Restless Legs Syndrome

Frustration. Exhaustion. Inability to rest or sleep without twitchy or uncomfortable legs. An overwhelming urge to move affected limb.

Many people would not realize that these distinctive symptoms actually have a name and therefore go undiagnosed and untreated resulting in restlessness, difficulty in sleeping and daytime sleepiness.

Restless legs syndrome (RLS) is a central nervous disorder possibly with some genetic predisposition or related to an imbalance of dopamine in the brain. Dopamine is a brain chemical that affects movement and as levels normally drop at night this may explain why RSL is worse at this time. Iron is a significant factor in the production of dopamine which may account for the link between low iron levels and RLS symptoms.
RSL may be acerbated, but not caused by stress or psychiatric conditions.

As indicated RLS usually affects the legs particularly the calves but some people may experience symptoms in the upper legs, feet, hands or arms.

Primary RSL seems to have no cause. Those affected may have developed the condition during childhood and this may have been attributed to growing pains (or even ADHD). There is a tendency for the condition to increase with age with significant increase in severity often seen after age 50.

With secondary RLS there is usually a link to another condition. These include anaemia, kidney disease, Parkinson’s disease, pregnancy, thyroid problems, neurologic lesions, sleep apnoea or narcolepsy, and alcoholism.
There are certain medications that when taken may trigger or increase RSL symptoms, as may the withdrawal of some drugs.

Diagnosis is usually made on the basis of reported symptoms and medical history. The four established criteria are:
• Irresistable urge to move your legs along with uncomfortable sensations (may be described as creeping, crawling, pulling, tingling, itching, pain, burning)
• Symptoms commence or get worse at rest (sitting, lying down)
• Symptoms are partially relieved by activity (stretching, walking)
• Symptoms are worse at night

Blood tests or other investigations may be done to exclude other possible causes.

RSL doesn’t lead to other serious conditions but symptoms can become incapacitating for some sufferers especially excessive tiredness from sleep deprivation.

There is no cure for RLS but there are treatments available that can manage the condition and relieve discomfort. This may involve treatment of underlying conditions, lifestyle techniques which may require changes in daily behavior or habits, use of support groups and in severe cases transcutaneous electric nerve stimulation (TENS) for a short time at night may be of help. Medications are commonly prescribed but there is no one drug that works for everyone and they should always be used with caution as may have side effects or increase the symptoms of RSL. Usually the drugs prescribed are ones used for other conditions but have been found to be beneficial with symptoms of RLS. They may include dopaminergic agents, Benzodiazepines, non benzodiazepine sedatives, opiates and narcotics and hypertensive medications.

RSL may necessitate referral to a sleep specialist for further evaluation. This may require observation overnight at a sleep clinic where sleep can be monitored for periodic limb movements during sleep. However a diagnosis can usually be made without a sleep study.

Irene