Restless Leg Syndrome


RESTLESS LEG SYNDROME

Description:

A sense of indescribable uneasiness, twitching, or restlessness that occurs in the legs after going to bed, frequently leading to insomnia, which may be relieved temporarily by walking about; thought to be caused by inadequate circulation or as a side effect of antipsychotic medication.

Alternative Names: Akathisia, Ekbom syndrome, and Nocturnal myoclonus.

Abbreviation: RLS.

Restless Leg Syndrome (RLS) is a neurological disorder. It is characterized by an urge to move the legs in order to relieve abnormal sensations such as pain, creeping, or burning. In fact, some people say it feels like insects are crawling around inside their legs.

Most people with RLS also experience a more common condition known as periodic limb movement disorder (PLMD). PLMD is involuntary leg twitching or jerking movements during sleep that typically occur every 10 to 60 seconds, in periods or throughout the night. The symptoms cause repeated awakening and disrupted sleep. Unlike RLS, the movements caused by PLMD are involuntary-people have no control over them. Although many patients with RLS also develop PLMD, most people with PLMD do not experience RLS. Like RLS, the cause of PLMD is unknown.

The urge to move the legs occurs during periods of rest, such as before falling asleep, and generally tends to be worse in the evenings and at night. Although movement relieves the symptoms, the sensations often return. Although this condition is known as Restless Leg Syndrome, the abnormal sensations can occur in the arms as well.

Restless legs syndrome (RLS) may affect as many as 12 million people in the United States. More than half of the people who have RLS have family members with the condition.

RLS can affect people of any race or ethnic group, but the disorder is more common in people of Northern European descent. RLS affects both genders, but women are more likely to have it than men. Research has also shown that more than 50%, or over half of those with primary Restless Legs Syndrome report having a family member with Restless Legs Syndrome.

Restless legs syndrome is one of the leading causes of insomnia, affecting more than five to 10 percent of the white population,

Types:

Primary RLS: This is the most common type of RLS. It is also called idiopathic RLS, the cause is not known. A good deal of research has studied this condition recently, and preliminary studies suggest that it can be a genetic disorder of altered brain chemistry. Primary RLS, once it starts, usually becomes a lifelong condition. Over time, symptoms tend to get worse and occur more often, especially if they began in childhood or early in adult life. In milder cases, there may be long periods of time with no symptoms, or symptoms may last only for a limited time.

Secondary RLS: This type of RLS is caused by another disease or condition sometimes, from taking certain medicines. Symptoms usually go away when the disease or condition improves, or if the medicine is stopped.

Restless legs syndrome rarely results in any serious consequences. However, in some cases severe and persistent symptoms can cause considerable mental distress, chronic insomnia, and daytime sleepiness. In addition, since restless legs syndrome (RLS) is worse when resting, people with severe RLS may avoid daily activities that involve long periods of sitting, such as going to movies or traveling long distances.

Symptoms:

People with Restless Legs Syndrome can experience their symptoms very differently. It can also be difficult for patients to describe their symptoms. Many people with Restless Legs Syndrome feel a strong, irresistible urge to move their legs whenever they sit or lie down. They may also have uncomfortable sensations in their legs, often described as creeping, crawling, tingling, or pulling.

The four key signs of restless legs syndrome (RLS) are:

    A strong urge to move your legs. This urge often, but not always, occurs with unpleasant feelings in your legs. When the disorder is severe, you also may have the urge to move your arms.

  1. Symptoms that start or get worse when you're inactive. The urge to move increases when you're sitting still or lying down and resting.

  2. Relief from moving movements, especially walking, helps relieve the unpleasant feelings.

  3. Symptoms that start or get worse in the evening or at night.

Causes and Risk factors:

One current theory suggests that a deficiency in a brain chemical called dopamine causes restless legs syndrome.

A number of conditions can affect how much iron is in the brain or how it's used. These conditions include kidney failure, Parkinson disease, diabetes, rheumatoid arthritis, pregnancy, and iron deficiency. All of these conditions increase the risk of having RLS.

Iron deficiency, even at a level too mild to cause anemia, has been linked to restless legs syndrome (RLS) in some people. Studies suggest, in fact, that RLS in some people may be due to a problem with getting iron into cells that regulate dopamine in the brain. Some studies have reported RLS in 25 - 30% of people with low iron levels.

A new study confirmed that a gene associated with restless legs syndrome (RLS) susceptibility is located on chromosome 12q and also suggests that at least one other gene may be involved in restless leg syndrome,

People whose family members have RLS also are more likely to develop the disorder. This suggests that genetics may contribute to the faulty use or lack of iron in the brain that triggers RLS.

Medications including tricyclic antidepressants, anti-nausea and anti-seizure drugs, selective serotonin reuptake inhibitors (SSRIs), lithium, and some cold and allergy drugs may increase or trigger RLS symptoms. In addition, withdrawal from sedatives may trigger RLS.

Diagnosis:

The diagnosis of RLS requires an assessment of your medical history and description of symptoms. The doctor will rule out other possibilities and focus on the presence of four factors in order to diagnose your condition.

There is no blood or lab test specifically for the diagnosis of RLS, still, your doctor will likely order blood tests to measure your iron levels. He or she also may order muscle or nerve tests. These tests can show whether you have a condition that may worsen RLS or that has symptoms similar to those of RLS.

Certain laboratory tests may be helpful in determining causes of restless legs syndrome (RLS) or conditions that rule it out. They include:

    Blood glucose tests for diabetes.

  • Tests for kidney problems.

  • In certain cases, tests for thyroid hormone, magnesium, and folate levels.

Treatment:

Although no cure exists for Restless Legs Syndrome, different types of treatment can be used to manage the condition and relieve discomfort. If your symptoms are mild, self-help may be sufficient treatment. If your Restless Legs Syndrome is caused by an underlying condition, treatment of the underlying condition often cures the RLS.

Medical Treatment:

Common medications prescribed for RLS include:

    Dopaminergic agents (Examples: Ropinirole, Pramipexole) - Often, this is the first line of treatment for RLS. Normally used to treat Parkinson's disease, these medications increase dopamine, a neurotransmitter that regulates muscle movements.

  • Benzodiazepines - These are sleep medications, or central nervous system depressants, which also suppress muscle contractions.

  • Non-benzodiazepine sedatives - Short-acting hypnotic agents, or sleeping pills. These may be helpful for mild RLS that occurs primarily at bedtime.

  • Opiates / narcotics (Examples: low-potency Darvon, high-potency Percodan) - Pain-killing and relaxing drugs can suppress RLS in some people. Addictive and should be used only in low dosages.

  • Anticonvulsants (Examples: Gabapentin, Neurontin) - normally used to prevent seizures, and reduce muscle contractions for some people.

  • Hypertensive medications - Generally prescribed for high blood pressure.

Regular, moderate exercise, healthful in any case, may help prevent RLS. Patients report that either bursts of excessive energy or long sedentary periods worsen symptoms.

Applying electrical stimulation to feet and legs reduces nighttime leg jerking in some patients who have severe RLS. Using a portable, bedside TENS unit, you apply electrical stimulation for 15 to 30 minutes to your legs.

Other activities that also may help relieve symptoms include:

    Walking or stretching.

  • Taking a hot or cold bath.

  • Massaging the leg or arm.

  • Using heat or ice packs.

Medicine and medications:

Levodopaa, Dopamine agonists (pergolide, pramipexole, and ropinirole), narcotics, Benzodiazepines, Anticonvulsants, and iron supplements.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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