Bryophyllum pinnatum in the treatment of restless legs syndrome: A case series documented with polysomnography

We set out to experimentally treat restless legs syndrome patients with preparations of Bryophyllum pinnatum that have been proposed to possess sedative and muscle relaxant properties. The disease courses of our five patients suggest that treatment with these preparations (mainly chewable tablets) can improve restless legs syndrome and sleep quality. Restless legs syndrome (RLS) is a neurologic disorder characterized by a compelling urge to move one's legs, usually worsening in the evening and at night.1 The diagnosis is done clinically, based on five essential criteria (see Box ).1 Treatment of RLS is challenging. Patients often suffer from disturbed quality of life, whereby sleep problems play a marked role. These can be severe, include insomnia, and are often associated with additional features such as repetitive leg jerks, that is involuntary and stereotyped movements during sleep, the so‐called periodic limb movements during sleep (PLMS). Current pharmacological treatment strategies for RLS include dopaminergic agents (L‐Dopa or dopamine agonists has), α2δ calcium channel ligands, opioids, and benzodiazepines, all of which, however, frequently have marked side effects, especially in long‐term treatment (see eg Ref.2, 3). Whereas originally a positive response to L‐Dopa or dopamine agonists was considered an additional criterion for the diagnosis of RLS,4 and dopamine agonists were used as first‐line treatment, nowadays dopaminergic agents are known to cause augmentation and compulsive behavior.3 Sleepiness and weight gain are typical side effects with α2δ ligands, and dependency and daytime somnolence are always risks in treatment with opioids and benzodiazepines. Box 1 Diagnostic criteria for restless legs syndrome according to Allen et al1 1. An urge to move the legs usually but not always accompanied by, or felt to be caused by, uncomfortable and unpleasant sensations in the legs. The urge to move the legs and any accompanying unpleasant sensations begin or worsen during periods of rest or inactivity such as lying down or sitting. The urge to move the legs and any accompanying unpleasant sensations are partially or totally relieved by movement, such as walking or stretching, at least as long as the activity continues. The urge to move the legs and any accompanying unpleasant sensations during rest or inactivity only occur or are worse in the evening or night than during the day. The occurrence of the above features is not solely accounted for as symptoms primary to another medical or a behavioral condition (eg myalgia, venous stasis, leg edema, arthritis, leg cramps, positional discomfort, habitual foot tapping).