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Cannabis for Restless Legs Syndrome?

Author: Charlie Coombs

Willis-Ekbom Disease (WED) or Restless Legs Syndrome (RLS) as it is more commonly called is classified as a neurological sensorimotor disorder. Its symptoms most often become worse – no, make that unbearable – in the evenings. Sleeping difficulties then occur as the symptoms wake people up or it is just so discomforting that they cannot even fall asleep, thus resulting in a secondary chronic sleep disorder.


Yet despite the fact that it affects a significant percentage of the population (noted by Dr. Richard Allen in 2005 as being 7% in North American and Western European countries [1]) the precise cause is still unidentified, and many GP’s remain unaware of its existence let alone diagnosis or treatment. Furthermore, treatment for RLS has been largely unsuccessful and is a hit or miss affair. A wide array of pharmacological treatments have been tried. These include Benzodiazepines, Hypnotics, Opioids, Anticonvulsants and Dopamine agents. Indeed, Pramipexole was approved by the American Food and Drug Administration in 2007 for RLS. But for those with more severe RLS, Pramipexole in fact worsens the symptoms through Augmentation. Augmentation is where increasing doses are required, but paradoxically result in an intensity of RLS symptoms at increasingly earlier times of the evening and with symptoms spreading to other parts of the body, such as the arms and hands. Pregabalin was also noted in some patients to have side effects of compulsive behaviour and suicide ideation.


However, with the current trend in many countries of relaxing laws pertaining to Marijuana, “medical marijuana”, or Cannabis as it is now more popularly called, it has been seen as an option. A small study in 2017 at the Clinical Neurosciences Centre, Bordeaux University Hospital by Thomas Megelin and Imad Ghorayeb [2] found Cannabis to alleviate symptoms of RLS in their patients. Furthermore, all participants said they had an improvement in their sleep after treatment with Cannabis finished, and described Cannabis as the most effective and the best tolerated treatment. Significantly, Barbara Koppel et al. [3] in a study of efficacy and safety of medical marijuana in select neurological disorders, noted that the risk of serious psychopathological effects was approximately 1%. This compares favourably to other treatments, for instance over 20% of RLS patients developed compulsive behaviours while taking Dopamine agonists.


Historical evidence suggests that the plant Cannabis Sativa has been used for millennia for the treatment of pain and nausea, but even now not a great deal is known about the plant. Currently, 120 Cannabinoids (the pharmacological active components of Cannabis) have been identified, of which Tetrahydrocannabinoil (THC) and Cannabidoil (CBD) are the current focus for their therapeutic potential;

  • THC is what gives the “high” associated with Cannabis use. THC has been found to provide pain relief, reduce nausea and have sedative effects.

  • CBD has no psychoactive effects but can reduce anxiety and depression, relieve pain and promote alertness.

  • CBN is a lesser known cannabinoids which has anti-inflammatory as well as pain relieving properties.

Over the past decade, the focus of investigation has primarily been on the use of Cannabis for an array of conditions such as Multiple Sclerosis, Parkinson’s Disease, Epilepsy, Migranes, Huntings Disease, Tourettes Syndrome and Alzheimers Disease [4].


More recently though Anastasia Suraev et al. [5] noted that promising preliminary evidence provides the rationale for future trials of cannabinoid therapies in individuals with sleep apnoea, insomnia, post-traumatic stress disorder-related nightmares, restless legs syndrome, rapid eye movement sleep behaviour disorder, and narcolepsy.


Unfortunately, due to its complicated legal status many people have a negative perception with users often being labelled “druggies”. Medical professionals appear extremely reluctant to recommend or prescribe “medical marijuana” due to the complex bureaucratic process involved. Additionally, whereas the side effects of pharmaceutical developed medications approved by the Food and Drug Authority have been listed, the extent of side effects of “medical marijuana” are in contention (for example driving impairment, psychotic predisposition, lung functioning etc). Our scientific understanding of Cannabis’ medical potential is poor at present, mostly due to issues of legality, and the lack of robust scientific trials and studies.

More research is needed before the potential benefits and safety can be accurately determined, such as accurately measuring and quantifying the strength of cannabis, and comparing the type of ingestion – whether it be inhalation, vaporizing, sublingual, eating, etc.

In the words of Nicole Skrobin, “if traditional treatment methods are ineffective or do more damage than good, it may be a sign to try something more natural”[6].

References:

  1. Richard Allen et al. “Restless Legs syndrome? Willis-Ekbom disease diagnostic criteria: updated IRLSSG consensus criteria – history, rationale, description and significance”. Sleep Medicine, 2014

  2. Thomas Megelin and Imad Ghorayeb. “Cannabis for restless legs syndromes: a report of six patients”. Sleep Medicine, August 2017

  3. Barbara Kopell et al. “Systematic review: Efficacy and safety of medical marijuana in selected neurologic disorders”. Neurology, April 2014

  4. Alison Mack, Janet E Joy. “Marijuana as Medicine? The Science Beyond the Controversy”. The National Acadamies Press. 2000

  5. Anastasia Suraev et al “Cannabinoid therapies in the management of sleep disorders: a systematic review of preclinical and clinical studies”. Sleep Medicine Reviews, May 2020

  6. Nicole Skrobin “The Fresh Toast”. thefreshtoast.com. October 2018.


If you are interested in helping researchers understand more about the effect of Cannabis on Restless Legs Syndrome please contact our RLS Coordinator, Charlie Coombs for more information rls@sleepoz.org.au