What Is Restless Legs Syndrome? What Causes Restless Legs Syndrome?

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Main Category: Neurology / Neuroscience
Also Included In: Sleep / Sleep Disorders / Insomnia
Article Date: 24 Apr 2009 - 0:00 PDT

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According to the Medilexicon's medical dictionary, restless legs syndrome is "a sense of indescribable uneasiness, twitching, or restlessness that occurs in the legs after going to bed, frequently leading to insomnia, which may be relieved temporarily by walking about; thought to be caused by inadequate circulation or as a side effect of some SSRIs and other psychotropic medications".

If you have RLS (restless legs syndrome) you have a disorder which causes a strong urge to move your legs. This urge is frequently accompanied with strange and unpleasant sensations in your legs. Patients say the only way to relieve those unpleasant feelings is to move their legs.

The following words are from patients as they describe the unpleasant feelings in their legs which trigger their urge to move them:

• Aching
• Burning
• Crawling
• Creeping
• Electric shocks
• Itching
• Tugging
• Tingling

Some patients experience those sensations in their arms as well.

A significant number of patients say the sensations occur when they are resting or inactive, and not exclusively after they go to bed. Symptoms tend to worsen in the evening and at night, and are often relieved for a short while in the morning.

Periodic Limb Movement Disorder (PLMD)

The patient's leg twitches or jerks uncontrollably about every 10 to 60 seconds. It usually occurs during sleep and is considered to be a type of sleeping disorder. PLMD makes the sufferer wake up frequently during the night, this undermines the quality and length of sleep. Most people with RLS have PLMD.

Restless legs syndrome can affect sleep

The majority of patients with RLS find it hard to fall asleep, and when they do, they find it difficult to stay asleep throughout the night. Consequently, many RLS sufferers find they are tired and sleepy during the day. Irregular and insufficient sleep can affect the patient's ability to learn, work, concentrate, and carry out normal routine tasks and activities. Lack of sleep can eventually lead to mood swings, irritability, depression, an undermined immune system, and other physical and health problems.

RLS is classed from mild to severe.

This depends on:

• How often the symptoms occur
• How severe the symptoms are
• How effective moving around is in relieving the symptoms
• The degree of sleep disturbance suffered

There are two main types of Restless Legs Syndrome

Primary RLS (idiopathic RLS)

Primary means the cause is not known. The RLS starts before the age of 45, and tends to be hereditary. This type of RLS can even start during childhood. Patients usually have this type for life once it starts. Symptoms will gradually worsen over time. Symptoms will also occur more often over time. Patient's whose symptoms are classed as mild may have long periods with no symptoms at all. This is the most common type of RLS.

Secondary RLS

Secondary means it is caused by another disease process or condition. The RLS generally starts after the age of 45, and does not tend to be hereditary. Patients with this type will experience a more abrupt onset. Symptoms do not usually worsen as time goes by.

RLS may be triggered by other conditions and diseases

The following diseases and symptoms have been known to trigger RLS:

• Diabetes
• Iron deficiency
• Kidney failure
• Parkinson disease
• Peripheral neuropathy
• Pregnancy
• Rheumatoid arthritis

When the RLS is triggered by a disease or condition the symptoms will start abruptly - there is not a gradual onset. Patients with the type of RLS that usually starts later in life will experience worse symptoms if the RLS is triggered by a medical condition or because they are taking certain medications.

What is the outlook for a Restless Leg Patient? What is the prognosis?

Symptoms of RLS generally worsen over time. Some people, however, may experience weeks or months without any symptoms at all.

If the RLS has been triggered by a condition, illness or medication, it may go away as soon as the trigger has gone, or has been relieved. Women who get RLS during their pregnancy tend to get better as soon as their baby is born. RLS patients who had kidney failure and then a kidney transplant will generally get better after the transplant (just dialysis will not usually relieve RLS).

What is the treatment for Restless Legs Syndrome?

Treating an underlying condition

If the underlying condition/illness that triggers the RLS is treated, the RLS might either go away or improve - this is especially the case with iron deficiency and peripheral neuropathy.

Lifestyle changes and OTC medications

Some simple lifestyle changes and OTC (over-the-counter) medications may help alleviate RLS symptoms, such as:

• Painkillers - if symptoms are very mild, ibuprofen has been found to relieve patients' symptoms.


