such as ALS [10].
Various hypothesis have emerged in attempt to define the mechanisms associated with and leading to the development of RLS. Since an unknown cause is frequent, authors often speculate on again, idiopathic dopamine deficiencies [11].
The same study also noted one could supplement with.
Other studies support the idea of low levels of dopamine (D3) receptors in the Brain [12]. However, this is a fairly rare occurrence without prior substance-abuse and thus can only be explained in a small proportion of patients [13].
Some studies have found INCREASED dopamine D2 receptors in Restless Legs Syndrome as well [14].
The use of anti-psychotic drugs [15] and SSRI-antidepressants [16] seems to up the risk of developing restless legs syndrome.
Magnesium deficiency can play a huge role and lead to RLS [17].
All current research suggests that a combination of factors is most likely. However, nutritional factors do not always represent the proper treatment. When accounted for, there is still a great deal of patients who do not respond to the "simple factors" [18].
Time Spent with Gabapentin; the Friendly & Mild Tranquilizer
Gabapentin, though an effective medicine, is still characteristically a type of mild tranquilizer [19]. Some call it a muscle-relaxer [20], and sometimes it is referred to as an agent that "relaxes the nerves" and as such - you can expect that there is one hell of a lot of reports of side-effects, right?
Actually not really.
Gabapentin is SO MILD that many don't get any side-effects, rather higher doses are needed (1200-1800mg >) in order for them to appear [21].
User Reports on GABApentin indicate generally mild-side effects.
The specific side-effects of Gabapentin appear mostly to be somnolence (or transient tiredness) [22], sometimes mild brain fog [23] and general drowsiness [24]. Impaired inhibition is less common with Gabapentin than with Benzodiazepines, but may happen with higher doses and / or combination treatments [25].
Restless Legs Syndrome or RLS is a condition which causes uncomfortable sensations in the legs, described as an "unusual sensation leading to the urge to move the legs". Some describe it as a mild pinch, a tickle in the muscle, a feeling like a nerve is spasming and others describe an electrical sensation [4]. In any case, the condition is frustrating and it disrupts sleep and sleep quality [5].
Imagine being woken up multiple times at night by of all things, YOUR LEG. But a nerve somewhere in there that just won't be quiet, or your brain perhaps playing a dysfunctional rather than, cooperative role when you are trying to go to sleep!
That is what restless legs sufferers deal with.
This condition has been described since 1685 [6]. Doctors early on didn't actually officially give it a name until 1944 [7] where Dr.Ekbom (Karl-Axel Ekbom) gave a thorough clinical description along with his findings.
Since then, much more research has been done.
Many studies have found that the condition seems to occur after different forms of surgery [8] as well as other forms of trauma [9] and conditions which may cause neurodegeneration; such as ALS [10].
Various hypothesis have emerged in attempt to define the mechanisms associated with and leading to the development of RLS. Since an unknown cause is frequent, authors often speculate on again, idiopathic dopamine deficiencies [11].
The same study also noted one could supplement with.
- A quality Iron supplement.
- Folic Acid or L-Methylfolate supplement.
This could alleviate RLS as well and that the mechanism was most likely a lack of brain dopamine in the substantia nigra that lead to dysfunctional nerve communication in motor nerves in the limbs.
Other studies support the idea of low levels of dopamine (D3) receptors in the Brain [12]. However, this is a fairly rare occurrence without prior substance-abuse and thus can only be explained in a small proportion of patients [13].
Some studies have found INCREASED dopamine D2 receptors in Restless Legs Syndrome as well [14].
The use of anti-psychotic drugs [15] and SSRI-antidepressants [16] seems to up the risk of developing restless legs syndrome.
Magnesium deficiency can play a huge role and lead to RLS [17].
All current research suggests that a combination of factors is most likely. However, nutritional factors do not always represent the proper treatment. When accounted for, there is still a great deal of patients who do not respond to the "simple factors" [18].
Time Spent with Gabapentin; the Friendly & Mild Tranquilizer
Gabapentin, though an effective medicine, is still characteristically a type of mild tranquilizer [19]. Some call it a muscle-relaxer [20], and sometimes it is referred to as an agent that "relaxes the nerves" and as such - you can expect that there is one hell of a lot of reports of side-effects, right?
Actually not really.
Gabapentin is SO MILD that many don't get any side-effects, rather higher doses are needed (1200-1800mg >) in order for them to appear [21].
User Reports on GABApentin indicate generally mild-side effects.
The specific side-effects of Gabapentin appear mostly to be somnolence (or transient tiredness) [22], sometimes mild brain fog [23] and general drowsiness [24]. Impaired inhibition is less common with Gabapentin than with Benzodiazepines, but may happen with higher doses and / or combination treatments [25].
Many studies even fail to find a sedative effect nor any apparent impairment of Memory.
Gait disturbance has been reported at very high doses used for post-operative stabilization.
Gait disturbance has been reported at very high doses used for post-operative stabilization.
User Reports of DOPAMINE Agonists indicate more side-effects.
Dopamine agonists are another class of medication used to treat Restless Legs Syndrome. They are associated with more behavioral effects [26] but in many cases have the advantage of also improving symptoms of Depression, if that happens to be a concern for the affected individual with RLS [27].
Somnolence and general fatigue are reported more with them than Gabapentin [28] although Insomnia is also a reported side-effect [29].
