I suffer from nocturnal bouts of Restless Legs Syndrome for which I take a small daily dose of Pramipexole. But it makes me exhausted and pretty bad during the day. I’m done.
Dinah Prince, Caerleon, Gwent.
Restless Legs Syndrome (RLS) is a deeply uncomfortable feeling in the lower limbs that only movement resolves – hence the name.
The urge to move your legs constantly is worse at rest, but especially at night when it can be bad enough to disrupt sleep, which can also affect daytime well-being.
Although the cause of RLS isn’t entirely clear, we do know that there may be a genetic element, and there’s some evidence that it might be related to levels of dopamine, a chemical messenger in the brain that helps control muscle movement: the Dopamine levels naturally decrease at night.
Pramipexole is one of the most commonly prescribed treatments for RLS — it belongs to a group of drugs called dopamine agonists, which work by mimicking the effects of dopamine.
The urge to move your legs constantly is worse at rest, but especially at night when it can be bad enough to disrupt sleep, which can also affect daytime well-being
However, although they are effective in treating RLS, they can cause side effects such as drowsiness, fatigue, and nausea.
In your lengthy letter, you ask whether an alternative drug, pregabalin, might not be a better choice. Both pregabalin and a similar drug called gabapentin have been shown to be effective for RLS. Although dizziness and drowsiness are also known side effects of these drugs, you have everything you need to benefit from trying both, starting at low doses, and I would suggest reporting this to your GP. (However, these drugs may not be appropriate for people who are overweight, have major depression, or have an unsteady gait.)
You may also need iron supplements if your blood levels of ferritin (a measure of how much iron is stored in your body) are below 75 ng/mL – low iron levels can interfere with the activity of dopamine in the brain.
Iron tablets or injections can restore ferritin levels and relieve symptoms of RLS, although it’s likely your doctor took this into account when making the diagnosis. I hope it helps.
My husband and I have been married for 51 years, but his mental memory has been failing lately. He puts things in the wrong place and needs simple instructions repeated multiple times. Our daughters shrug off my concerns about dementia and the GP will only examine him if he asks for it himself but insists he is fine.
name and address given.
From your description of the changes in your husband’s mental acuity, I suspect he has mild cognitive impairment – an alteration in brain function, with memory problems being the most common symptom.
A general practitioner can make an initial assessment using a standard questionnaire called the mini mental state exam. If his score is low, he may need to be referred for a brain scan and more detailed testing by a clinical psychologist.
But he may also need blood tests to check, for example, his thyroid function and vitamin B12 levels, as these are possible causes of cognitive decline. Another possibility is “masked” depression — a depressive disorder with no obvious mood changes or side effects from medications he takes regularly.
From your description of the changes in your husband’s mental acuity, I suspect he has mild cognitive impairment – an alteration in brain function, with memory problems being the most common symptom
I would suggest that you and your daughters call a family reunion to convey your concerns to your husband.
Provide examples of his mistakes: The goal is to allow him to talk about his own fears and at least accept that he should get a medical opinion.
Explain that one in six over the age of 70 has mild cognitive impairment, but half will not develop dementia.
As I explained in a recent column on the subject, there is no drug proven to help with mild cognitive impairment, but some research suggests that regular physical activity, a nutritious diet, and cognitive training hold promise.
I am confident that this approach will convince your husband that he needs to see his GP.
Write to Dr. scurr
Write to Dr. Scurr from Good Health, Chron, 9 Derry Street, London W8 5HY or by email: [email protected] – provide your contact details. dr Scurr cannot conduct personal correspondence. The answers should be viewed in a general context. If you have health concerns, consult your GP
From my point of view: Woe to the patients who cannot go online
Family Doctors of my generation lived in a golden era and while it wasn’t without problems, I never thought I would live to see a time when medical care in the community would be so depleted.
When I started, a GP was contracted to see every patient over the age of 75 once a month. The general practitioner would also keep an eye on the infirm and the elderly on a regular basis.
Both services have been discontinued, and worse, the advent of technology (email and video calling) has further abandoned those who cannot use it.
A whole sector of our population was thrown to the wolves to eat. Who cares for the widowed, frail elderly who aren’t online, can’t use a smartphone, or don’t have family to fight for them?
Every practice should be forced to cater to their needs – and that includes reintroducing regular health checks. lives depend on it.
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