Control of medically refractory restless legs syndrome with intrathecal morphine: case report.

Abstract

Restless legs syndrome is now widely recognized and is usually successfully treated with medication. Occasionally, it may be severe and refractory to medication. Intrathecal opiates have been previously described to be useful in this situation in a single report. We report the successful use of low-dose intrathecal morphine in a severe case of restless legs syndrome refractory to medication. The surgery was complicated by extreme restlessness in the recovery room resulting in withdrawal or breakage of the catheter on multiple occasions. Relief of symptoms was lost with each catheter malfunction. We describe the possible origin of this complication and a solution to the problem resulting in the successful control of symptoms for 7 months since the last surgery. Intrathecal opiates for restless legs syndrome are currently considered investigational, but we hope, with this second report of the efficacy of low-dose intrathecal narcotics in this condition, to stimulate further investigation of this treatment modality.