The most alarming side-effects (besides tiredness) are of course, the pathological states that sometimes arise from taking dopamine agonist drugs, particularly in a course of longer therapy.
Though - some experts argue that genes play a role in susceptibility to this group of side-effects.
One withdrawal too many and one face too Ugly.
The main thing to distinguish between the two drugs used for RLS are that one is a drug with generally no severe withdrawal symptoms [30] (Gabapentin) whereas dopamine agonists are well-on capable of leaving a trail of destruction among discontinuers [31].
Gabapentin is though associated with withdrawal symptoms moreso with higher doses, whereas with dopamine agonists they occur regardless of dose. Some patients do not experience withdrawal symptoms but it is important to distinguish between each TYPE of withdrawal symptom.
Gabapentin Withdrawal
Dopamine agonists are another class of medication used to treat Restless Legs Syndrome. They are associated with more behavioral effects [26] but in many cases have the advantage of also improving symptoms of Depression, if that happens to be a concern for the affected individual with RLS [27].
Somnolence and general fatigue are reported more with them than Gabapentin [28] although Insomnia is also a reported side-effect [29].
The most alarming side-effects (besides tiredness) are of course, the pathological states that sometimes arise from taking dopamine agonist drugs, particularly in a course of longer therapy.
Though - some experts argue that genes play a role in susceptibility to this group of side-effects.
One withdrawal too many and one face too Ugly.
The main thing to distinguish between the two drugs used for RLS are that one is a drug with generally no severe withdrawal symptoms [30] (Gabapentin) whereas dopamine agonists are well-on capable of leaving a trail of destruction among discontinuers [31].
Gabapentin is though associated with withdrawal symptoms moreso with higher doses, whereas with dopamine agonists they occur regardless of dose. Some patients do not experience withdrawal symptoms but it is important to distinguish between each TYPE of withdrawal symptom.
Gabapentin Withdrawal
- Generally described as an alcohol or benzo-type withdrawal accompanied by Anxiety, sweating, rebound Insomnia and trouble concentrating. Resolves after a few weeks generally although some have found it is better to reinstitute the drug [32] then taper more slowly over the period of months [33]. That would mean, lowering the dose by tinier amounts and taking longer before full discontinuation.
Dopamine Agonist Withdrawal.
CONCLUSION
Both Gabapentin/Gabapentine & dopamine agonists appear to be equally effective in treating RLS.
The main conclusion that can be reached is that Gabapentin is more benign in potential side-effects, has less of an effect on behavior and a less propensity to aggravate Psychiatric symptoms. However, some are not responders to Gabapentin and some do not prefer the somewhat mild 'sedative' properties it possesses. Gabapentin is an incredibly useful medication for a variety of nerve disorders so patients may find that it is not only more balanced but is more acceptable in treating various nerve conditions or in cases where there is a history of Migraines and in that aspect Gabapentin may help as well [34].
On the other hand, given the frequent rates of Depression among those with Restless Legs Syndrome [35], Pramipexole or other dopamine agonists may be more useful in treating both disorders and pramipexole, when it is adhered to and taken normally may have more beneficial effects on motivation versus Gabapentin [36].
The drugs both have their own set of advantages and disadvantages of course. However the benefits must be weighed with the risks and more particularly, the patients personal and medical history [37]. While Gabapentin may be more useful for elderly populations, younger populations or those without Parkinson's or other neurological disorders may ironically benefit MORE from a dopamine agonist than Gabapentin [38]. It is worth noting that not a year goes by without a report of Gabapentin abuse, somewhere.
- Generally more severe and accompanied by Anhedonia (loss of interest in activities/pleasure feelings), Depression, Anxiety and even Rage.
- The drugs are associated with these side-effects and withdrawal effects moreso when the drug (medication) is taken for a longer period of time.
CONCLUSION
Both Gabapentin/Gabapentine & dopamine agonists appear to be equally effective in treating RLS.
The main conclusion that can be reached is that Gabapentin is more benign in potential side-effects, has less of an effect on behavior and a less propensity to aggravate Psychiatric symptoms. However, some are not responders to Gabapentin and some do not prefer the somewhat mild 'sedative' properties it possesses. Gabapentin is an incredibly useful medication for a variety of nerve disorders so patients may find that it is not only more balanced but is more acceptable in treating various nerve conditions or in cases where there is a history of Migraines and in that aspect Gabapentin may help as well [34].
On the other hand, given the frequent rates of Depression among those with Restless Legs Syndrome [35], Pramipexole or other dopamine agonists may be more useful in treating both disorders and pramipexole, when it is adhered to and taken normally may have more beneficial effects on motivation versus Gabapentin [36].
The drugs both have their own set of advantages and disadvantages of course. However the benefits must be weighed with the risks and more particularly, the patients personal and medical history [37]. While Gabapentin may be more useful for elderly populations, younger populations or those without Parkinson's or other neurological disorders may ironically benefit MORE from a dopamine agonist than Gabapentin [38]. It is worth noting that not a year goes by without a report of Gabapentin abuse, somewhere.
In/Tags: gabapentin vs dopamine agonist, gabapentin vs dopamine agonists, gabapentin vs dopamine agonist restless legs syndrome, drawbacks of gabapentin for restless legs, best medication for restless legs 2017, best herb for restless legs 2017,
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