Restless Legs Syndrome

Restless legs syndrome (RLS) is a neurologic sensorimotor and sleep disorder that is often characterized by an unpleasant and uncontrollable urge to move legs that result in sleeplessness. RLS is also called as Willis-Ekbom Disease. Sleep is the best form of rest that activates human to restart or recharge himself for his daily activities. Every human needs at least 7-9 hrs of undisturbed sleep everyday to have an optimal health. Mostly RLS is unrecognized and is very tricky to diagnose. RLS occurs in both men and women but the incidence is high in women and it can occur at any age, and the symptoms are more frequent and last longer with the age. RLS is more common in those with conditions such as diabetes, anaemia, rheumatoid arthritis and pregnant women.

Causes

In most cases, the exact cause of RLS is not known (idiopathic). However, sometimes it may have a genetic component (familial). In some other cases research indicates low levels of iron (ferritin) and dopamine (a neurotransmitter which controls muscle activity and movement) concentration in the brain may be responsible for RLS.

RLS appears to be related to some of the following conditions but not proven completely diseases like

  • Chronic diseases like kidney failure, peripheral neuropathy, Parkinson’s disease, iron deficiency, rheumatoid arthritis and diabetes are likely to be linked to RLS.
  • A Certain class of medications may aggravate the RLS symptoms. Medications related to cold and allergy which contain antihistamines, and others being antidepressants, antipsychotic, anti-nausea drugs and calcium-channel blockers.
  • Pregnant women, especially in the last trimester may experience a high dosage of RLS symptoms and symptoms usually disappear within a month after delivery.
  • In some individuals’ alcohol consumption, sleep deprivation, being overweight, stress and lack of exercise may also aggravate the symptoms of RLS.

Signs and Symptoms

  • The most important symptom being, a strong and irresistible urge to move your legs.
  • Unusual sensations like tingling, crawling, itching, creeping, pulling, throbbing and aching occur within the limbs rather than on the skin.
  • Fatigue, restlessness, floor pacing, tossing and turning in the bed and rubbing the legs.
  • Sleeplessness in the nights and excessive sleepiness at daytimes.
  • Periodic Limb Movement Disorder (PLMD) – Involuntary, repetitive, periodic, cramping or jerking limbs during the sleep. 80% of the people with RLS also have PLMD.

Diagnostic Measures

Diagnosing RLS is very tricky and it basically involves 4 important features.

  1. Taking the history of symptoms – A strong urge to move legs is often accompanied by uncomfortable sensations which include creeping, pulling, itching, creepy-crawly, gnawing or tugging. This is one of the criteria for diagnosing RLS.
  2. Symptoms get better when you move your legs – The uncomfortable sensations go away partially or totally by the movement of your legs, relief persists as long as movement is continued, and here is another sign of RLS.
  3. Symptoms start or get worse at rest – The longer you rest, the greater the chance you will experience RLS symptoms will occur and more severely they are likely to be.
  4. Symptoms are worst in the late evenings or nights – The symptoms of RLS follow a circadian pattern, so the symptoms become worst in the late evenings or nights.

Health Conditions Linked to RLS

  • Anaemia (Iron deficiency)
  • Rheumatoid Arthritis
  • Parkinson’s disease
  • Diabetes
  • Thyroid problems
  • Pregnancy
  • Alcoholism
  • Kidney disease
  • Neurologic lesions
  • Varicose veins
  • Insomnia/Narcolepsy/Sleep apnea
  • Periodic Limb Movement Disorder

Treatment (Medical)

General approach for the treatment of RLS involves

Dopamine agonists – These compounds mimic the original neurotransmitter, dopamine. Dopamine agonists activate dopamine receptors which in turn activate the signaling pathways. These are most often used medicines in treating RLS. The drugs include pramipexole (Mirapex), rotigotine (Neupro) and ropinirole (Requip).

Dopaminergic agents – Generally these drugs are used in the treatment of Parkison’s disease but used in lessening the symptoms of RLS also. These agents increase the level of dopamine in the brain. Frequently used agents are Levodopa combined with Carbidopa and Levodopa combined with benserazide.

Benzodiazepines – These are a class of psychoactive drugs that act on the central nervous system, selectively on GABA receptors.  They possess sedative, anti-anxiety and muscle relaxant properties. The generally used benzodiazepines are Diazepam (Valium), Alprazolam (Xanax), Loprazolam (Somnovit) and Triazolam (Apo-Triazo, Halcion, Hypam, and Trilam).

Opiates (Narcotics) – These medications can alleviate the strange sensations and pain and help you to get a good sleep or relax. As most of the opiates are addictive, they should be used for a shorter span and in severe conditions. Some of the opiates include Hydrocodone (Norco), Oxycodon (Oxycontin) and combined Oxycodone and Acetaminophen (Percocet, Roxicet).

Anticonvulsants (most commonly called as antiepileptic drugs or anti-seizure drugs) – Gabapentin (Neurotin), Gabapentin enacarbil (Horizant), Pregablin (Lyrica), Cymbalta (Duloxetine), Carbamazepine (Tegretol), Valproic acid (Depakote).

Alpha2 agonists – Clonidine (Catapres), Methyldopa (Aldomet) these Alpha2 agonists are responsible for the stimulation alpha2-receptors in the central nervous system which decreases sympathetic activity which further leads to decreased blood pressure and heart rate.

Treatment (Non-Medical)

  • Follow good sleeping habits, make a routine to go to bed at the same time in the night and wake up at the same time in the morning regularly.
  • Take iron supplementation if the cause is due to iron deficiency.
  • Massage your muscles especially your calves before bedtime which may help to ease the pain.
  • Say no to smoking.
  • Minimize the use of alcohol and caffeine.
  • Brisk walking for 30mins and mild exercises during the day can give a relief from RLS symptoms.
  • Placing a heating pad or an ice-pack on your legs might help.
  • Try a cool shower or lukewarm bath, sometimes a change in temperature helps.
  • Stimulating your feet with electrical impulses (Transcutaneous electric nerve stimulation – TENS therapy) also eases the symptoms.
  • Osteopathic exercise technique – positional release manipulation could benefit people with RLS.
  • Give acupuncture, hypnotherapy and reflexology a try to relieve the RLS symptoms.

 

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