I read with interest O'Keeffe's1 excellent review article on restless legs syndrome (RLS), an often neglected and overlooked nonarticular rheumatic condition. It should be emphasized that although periodic movements of sleep is present in approximately 10% of the normal population, almost all patients who have RLS have periodic movements of sleep as well.2
I agree with O'Keeffe's therapeutic recommendations, especially that levodopa is effective; however, in my experience, troublesome side effects are not uncommon during extended therapy. On the other hand, a useful pharmacological approach for the treatment of RLS, which is not described by O'Keeffe, is the use of orphenadrine citrate. Although no randomized controlled trials have been reported, observational studies in my experience and in that of others have shown orphenadrine to be extremely effective and safe in controlling the symptoms of RLS and periodic movments of sleep.3-5 Initial dosage should be one 100-mg tablet
Neustadt DH. Therapy for Restless Legs Syndrome. Arch Intern Med. 1996;156(20):2386. doi:10.1001/archinte.1996.00440190144016
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