Case Report: Restless Legs Syndrome Resolved By Reversing Vitamin B1 Deficiency

By Dr. Howard Benedikt and Dr. Richard H. Mann

A seventy-year-old white female presented to the office with a complaint of pain across the base of her spine of three month's duration. Additionally, the patient claimed that for the past 3 years she had experienced tingling in her legs which would often awaken her at night. Her symptoms were stable, of gradual onset, and without radiations. She denied any history of precipitating trauma and claimed that this was her first episode of such symptoms.

She claimed she had previously been seen by her primary care physician for this problem and was diagnosed with restless legs syndrome (RLS) and sprain/strain of her lower back. Her primary care physician recommended an anti-inflammatory plus clonazepam or diazepam which she declined. She reported that in the past she had tried magnesium, calcium and vitamin C–all to no avail. Her medical history was negative. She denied taking any medications or currently being treated for any medical conditions.

Her physical examination was within normal limits. Her range of motion was restricted in flexion and extension at the hips. Toe and heel walk were within normal limits. Lasegue, FABER (Patrick's), and pinwheel test were within normal limits. +2 trigger points were noted along her lumbar spinal muscles as well as right gluteus maximus.

A diagnosis of RLS was made and the patient was placed on NeuRemedy® brand of benfotiamine capsules 300mg po bid. She reported total resolution of her symptoms within four days. The patient has continued taking NeuRemedy® and when last seen, at five months post initiation of therapy, remains asymptomatic. Her lower back pain improved with spinal manipulation.

Discussion: Benfotiamine is a highly absorbable lipid-soluble form of vitamin B1. It has been shown in multiple studies to be effective in improving both central and peripheral nervous system function. Vitamin B1 deficiency or insufficiency is a common cause of neurological dysfunction. In the central nervous system vitamin B1 deficiency is associated with Alzheimer's Disease and in the peripheral nervous system it is a common cause of the peripheral neuropathy associated with diabetes and excessive alcohol consumption. RLS is a sleep disorder that causes episodic highly unpleasant sensations in the legs. Symptoms are worse at night while lying in bed or while sitting. Many clinicians believe RLS is closely related to peripheral neuropathy. This case illustrates that benfotiamine supplementation may reverse the symptoms of RLS and that RLS may be associated with vitamin B1 deficiency.