Restless legs syndrome (RLS) is a neurological disorder characterized by uncontrollable urge to move when at rest. This urge stems from the unpleasant sensations such as burning, creeping or tugging in the legs and the movements are being made to relieve these feelings. These sensations are medically known as paresthesia (abnormal sensations) or dysesthesias (unpleasant abnormal sensations) and they range in severity from mildly uncomfortable to irritating or painful. The most unusual aspect of the condition is that lying down and trying to relax activates the symptoms. As a result, most people with RLS have difficulty falling asleep and staying asleep. It represent a very serious condition because many people with RLS report that their job, personal relations, and daily activities are strongly affected as a result of their exhaustion. Incidence
Some researchers estimate that RLS affects as many as 12 million Americans. There might be a lot more affected people but this condition is often under-diagnosed or in some cases, misdiagnosed. It is often confused with nervousness, insomnia, stress, arthritis, muscle cramps, or aging. Big problem is that RLS occurs in both genders, although the incidence may be slightly higher in women. It can begin at any age, even as early as infancy- but most patients are middle-aged or older.
Restless Legs Syndrome and Periodic Limb Movement Disorder
Several researches have proven that 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.
Unlike RLS, the movements caused by PLMD are involuntary. Although many patients with RLS also develop PLMD, most people with PLMD do not experience RLS.
Signs and symptoms
Common signs and symptoms include:
%26bull; Origination during inactivity
The most common characteristic is that the sensation typically begins while the patient is lying down or sitting for an extended period of time. This usually happens in a car, airplane or cinema.
%26bull; Relief by movement
The sensation of RLS lessens if the patient gets up and moves. Different patients do different stuff to relieve their symptoms. Some fight against these sensations by stretching, jiggling their legs, pacing the floor, some by exercising or walking.
%26bull; Worsening of symptoms in the evening
The symptoms are typically less bothersome during the day and are felt primarily at night.
%26bull; Nighttime leg twitching
Most patients with RLS find it difficult to get to sleep or stay asleep because of the twitching or kicking that occurs. The results are well known - insomnia leading to excessive daytime drowsiness.
Possible causes of RLS
In most cases, the cause of RLS is unknown. However, several theories tried to explain the possible causes of the disorder.
%26bull; Genetics
A family history of the condition is seen in approximately 50 percent of such cases. This suggests a genetic form of the disorder. It is also proven that people with familial RLS tend to be younger when symptoms start and have a slower progression of the condition.
%26bull; Low iron levels
People with low iron levels or anemia may be prone to developing RLS. Once iron levels or anemia is corrected, patients may see a reduction in symptoms.
%26bull; Other chronic diseases
It is proven that chronic diseases such as kidney failure, diabetes, Parkinson's disease, and peripheral neuropathy are associated with RLS. Treating the underlying condition often provides relief from RLS symptoms.
%26bull; Pregnancy
Some pregnant women experience RLS, especially in their last trimester. The good thing is that, for most of these women, symptoms usually disappear within 4 weeks after delivery.
%26bull; Kidney failure
Kidney failure may lead to iron deficiency which we have already stated as one of the possible causes of RLS.
%26bull; Certain medications
Certain medications such as anti-nausea drugs (prochlorperazine or metoclopramide), anti-seizure drugs (phenytoin or droperidol), antipsychotic drugs (haloperidol or Phenothiazines derivatives), and some cold and allergy medications may aggravate the symptoms.
%26bull; Other possible causes
Researchers also have found that caffeine, alcohol, and tobacco may aggravate or trigger symptoms in patients who are predisposed to develop RLS.
Diagnosis of RLS
Currently there is no single diagnostic test for RLS and the disorder is diagnosed clinically by evaluating the patient's history and symptoms. The International Restless
Legs Syndrome Study Group identified four basic criteria for diagnosing RLS:
1. a desire to move the limbs, often associated with paresthesia 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
Most people with RLS have sleep disturbances, largely because of the limb discomfort and jerking. The result is excessive daytime sleepiness and fatigue which could be crucial symptoms for making the exact diagnosis. Despite these efforts to establish standard criteria, the clinical diagnosis of RLS is difficult to make. Physicians must rely largely on patients' descriptions of symptoms and information from their medical history, including past medical problems, family history, and current medications. Patients may be asked about frequency, duration, and intensity of symptoms as well as their tendency toward daytime sleep patterns and sleepiness, disturbance of sleep, or daytime function. The diagnosis is especially difficult with children because the physician relies heavily on the patient's explanations of symptoms, which, given the nature of the symptoms of RLS, can be difficult for a child to describe. The syndrome can sometimes be misdiagnosed as %26quot;growing pains%26quot; or attention deficit disorder.
Treatment of RLS
Treating an underlying condition is basically the main way of treating RLS. If it is a case of iron deficiency, correcting the deficiency may involve taking iron supplements. The problem is if a patient has restless legs syndrome without any associated condition. In this case treatment focuses on lifestyle changes and medications.
Physicians also may suggest a variety of medications to treat RLS, including :
%26bull; Medications for Parkinson's disease
These drugs reduce the amount of motion in patient%26rsquo;s legs by affecting the level of the chemical messenger dopamine in brain.
They include pramipexole (Mirapex%26reg;), pergolide (Permax%26reg;), ropinirole (Requip%26reg;), and a combination of carbidopa and Levodopa (Sinemet%26reg;).
%26bull; Opioids
Nnarcotic medications are made to relieve mild to severe symptoms, but they may be addictive if used in high doses. Some examples include codeine, the combination medicine oxycodone and acetaminophen (Percocet%26reg;, Roxicet%26reg;), and the combination medicine hydrocodone and acetaminophen (Vicodin%26reg;, Duocet%26reg;).
%26bull; Muscle relaxants and sleep medications
These medications don't eliminate the leg sensations, and they may cause daytime drowsiness. Commonly used sedatives for RLS include Clonazepam (Klonopin%26reg;), Eszopiclone (Lunesta%26reg;), Ramelteon (Rozerem%26reg;), temazepam (Restoril%26reg;, Razapam%26reg;), zaleplon (Sonata%26reg;) and Zolpidem (Ambien%26reg;).
%26bull; Medications for epilepsy
Certain epilepsy medications, such as gabapentin (Neurontin%26reg;), may work well for some people with RLS although the precise mechanism is still unknown.
What is the prognosis?
This condition is generally a life-long condition for which there is no cure and symptoms may gradually worsen with age. Nevertheless, current therapies can control the disorder, minimizing symptoms and increasing periods of restful sleep.
Tips for the patients
%26bull; Take pain relievers exactly how your doctor prescribed them
%26bull; Try baths and massages and apply warm or cool packs
%26bull; Try relaxation techniques, such as meditation or yoga
%26bull; Establish good sleep hygiene and try to exercise regularly
%26bull; Avoid caffeine, cut back on alcohol and tobacco
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