Restless legs syndrome

This condition is difficult to diagnose with certainty. It may respond to simple lifestyle changes or drug therapy.

What is restless legs?

Restless legs syndrome (RLS) is a neurological disorder characterized by unpleasant sensations in the legs and an uncontrollable urge to move when at rest in an effort to relieve these feelings. RLS sensations are often described by people as burning, creeping, tugging, or like insects crawling inside the legs. Often called paresthesias (abnormal sensations) or dysesthesias (unpleasant abnormal sensations), the sensations range in severity from uncomfortable to irritating to painful. 

Most people with RLS have difficulty falling asleep and staying asleep. Left untreated, the condition causes exhaustion and daytime fatigue.  

RLS usually occurs in middle age or older and is more common in women.

More than 80 percent of people with RLS also experience a more common condition known as periodic limb movement disorder (PLMD). PLMD is characterized by involuntary leg twitching or jerking movements during sleep that typically occur every 10 to 60 seconds, sometimes throughout the night.

What are common signs and symptoms of restless legs? 

People with RLS feel uncomfortable sensations in their legs, especially when sitting or lying down, accompanied by an irresistible urge to move about. These sensations usually occur deep inside the leg, between the knee and ankle; more rarely, they occur in the feet, thighs, arms, and hands. Although the sensations can occur on just one side of the body, they most often affect both sides. The discomfort is relieved by moving the legs. 

The symptoms are more often noticed in the evening or at night, especially during the onset of sleep but may also occur during periods of inactivity such as long car trips, sitting in a movie theatre, long-distance flights, immobilization in a cast, or relaxation exercises. 

What causes restless legs syndrome? 

In most cases, the cause of RLS is unknown. A family history of the condition is seen in approximately 50 percent of such cases. In other cases, RLS appears to be related to the following factors or conditions:

  • low iron levels or anaemia
  • kidney failure
  • diabetes
  • medications including antinausea drugs, antiseizure drugs, antipsychotic drugs, and some cold and allergy medications-may aggravate symptoms
  • Caffeine, alcohol, and tobacco may aggravate or trigger symptoms in patients who are predisposed to develop RLS. Some studies have shown that a reduction or complete elimination of such substances may relieve symptoms.

How is restless legs syndrome diagnosed? 

Currently, there is no single diagnostic test for RLS. The disorder is diagnosed based on the history, examination and some routine tests. 

In 1995, the International Restless Legs Syndrome Study Group identified four basic criteria for diagnosing RLS

(1) a desire to move the limbs, often associated with paresthesias or dysesthesias,

(2) symptoms that are worse or present only during rest and are partially or temporarily relieved by activity,

(3) motor restlessness,

(4) nocturnal worsening of symptoms.

How is restless legs syndrome treated?

Although movement brings relief to those with RLS, it is generally only temporary. However, RLS can be controlled by finding any possible underlying disorder. Often, treating the associated medical condition, such as peripheral neuropathy or diabetes, will alleviate many symptoms. 

For patients with idiopathic (no obvious cause) RLS, treatment is directed toward relieving symptoms. For those with mild to moderate symptoms, prevention is key, and many physicians suggest certain lifestyle changes and activities to reduce or eliminate symptoms. Decreased use of caffeine, alcohol, and tobacco may provide some relief. Physicians may suggest that certain individuals take supplements to correct deficiencies in iron, folate, and magnesium. 

Studies also have shown that maintaining a regular sleep pattern can reduce symptoms. Some individuals, finding that RLS symptoms are minimized in the early morning, change their sleep patterns. Others have found that a program of regular moderate exercise helps them sleep better; on the other hand, excessive exercise has been reported by some patients to aggravate RLS symptoms. 

Taking a hot bath, massaging the legs, or using a heating pad or ice pack can help relieve symptoms in some patients. Although many patients find some relief with such measures, rarely do these efforts completely eliminate symptoms 

Physicians also may suggest a variety of medications to treat RLS. The drug usually used is Mirapexin and it is prescribed in a gradually increasing dose until the most effective dose is found: 

  • 0.125mg 2- 3 hours before bed for 4-7 days
  • 0.25mg 2- 3 hours before bed for 4-7 days
  • 0.5mg 2- 3 hours before bed for 4-7 days
  • 0.75mg 2- 3 hours before bed for 4-7 days

Side effects: Drowsiness, visual hallucinations, hypotension, nausea, headache and fatigue.

Anticonvulsants such as carbamazepine and gabapentin are also useful for some patients, as they decrease the sensory disturbances (creeping and crawling sensations). Dizziness, fatigue, and sleepiness are among the possible side effects.

What is the prognosis of people with restless legs? 

RLS is generally a lifelong condition for which there is no cure. Symptoms may gradually worsen with age, though more slowly for those with the idiopathic form of RLS than for patients who also suffer from an associated medical condition. 

Nevertheless, current therapies can control the disorder, minimizing symptoms and increasing periods of restful sleep. 

In addition, some patients have remissions, periods in which symptoms decrease or disappear for days, weeks, or months, although symptoms usually eventually reappear. A diagnosis of RLS does not indicate the onset of another neurological disease.

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