Restless legs syndrome (RLS)
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Restless Legs Syndrome (RLS) manifests as a strong urge to move the legs, often triggered by discomfort sensation in the legs. It usually occurs during evening or nighttime when sitting or lying down, with movement offering temporary relief. RLS can start at any age and worsen with time, affecting sleep and daily activities.
Managing RLS involves adopting self-care habits and lifestyle changes, with medication often providing relief for many sufferer.
Restless Legs Syndrome (RLS), also known as Willis-Ekbom disease.
Types of RLS
There are two types of restless legs syndrome:
- Early onset: Typically diagnosed before the age of 45, this form of RLS often has a familial pattern and advances gradually over time.
- Late onset: Characterized by a faster progression, this type of RLS is diagnosed after the age of 45.
Symptoms
The primary indication of restless legs syndrome is a compelling need to move the legs. It is typical to encounter:
- Uncomfortable feelings that start when you’re resting. The sensation in the legs usually starts when you’ve been sitting or lying down for a long period. It could occur when seated in a vehicle, an aircraft, or a theater.
- Comfort through mobility. RLS becomes less intense as you move. Walking, pacing, leg jiggling, and stretching can all help with symptoms.
- A worsening of the symptoms at night. Most symptoms happen at night.
- Leg twitches during night. Periodic limb movement of sleep is a more prevalent condition that may be linked to RLS. Leg twitches and kicks may occur during the course of the night due to this condition.
Patients commonly characterize RLS symptoms as intense and uncomfortable sensations in the legs or feet, typically occurring bilaterally. In rarer cases, these sensations can extend to the arms.
These feelings are perceived internally within the leg rather than on the surface of the skin. They’re often characterized as.
- Itching
- Aching
- Electric
- Crawling
- Creeping
- Pulling
- Throbbing
At times, individuals may find it challenging to articulate the sensations associated with RLS. Typically, those affected do not liken the experience to muscle cramps or numbness. However, there is a consistent portrayal of an urge to move the legs. Fluctuations in symptom severity are common. Symptoms may intermittently subside for periods before recurring.
RLS has the potential to disrupt sleep, induce daytime drowsiness, and impact overall quality of life. If you experience symptoms of restless legs syndrome, it’s advisable to consult your doctor.
Causes
The exact cause of restless legs syndrome often eludes identification. Researchers hypothesize that an imbalance in the brain neurotransmitter dopamine might play a role. Dopamine is responsible for transmitting signals that regulate muscle movement.
Heredity
In some cases, RLS exhibits a familial pattern, particularly when the onset occurs before the age of 40. Researchers have pinpointed specific locations on chromosomes where genes associated with RLS might reside.
Pregnancy
Pregnancy or hormonal fluctuations can exacerbate symptoms of RLS. For some individuals, RLS may manifest for the first time during pregnancy, particularly in the later stages. Nonetheless, symptoms typically resolve post-delivery.
Risk factors
RLS can arise at any age, including childhood, but becomes more prevalent as individuals age. Furthermore, it tends to affect women more frequently than men. Typically, RLS is not indicative of a severe underlying medical issue; however, it can occasionally coincide with other conditions such as:
- Peripheral neuropathy. Chronic illnesses like diabetes and alcoholism can occasionally cause damage to the nerves in the hands and feet.
- A shortage of iron. RLS can be brought on by or made worse by iron deficiency, which is the body’s low iron levels. Individuals who have experienced bleeding in the intestines or stomach in the past may be iron deficient. Those who frequently donate blood or have heavy menstrual cycles may also be affected by deficiencies.
- Kidney failure. Iron deficiency, frequently accompanied by anemia, is a possibility if you have kidney failure. Iron stores in the blood might drop when renal function is impaired. RLS may be brought on by or made worse by these and other alterations in body chemistry.
- Problems with the spinal cord. RLS has been connected to spinal cord injury or damage. RLS development is often exacerbated by prior spinal cord anesthesia, such as a spinal block.
- Parkinson’s disease. RLS is more common in those with Parkinson’s disease who also use drugs known as dopaminergic agonists.
Diagnosis
Diagnosing restless legs syndrome involves your healthcare provider conducting a comprehensive review of your medical history and discussing your symptoms with you.
The diagnosis of RLS is based on specific criteria established by the International Restless Legs Syndrome Study Group, which include:
- You experience a compelling, frequently irresistible urge to move your legs, often accompanied by discomfortfeelings in the legs.
- Symptoms tend to emerge or intensify during periods of rest, such as when sitting or lying down.
- Engaging in activity, such as walking or stretching, offers partial or temporary relief from symptoms.
- Symptoms typically worsen during nighttime.
- No other medical or behavioral condition adequately explains the symptoms.
Your doctor may conduct both physical and neurological examinations. Blood tests, particularly focusing on iron levels, may be ordered to rule out other possible causes of your symptoms. If needed, you might be referred to a sleep specialist. While an overnight stay at a sleep clinic may be necessary for further assessment if another sleep disorder like sleep apnea is suspected, typically diagnosing RLS does not require a sleep study.
Treatment
Symptoms of restless legs syndrome may resolve upon addressing an underlying condition, such as iron deficiency. Treating an iron deficiency may entail oral iron supplementation or intravenous administration. It’s crucial to take iron supplements under medical supervision and following assessment of your blood iron levels.
For individuals with RLS not linked to another condition, treatment primarily centers on lifestyle modifications. If these prove ineffective, medication may be prescribed by your doctor.
Medications
There are various prescription medications available to alleviate the leg restlessness. While originally designed to treat other ailments, they have shown efficacy in managing RLS. These medications comprise:
- Medications that elevate dopamine levels in the brain: These drugs influence the levels of dopamine, a neurotransmitter in the brain. Rotigotine, pramipexole, and ropinirole are FDA-approved for managing moderate to severe RLS.
Short-term side effects of these medications are typically mild and may include nausea, dizziness, and fatigue. However, they can also result in impulse control issues, such as compulsive gambling, and daytime drowsiness. Occasionally, dopamine medications that initially alleviate RLS symptoms may become less effective over time or leading to augmentation. This may present as a return of symptoms earlier in the day or affecting other body parts like the arms. If augmentation occurs, your doctor may suggest switching to another medication.
For those experiencing occasional RLS symptoms, carbidopa-levodopa may be prescribed as needed. However, using this medication daily or near-daily is not recommended, as it can contribute to augmentation. - Medications targeting calcium channels: Drugs like gabapentin, gabapentin enacarbil, and pregabalin have shown effectiveness in managing RLS symptoms for certain individuals.
- Opioids: Primarily prescribed for severe symptoms, these medications carry a risk of addiction, particularly when taken in high doses. Examples include tramadol, codeine, oxycodone, and hydrocodone.
- Muscle relaxants and sleep aids: These medications can improve sleep quality but do not directly alleviate leg sensations. They may also induce daytime drowsiness. Typically, they are considered when other treatments fail to provide relief.
Finding the most effective medication or combination of medications to manage RLS may involve several trials. Many medications commonly used for RLS are not typically recommended during pregnancy. Instead, doctors may suggest self-care techniques to alleviate symptoms. However, if symptoms become troublesome during the last trimester, certain medications may be approved under medical supervision.
Additionally, some medications have the potential to worsen RLS symptoms. These may include certain antidepressants, antipsychotics, anti-nausea drugs, and cold/allergy medications. If possible, doctors may advise against their use. However, if necessary, they can discuss alternative treatments to help manage RLS symptoms.
