Restless Legs (RLS)

restless-legs2Restless leg syndrome (RLS) is a neurological disorder, giving unpleasant sensations with an irresistible urge to move the legs. The condition can be distressing and can disrupt daily performance.

Around one in ten people are affected by RLS at some point in their life. The condition is more common from middle-age onward (but the symptoms can develop at any age, including childhood), with women twice as likely to develop it as men.

The cause is unknown in most patients, but can be worsened by stress, and is often passed down in families.

RLS may also accompany various chronic diseases, iron deficiency, pregnancy, the use of certain medications and withdrawal from sedatives, or low levels of dopamine, which helps control muscle movement.

 

Symptoms

restless-legs4These are most often described as creeping or crawling, itching, tingling or bubbling sensations in the feet, calves and thighs, and occasionally in the arms. When the symptoms arise, the sufferer finds it impossible to keep still and will have to jerk the affected limb, often needing to jump out of bed.

 

Symptoms usually occur in bed at night when the sufferer lies down, or sometimes during the day when sitting for long periods, causing air or car travel, classes or meetings to be uncomfortable.

 

They can occur now and again or every night, and vary from mild to severe, which, whilst not life-threatening, can result in poor quality sleep or insomnia, leading to daytime tiredness, anxiety, depression, and confusion.

Causes

Restless leg syndrome is sometimes called Nocturnal myoclonus, Akathisia and is sometimes known as Ekbom syndrome.

 

Some cases of RLS are caused by an underlying health condition, such as Parkinson’s disease, diabetes, anaemia (iron deficiency) or kidney failure. One in five pregnant women will experience symptoms of RLS in the last three months of their pregnancy.
However, in most cases there is no obvious cause of RLS, and it may simply be due to an inherited gene.

 

A growing number of neurologists now believe that the symptoms are caused by low levels of dopamine, a chemical released by nerve cells which helps control muscle movement.

Diagnosis

restless-legs3Although there is no known cure and no specific test for restless leg syndrome, addressing any underlying causes can cure the person of symptoms, so a general check-up and blood tests are advised.

 

Tests will be made to rule out disorders with similar symptoms, including iron deficiency anaemia and peripheral nerve disease. It is also helpful to consider whether recent stress and emotional upset can be a contributory cause.

 

Most patients also have periodic limb movement disorder (PLMD), which are rhythmic leg movements during sleep.

Treatment

Where mild or occasional RLS is not linked to an underlying health condition, sufferers may find lifestyle changes, such as taking up regular exercise, avoiding alcohol and caffeine and giving up smoking, can help. If stress is a cause, try gentle stretching exercises, massage and warm baths.

 

Where RLS is more severe, medication may be prescribed; for example iron supplements to control iron deficiency anaemia, or medicine to regulate the levels of dopamine in the body.

 

Pregnancy-related RLS will usually cease once a woman has given birth.

 

Symptoms can get worse over time and severely affect the sufferer’s life. Low doses of pramipexole (Mirapex) or ropinirole (Requip) can be very effective at controlling symptoms in some people.

 

If your sleep is severely disrupted, your health care provider may prescribe medications such as Sinemet (an anti-Parkinson’s medication), gabapentin and pregabalin, or tranquilizers such as clonazepam. However, these medications may cause daytime sleepiness.

 

Patients with iron deficiency should receive iron supplements.Low doses of narcotics may sometimes relieve symptoms of restless leg syndrome.