Vivian Eyoita
31 March 2007
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Lagos — Restless Legs Syndrome (RLS) is a medical condition in which the legs feel very uncomfortable in the seated position or when lying down. It prompts sufferers to get up and walk around to alleviate the symptoms. RLS affects both sexes, may start at any age and may worsen with age. RLS can disrupt sleep and hence lead to daytime drowsiness. Patients typically describe the unpleasant sensation of Restless Legs Syndrome as a deep-seated crawling, tingling, creeping, jittery, aching or burning sensation in the feet, calves, thighs or arms.
In some cases, patients are unable to accurately describe the sensations felt. The sensation typically starts when seated or lying down for extended periods of time. The feelings improve when patients resume activity by walking around, stretching, jiggling legs or exercising. Patients have a compelling desire to move as a result, giving the condition its name. Symptoms tend to worsen at night and are not much of a bother during the day. More than 80% of cases of RLS is associated with periodic limb movements of sleep (PLMS) formerly known as myoclonus. With PLMS, patients involuntarily flex and extend legs during sleep without knowing it often leading to a restless night's sleep for the individuals bed partner. Hundreds of these twitching or kicking movements may occur through the night. In severe RLS, these movements may also occur while awake. PLMS is commonly seen in older adults that don't have restless legs syndrome and that does not always disrupt sleep. Most patients with RLS find it difficult to fall asleep and stay asleep. The insomnia may lead to excessive daytime drowsiness and even taking a nap during the day may be impossible because of the symptoms. The symptoms of RLS can range in severity from bothersome to incapacitating and in some cases the symptoms disappear for periods of time. RLS may develop at any age and even in childhood. It is however more common in advancing age.
In several cases there is no known cause for RLS. Medical researchers believe that it may be due to an imbalance of a brain chemical known as Dopamine. This chemical sends messages that control muscle movement. Up to 50% of patients with RLS have a positive family history of the disease especially in cases that start at an early age. Sites on the chromosomes where the genes for RLS may be present have been identified by researchers. Stress worsens the symptoms of RLS. Pregnancy and Hormonal changes may also temporarily worsen symptoms and some women experience RLS for the first time in pregnancy, particularly in the third trimester. Fortunately, these symptoms usually disappear about a month after childbirth. RLS is not related to a serious medical condition but it sometimes accompanies other conditions such as Iron Deficiency. Even in the absence of anaemia, iron deficiency may cause or worsen RLS. Peripheral Neuropathy which describes damage to nerves in the hands and feet due to conditions such as Diabetes and Alcoholism may also be associated with RLS. Patients with kidney failure may also have iron deficiency. When kidney function is impaired, iron stores may reduce leading to or worsening RLS.
Some patients with RLS never seek medical advice because of the fear that they may not be able to accurately describe symptoms or the fear that they will not be taken seriously. Some doctors wrongly attribute the commonly experienced symptoms to nervousness, muscle cramps, stress or insomnia. In recent times, RLS has received increased media attention and focus from the medical community increasing the awareness of the disease. A detailed medical history will help doctors make a diagnosis. There is no lab test to diagnose the condition but blood tests and nerve studies may be performed to rule out other conditions that may lead to similar symptoms. A sleep specialist may also be consulted for further evaluation.
Treatment of underlying conditions associated with RLS may greatly improve the symptoms. In cases that are not associated with an underlying condition, the focus of treatment is geared towards lifestyle changes and medications. The medications used were originally developed to treat other conditions but have been found useful in the treatment of RLS. Such medications include drugs used for the treatment of Parkinson's disease which reduce the motion in the legs by altering the levels of dopamine in the brain. These include Pramipezole, Pergolide, Ropinirole and a combination of Levodopa and Carbidopa. Narcotic medications such as Opioids may releive mild to severe symptoms. These include Codeine, a combination of Oxycodone and Acetominophen and a combination of Hydrocodone and Acetominophen. There is a danger of dependency if these narcotics are taken in high doses. Sedatives may be given to help individuals sleep but they do not address the jerking movements and sensations. These drugs such as Clonazepam, Eszopiclone and Ramelteon may lead to daytime drowsiness. Some patients respond well to drugs used for the treatment of Epilepsy such as Gabapentin. Some doctors prescribe a combination of medications for best results. It may take several trials to find out what drugs and dosages work best for affected patients. Some patients develop tolerance to treatment and may find symptoms returning at times earlier than previously experienced. These medications are not prescribed in pregnancy so expectant mothers are advised on the self-care techniques available. There are also medications that may worsen the symptoms of RLS. These include Antiemetics (anti-nausea), Calcium channel blockers used to treat heart conditions and hypertension and most Antidepressants.
If these medications must be taken for medical conditions, the addition of drugs for the treatment of RLS may be used to alleviate symptoms.
There are lifestyle changes that may help alleviate the symptoms of RLS. The use of over-the-counter pain relievers such as ibuprofen, when symptoms in mild cases begin, may relieve the twitching and sensations. Soaking in a warm bath and massaging muscles may also help relax muscles. Relaxation and Meditation techniques may also be useful. The alternating use of hot and cold packs may reduce symptoms. Other methods include establishing a good sleep routine, staying mentally alert before bedtime (boredom and drowsiness maworsen symptoms) and regular but moderate exercise. In some cases, symptoms are greatly improved by cutting back on caffeine, alcohol and tobacco.
Restless legs syndrome is generally a lifelong condition and developing coping strategies help individuals live with the disease.
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