• Warm baths - relaxing in a warm bath and massaging your legs may help relax your muscles and reduce the intensity of symptoms


• Warm or cool packs - some patients prefer warm packs, other find cool packs work better, while some say that alternating from hot-cold-hot works best.


• Relaxation techniques - experts say that stress can make RLS worse. Relaxation techniques, such as Yoga and Tai Chi are known to help RLS patients enormously.


• Sleep routine and environment - RLS patients who are tired tend to experience worsened symptoms. A cool and quiet bedroom helps people sleep better. Go to bed at the same time every night, and get up at the same time every morning. Many patients say they have managed to get a better night's sleep by going to bed a bit later.


• Exercise and physical activity - exercise can help RLS, but can also make it worse. The majority of patients comment that moderate exercise helps symptoms a lot, while too much exercise sometimes makes them worse. Many also say that working out late in the evening does not help them.


• Caffeine - some patients have found that their symptoms improve if they either cut back on caffeine or stop consuming it altogether. Drinks containing coffee, tea, chocolate and many sodas have caffeine in them. If abstaining from caffeine helps relieve symptoms, it will do so usually after a few weeks - so, it is important to persevere.


• Alcohol - some patients have found that either cutting down on alcohol or abstaining completely helps.


• Tobacco - this can be an RLS trigger for some people. So, either cutting down or giving up smoking altogether may help.

Medication

When other therapies have not worked, the doctor may prescribe medication for RLS. A doctor may prescribe one of the medicines below, or a combination - this depends on the individual patient.

• Alpha 2 agonists - these may help in cases of primary RLS, but will have no effect on periodic limb movement during sleep. They are used to stimulate the alpha 2 receptors in the brain stem. Alpha 2 agonists activate neurons that make the part of the nervous system that controls muscle movement and sensations less active. Catapres (clonidine hydrochloride) is an Alpha 2 agonist.


• Anticonvulsants - these are for patients who experience pain, neuropathy, or have symptoms during the daytime. Anticonvulsants are used for treating muscle spasms. Neurontin (gabapentin) is a popular anticonvulsant.


• Benzodiazepines - these (sedative) medications help the patient sleep through the symptoms of RLS. If a patient with RLS has persistent sleeping problems the doctor may prescribe a benzodiazepine. Restoril (temazepam), Xanax (alprazolam), and Konopin (clonazepam) are common benzodiazepines.


• Dopaminergic agents - these raise the levels of dopamine - a neurotransmitter - in the brain. They are used for treating the unpleasant leg sensations experienced by RLS patients. Levodopa and carbidopa are common dopaminergic agents.


• Dopamine agonists - these also raise brain dopamine levels. Some elderly patients may find the side-effects are not worth the benefits. However, dopamine agonists are said to have a smaller probability of side-effects compared to levodopa. Dopamine agonists are used for the treatment of unpleasant leg sensations. Permax (pergolide mesylate), (Parlodel) bromocriptine mesylate, Mirapex (pramipexole), and Requip (ropinirole hydrochloride) are common dopamine agonists.


• Opiates - these are used for treating pain, but they can also relieve RLS symptoms. Doctors may prescribe these when other medications have failed. Codeine and propoxyphene are examples of low dose opiates, while are oxycodone hydrochloride, methadone hydrochloride, and levorphanol tartrate are examples of common high dose opiates. For further information about opioids please visit All About Opioids and Opioid-Induced Constipation (OIC).

Parkinson's disease and Epilepsy drugs are sometimes used for RLS patients as they can reduce involuntary movements.

Diagnosis of Restless Legs Syndrome

The doctor relies on a good medical history and a physical examination when making a diagnosis. According to Wikipedia, sleep registration in a laboratory (polysomnography) is not necessary for the diagnosis.

When considering the differential diagnosis the doctor should look out for peripheral neuropathy, radiculopathy (conditions which have caused damage to the nerve roots which connect the spine to the rest of the nervous system) and leg cramps - in these conditions the urge to move is less pronounced than the level of pain.

The doctor must also consider akathisia, a side effect of some antidepressants and antipsychotic medications - there is a more constant form of leg restlessness without discomfort or unpleasant sensations.

A Doppler ultrasound evaluation of the vascular system will eliminate any venous disorders, which commonly trigger RLS.

Written by - Christian Nordqvist

Original article date: 3 May 2004
Article updated: 23 April 2009



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