Ask an expert - neuro and psycho logical - restlessness (Akathisia)

3 questions

Restless leg syndrome is awful, as this 'expert' knows from personal experience back in the 80s when nothing, but nothing, would make the problem relent. It is nowgaining recognition as a diagnosable problem, with a new name(!), and there are a number of treatment options which are being explored. A review article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101885/ cites several of these, and the one acupuncture review this in turn cites

http://www.ncbi.nlm.nih.gov/pubmed/18843716

mentions two to three studies which are interesting but generally concludes that the majority of studies are too small and not methodologically sound enough to draw firm conclusions.

From a Chinese medicine perspective, however, there are entirely different ways of looking at the balance of energies within the body which can sometimes make sense of problems such as these within a theoretical structure which is quite different from western medicine. Problems like restless legs syndrome, where the leg feels as though it is 'over-energised' can sometimes make sense in a system of thought which looks at the free flow of energy within the system, and tries to understand the pathologies which arise in terms of excesses and deficiencies, and especially blockages. A skilled practitioner should very quickly be able to make sense of the energy flows within the system, and be able to offer you some sense of whether there is something which is treatable.

Even where this is not the case it is important to mention that the older theories of Chinese medicine were primarily aimed at balancing the whole system, seeing symptoms only as alarm bells, not the problem itself. Working in this kind of way our members very often have an effect on problems without necessarily being able to give a highly specific audit trail of what is causing something to go wrong.

We have not come across much in the way of new research, although another small study published early this year (2015)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4339862/

repeats the general pattern of significant effects but small study sizes which means that we cannot give a more unqualified recommendation.

As far as motor axonal neuropathy is concerned, there is very little focused research on this specific presentation of peripheral neuropathy. There is a systematic review published earlier this year

https://www.ncbi.nlm.nih.gov/pubmed/28112552

which embraces a number of papers about neuropathies very similar to axonal neuropathy, but nothing specifically about it. Most studies of this kind tend to be very small, and inevitably the conclusion is that more studies on a larger scale would be necessary. The main question which is left unanswered is 'who will pay for them?'

If you are considering acupuncture treatment for the problem the best advice we can give is that you visit a local BAcC member to ask for a brief face to face chat about what may be possible. It follows from what we have said before that each case is unique and different, and a face to face assessment is the only way to get a specific answer about what you might expect. Many practitioners are happy to give up a small amount of time without charge to prospective patients to make this kind of assessment.

Q:  I am a long-term sufferer from restless leg syndrome, but over recent years it has grown immeasurably worse to the point where I am unable to sleep for many houRS each night. Alongside this, I have an additional problem of tinnitus which has also increased in intensity over the past few months - though whether there is any link between these, I am obviously not qualified to say.

My question is whether you could provide me with the contact details of an acupuncturist who specialises in these conditions. I live in Dorset on the south coast, but am quite prepared to travel over a significant distance, if this is necessary. Having already had treatment from a local practitioner, I feel I would prefer to speak to someone with a specific understanding of these conditions in order to receive effective treatment.

If you could help, I would be most grateful..

A:  We have been asked about restless leg syndrome (which has now qualified for the name Ekbom Syndrome), and a stock response we have used for a couple of years is:

 Restless leg syndrome is awful, as this 'expert' knows from personal experience back in the 80s when nothing, but nothing, would make the problem relent. It is now
gaining recognition as a diagnosable problem, with a new name(!), and there are a number of treatment options which are being explored. A review article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101885/ cites several of these, and the one acupuncture review this in turn cites

http://www.ncbi.nlm.nih.gov/pubmed/18843716 mentions two to three studies which are interesting but generally concludes that the majority of studies are too small
and not methodologically sound enough to draw firm conclusions. From a Chinese medicine perspective, however, there are entirely different ways of looking at the balance of energies within the body which can sometimes make sense of problems such as these within a theoretical structure which is quite different from western medicine. Problems like restless legs syndrome, where the leg feels as though it is 'over-energised' can sometimes make sense in a system of thought which looks at the free flow of energy within the system, and tries to understand the pathologies which arise in terms of excesses and deficiencies, and especially blockages. A skilled practitioner should very quickly be able to make sense of the energy flows within the system, and be able to offer you some sense of whether there is something which is treatable.

Even where this is not the case it is important to mention that the older theories of Chinese medicine were primarily aimed at balancing the whole system, seeing symptoms only as alarm bells, not the problem itself. Working in this kind of way our members very often have an effect on problems without necessarily being able to give a highly specific audit trail of what is causing something to go wrong.

We have not come across much in the way of new research, although another small study published early this year http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4339862/

repeats the general pattern of significant effects but small study sizes which means that we cannot give a more unqualified recommendation.

