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Aug 08, 2006
Restless legs syndrome
by SirGan
 Restless legs syndrome (RLS) is a neurological disorder characterized by uncontrollable urge to move when at rest in an effort. It is also accompanied with unpleasant sensations in the legs and these movements are being made to relieve these feelings. Patients are describing these sensations as burning, creeping, tugging, or like insects crawling inside the legs. They are medically known as paresthesia (abnormal sensations) or dysesthesias (unpleasant abnormal sensations). The fact is also that these sensations range in severity from uncomfortable to irritating to painful. What is so strange about this disorder? Well, the most unusual aspect of the condition is that lying down and trying to relax activates the symptoms. As a result, most people with RLS have difficulty falling asleep and staying asleep. Although it doesn’t sound like one- it represent a very serious condition because many people with RLS report that their job, personal relations, and activities of daily living are strongly affected as a result of their exhaustion. Incidence of the conditionSome researchers estimate that RLS affects as many as 12 million Americans. Some experts are saying that there is a lot more of cases but because the condition is often under-diagnosed and, in some cases, misdiagnosed. It is often misdiagnosed with nervousness, insomnia, stress, arthritis, muscle cramps, or aging. Big problem is that RLS occurs in both genders, although the incidence may be slightly higher in women. It can begin at any age, even as early as infancy- but most patients are middle-aged or older.
Restless Legs Syndrome and Periodic Limb Movement DisorderSeveral researches have proven that more than 80 percent of people with RLS also experience a more common condition known as periodic limb movement disorder (PLMD). What is the difference? Well, it is simple- PLMD is characterized by involuntary leg twitching or jerking movements during sleep that typically occur every 10 to 60 seconds, sometimes throughout the night.
Signs and symptomsCommon characteristics of the signs and symptoms include:
The most common characteristic is that the sensation typically begins while the patient is lying down or sitting for an extended period of time. This happens especially in a car, airplane or cinema…
There is no doubt- common symptoms is that the sensation of RLS lessens if patient gets up and moves. That’s why; different patients do different stuff to relieve their symptoms. Some fight against these sensations by stretching, jiggling their legs, pacing the floor, some by exercising or walking.
Bad thing about this disorder is also that all the symptoms typically are less bothersome during the day and are felt primarily at night.
Doctors used to call this condition myoclonus. Could you imagine hundreds of these twitching or kicking movements which may occur throughout the night? That’s why most patients with RLS find it difficult to get to sleep or stay asleep. The results are well known- insomnia leads to excessive daytime drowsiness.
Possible causes of RLSUnfortunately- in most cases, the cause of RLS is unknown. However, several theories tried to explain the possible causes of the disorder!
Every patient should know that a family history of the condition is seen in approximately 50 percent of such cases. This of course suggests a genetic form of the disorder. Another thing is also important: it is proven that people with familial RLS tend to be younger when symptoms start and have a slower progression of the condition.
People with low iron levels or anemia may be prone to developing RLS. Once iron levels or anemia is corrected, patients may see a reduction in symptoms.
It is proven that chronic diseases such as kidney failure, diabetes, Parkinson's disease, and peripheral neuropathy are associated with RLS. The proof is that treating the underlying condition often provides relief from RLS symptoms.
It isn't a secret that some pregnant women experience RLS, especially in their last trimester. Only good thing is that, for most of these women, symptoms usually disappear within 4 weeks after delivery.
It is also proven that, if someone has kidney failure, he or she also may have iron deficiency. When the kidney fails to function properly, iron stored in blood can decrease.
Certain medications-such as anti-nausea drugs (prochlorperazine or metoclopramide), anti-seizure drugs (phenytoin or droperidol), antipsychotic drugs (haloperidol or Phenothiazines derivatives), and some cold and allergy medications-may aggravate symptoms.
Researchers also have found that caffeine, alcohol, and tobacco may aggravate or trigger symptoms in patients who are predisposed to develop RLS.
Diagnosis of RLSUnfortunately- currently there is no single diagnostic test for RLS and the disorder is diagnosed clinically by evaluating the patient's history and symptoms. Everyone should know that The International Restless Legs Syndrome Study Group identified four basic criteria for diagnosing RLS:
Most people with RLS have sleep disturbances, largely because of the limb discomfort and jerking. The result is excessive daytime sleepiness and fatigue which could be crucial symptoms for making the exact diagnosis! Despite these efforts to establish standard criteria, the clinical diagnosis of RLS is difficult to make. Physicians must rely largely on patients' descriptions of symptoms and information from their medical history, including past medical problems, family history, and current medications. Patients may be asked about frequency, duration, and intensity of symptoms as well as their tendency toward daytime sleep patterns and sleepiness, disturbance of sleep, or daytime function. The diagnosis is especially difficult with children because the physician relies heavily on the patient's explanations of symptoms, which, given the nature of the symptoms of RLS, can be difficult for a child to describe. The syndrome can sometimes be misdiagnosed as "growing pains" or attention deficit disorder.
Treatment of RLSThe fact is that treating an underlying condition is basically the main way of treating RLS. If it is a case of iron deficiency- correcting the deficiency may involve taking iron supplements. Problem is if a patient has restless legs syndrome without any associated condition. In this case treatment focuses on lifestyle changes and medications. Physicians also may suggest a variety of medications to treat RLS, including dopaminergic, benzodiazepines, opioids, and anticonvulsants. These include:
The most important thing there is to know about these drugs is that they reduce the amount of motion in patient’s legs by affecting the level of the chemical messenger dopamine in brain.
Everyone knows that narcotic medications are made to relieve mild to severe symptoms, but big problem is that they may be addicting if used in too high doses. Some examples include codeine, the combination medicine oxycodone and acetaminophen (Percocet, Roxicet), and the combination medicine hydrocodone and acetaminophen (Vicodin, Duocet).
These medications don't eliminate the leg sensations, and they may cause daytime drowsiness. Commonly used sedatives for RLS include Clonazepam (Klonopin), Eszopiclone (Lunesta), Ramelteon (Rozerem), temazepam (Restoril, Razapam), zaleplon (Sonata) and Zolpidem (Ambien).
Certain epilepsy medications, such as gabapentin (Neurontin), may work well for some people with RLS although the precise mechanism is still unknown!
What is the prognosis?Unfortunately- basic thing there is to know about this condition is that it is generally a life-long condition for which there is no cure and symptoms may gradually worsen with age. Nevertheless, current therapies can control the disorder, minimizing symptoms and increasing periods of restful sleep.
Tips for the patients
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