There is a hypothesis that reduced blood flow to the extremities may play a role in RLS symptoms. Research has been undertaken to ascertain whether sequential (pneumatic) compression devices may alleviate RLS symptomatology. In a small preliminary study from 2005, researchers from New Jersey evaluated 6 patients using enhanced external counter pulsation (EECP) devices on the legs for one hour daily Monday to Friday for 7 weeks (Rajaram SS, 2004). All 6 patients met the 2003 IRLSSG criteria and were assessed with the IRLS rating scale (IRLSSS) before and after the intervention. It should be noted that 3 subjects did not complete the IRLSSS until 4-5 months after EECP treatment. Further complicating the results, 4 of the 6 patients suffered from diabetic peripheral neuropathy and no electromyography or nerve conduction studies were done before or after EECP treatment to assess any potential neuropathy changes. Nevertheless, the research team found that the IRLS rating scale was significantly improved after EECP intervention and suggested that decreases in vascular flow may affect the nervous system (peripheral or central) causing the sensory symptoms of RLS. In a more rigorous prospective, randomized, double-blinded sham-controlled trial, Lettieri and Eliasson studied 35 subjects in 2009. Consecutive patients attending a sleep clinic for RLS for approached for recruitment. 41 RLS
patients were assessed for eligibility with 6 excluded (4 not meeting inclusion criteria and 2 refused to participate). The remaining 35 patients were randomized into either therapeutic or sham treatment with a sequential compression device for 1 hour daily for 4 weeks. Validated questionnaires were administrated at the start and end of the intervention. These forms included the International Restless Legs Syndrome Study Group Severity Scale (IRLSSS), the Johns Hopkins Restless Legs Severity Scale (JHRLSS), and the restless legs syndrome quality of life instrument (RLS-QLI). Iron therapy and RLS pharmacological use was similar between the sham control and intervention groups. The researchers found significant improvements in the IRLSSS, JHRLSS, and the RLS-QLI for the intervention group and suggest that pneumatic compression devices are a useful adjunctive or alternative therapy for RLS (Lettieri CJ, 2009).
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