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Restless Legs Syndrome
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Restless legs syndrome is also called RLS and is a disease of the nerves that affects the degree to which the legs move at rest. It is also considered a sleep disorder because it interrupts sleep. The signs and symptoms of restless legs syndrome include:
- Unusual sensations in the legs that cause the individual to move the legs
- Interference with sleep
- The sensation of pins and needles on the legs or an itchiness of the legs
- Symptoms which are worse at night, especially when quiet and lying in bed at night
- Sensations that lead to sleep deprivation and increased stress in the body and mind
Restless legs syndrome is common and affects up to ten percent of the population. It can affect infants, young people and middle aged people. It is most common in the middle aged population or elderly people.
RLS can be severe or mild, it can worsen over time so that it is disabling to the person. The symptoms tend to be worse at night and improve in the morning. Those over the age of fifty have the most disabling of all symptoms. Most people don't know what it is and don't seek medical attention. Those that seek medical attention are often not diagnosed for 10-20 years following the onset of symptoms.
The exact cause of restless legs syndrome isn't known. It was once felt to be due to circulatory problems in the legs that, in turn, affect the nerves of the legs. Others believe it is related to neurotransmitters in the central nervous syndrome that control the unconscious movements of the legs. Primary RLS occurs without any previous health problems. Secondary restless legs syndrome occurs when an individual has a medical condition known to cause RLS. This includes being anemic, having peripheral neuropathy, being iron deficient or having known peripheral neuropathy. Diabetes commonly causes peripheral neuropathy and sets people up to have secondary RLS. RLS is very common in pregnancy and affects up to 40 percent of pregnant women. Medications can cause RLS, including caffeine, anti-seizure medications, imipramine withdrawal and cigarette smoking.
Uncommon secondary causes of RLS include being deficient in vitamin B12 or magnesium, having severe kidney problems so you are on dialysis, having Lyme disease or Amyloidosis or having rheumatoid arthritis or Sjogren's syndrome.
The risk factors of primary restless legs syndrome include hereditary causes. About 25-75 percent of cases are familial and usually start earlier in life. Fatigue, stress and psychiatric factors can make RLS worse.
RLS is also linked to those who have had bypass surgery of the stomach, Parkinson's disease, COPD, certain tumors, myelitis of the spinal cord, venous insufficiency, high or low thyroid syndromes, acute intermittent porphyria, cholesterol emboli to the legs, or fibromyalgia.
RLS can occur every night or can occur on a come and go basis. These types of individuals can go weeks or even months before an episode of RLS. When the attacks are severe, there is moderate to severe sleep deprivation that is sometimes not obviously linked to the RLS condition.
There is no blood test or x-ray test for restless legs syndrome. Doctors must rely on a history, physical and medical knowledge to identify that the condition is present. Thyroid hormone studies are done to look for secondary causes of RLS as is a complete blood count and a blood test that tests the function of the organs. An EMG can check for the presence of nerve problems in the legs. An EMG is also known as an electromyogram and is a good test of muscle and nerve function in the legs. The doctor can also do a sleep study to see why you are not sleeping.
The treatment of restless legs syndrome is directed at the symptoms. Alcohol, caffeine and cigarettes must be avoided. Physical therapy such as leg stretching and hot or cold packs to the legs can be used to reduce the restlessness of the legs. Whirlpool baths sometimes help as well.
Medications can include the use of medications to increase dopamine, such as levodopa. Dopamine agonists that mimic dopamine are used as well. Benzodiazepines, such as Klonopin, are used to relax the legs. Opiates are used, but are rarely used because of the addiction potential. Neurontin is an anticonvulsant that is used to treat RLS. Medications that are known as alpha-2 agonists stimulate receptors within the brain stem and activate nerves that control muscle movements.