Tinnitus is for many acupuncturists one of the heartsink conditions. As we have replied on many occasions:

Tinnitus is one of the more intractable conditions which people seek acupuncture treatment for. Our Tinnitus fact sheet, found at lists a small amount of research which suggests that acupuncture may help, but there have been no significant trials which provide solid evidence. It is also fair to say that many practitioners are very cautious about taking on patients for whom tinnitus is the primary problem. It is quite easy to spend considerable time and money and be no better off than when you started, and the individual case reports in the tinnitus sufferers' magazines often have the same shape.

However, what many practitioners do find when treating people with tinnitus is that while the noise remains largely unchanged their ability to cope with it seems to improve. Evidence for this is largely anecdotal, though, and it would be wise to discuss carefully with any future practitioner whether they think that they might be able to help. In all events we would recommend that frequent and regular reviews of outcomes and progress are essential.

We don't think you can say more than this. There are two or three clearly identifable patterns in Chinese medicine, described as syndromes, where tinnitus is a specific named symptom which frequently appears, and it is possible, if your tinnitus has arisen as a part of the syndrome, that there may be some help which acupuncture treatment may offer. An experienced practitioner should be able to make a very straightforward determination on whether this is the case. Overall, however, there is not a great deal of cause for optimism about getting rid of the unwanted noise.

Some of our colleagues are a little more upbeat than this, but if you read the tinnitus sufferer magazines there is very little consensus about effective treatments. Every treatment will work for someone but there is not some treatment that will work for everyone.

There are, as the earlier reply suggests, a number of specific conditions understood in Chinese Medicine terms which would predispose a practitioner to being optimistic, and in turn, it is possible to link this with some of the more common causes or restless leg syndrome. However, it would be a very long shot to kill these two particular birds with one stone.

As for special expertise, all BAcC members are generalists by the very nature of Chinese medicine which treats people, not conditions. There are a number of areas where groups of members have focused their attention on particular patient groups, such as pregnant women, children or patients with mental health disorders, and we are working to define the basis on which these practitioners can call themselves expert practitioners in these fields. We have never heard of anyone specialising in treating either of these conditions.

All that we can say is that if you have tried treatment with someone local to you without success then you may find it helpful to move to a new practitioner for a slightly different approach. There is no reason to inform the existing practitioner of this move, although you may find it helpful if a former practitioner passes on notes of what they have tried already. None of us takes exception when patients transfer; it is best professional practice to do whatever is possible to make the transfer effective and to see that the patient gets the treatment best suited to them.

We'd have to be honest and say that without knowing a great deal more about you're case history we wouldn't want to hazard a view of whether acupuncture might help you.

Akathisia generally manifests as a side effect of serious medications or can be a side effect of Parkinson's disease, and while we have heard the occasional anecdotal tale about someone's symptom's being slightly reduced we have not heard of significant changes in someone's experience. Of course, we may be doing you a serious injustice to assume that either of these is the cause of your problem, and we are aware that akathisia is occasionally used to describe restless leg syndrome, or Willis Ekbom syndrome as it is increasingly being known. When asked about this earlier in the year we replied:

Q: I am enquiring if acupuncture could help allieviate my restless leg syndrome (Ekbom Syndrome)symptoms which are now affecting my ability to rest in the evening and to sleep.

A: Restless leg syndrome is awful, as this 'expert' knows from personal experience back in the 80s when nothing, but nothing, would make the problem relent. It is now gaining recognition as a diagnosable problem, with a new name(!), and there are a number of treatment options which are being explored. A review article

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101885/

cites several of these, and the one acupuncture review this in turn cites

http://www.ncbi.nlm.nih.gov/pubmed/18843716

mentions two to three studies which are interesting but generally concludes that the majority of studies are too small and not methodologically sound enough to draw firm conclusions.

From a Chinese medicine perspective, however, there are entirely different ways of looking at the balance of energies within the body which can sometimes make sense of problems such as these within a theoretical structure which is quite different from western medicine. Problems like restless legs syndrome, where the leg feels as though it is 'over-energised', can sometimes make sense in a system of thought which looks at the free flow of energy within the system, and tries to understand the pathologies which arise in terms of excesses and deficiencies, and especially blockages. A skilled practitioner should very quickly be able to make sense of the energy flows within the system, and be able to offer you some sense of whether there is something which is treatable.

so as you can see, although there may be more chance of making sense of this within a Chinese medicine perspective, the evidence is still not that great.

The best advice is to consult a BAcC member local to you to seek their view based on a brief face to face consultation of whether treatment may be of benefit. You can tell them in confidence how the problem has developed, and we are sure that they will be able to give you an honest view of whether acupuncture would help.

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