Can botulinum toxin put the restless legs syndrome to rest?

Journal: Medical Hypotheses. 2007 Mar 13; [E-publication ahead of print]

Authors and affiliations: Lim EC, Seet RC. Yong Loo Lin School of Medicine, National University of Singapore; National University Hospital, Singapore.

PMID: 17363179

The restless legs syndrome (RLS), affecting between 3% and 15% of the population, is characterized by an urge to move the legs during wakefulness, associated with a range of unpleasant sensory symptoms, especially when sitting or lying down at night. The symptoms can even be painful, and lead to sleep disturbances and depression. RLS is treated with dopaminergic agents, anticonvulsants, opioids, clonidine, and benzodiazepines.

In a small percentage of cases, RLS is refractory to treatment, requiring combination therapy. Botulinum toxin (BTX), derived from the exotoxin of Clostridium botulinum, cleaves soluble N-ethylmaleimide-sensitive factor attachment protein receptor (SNARE) proteins, causing chemodenervation of cholinergic neurons.

BTX has been demonstrated to ameliorate pain syndromes, possibly by reducing peripheral and central sensitization to pain. We postulate that BTX can be injected subcutaneously to the lower limbs to effect amelioration of the symptoms of RLS.

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