Restless Leg Syndrome (RLS) is a neurological disorder also known as Willis Ekbom Disease (WED), that causes irresistible and uncontrollable movements of legs.

It primarily causes an urge to move legs to get relief from discomfort in legs, that is often explained by individuals as creeping, crawling, tingling, aching, throbbing sensation, etc. in legs.

Its severity may be mild to severe and is seen in men and women but most commonly in women. It may occur at any age including childhood but generally worsens as age progresses.

The fact has to be accepted that it is a lifelong condition and there is no cure for Restless Leg Syndrome. However, a few lifestyle changes, medications help by controlling the disorder, minimizing the symptoms, preventing episodes and helping with better sleep.

Symptoms

The primary symptom of Restless Leg Syndrome is the urge to move legs. A few characteristics associated with this urge and criteria for diagnosis according to International Restless Leg Syndrome Study Group and International Classification of Sleep Disorders are

  • Discomfort, sensations such as throbbing, ache, crawling, etc. is felt by an individual typically at rest or while sitting, laying down for a long time such as in a movie theater, flight, etc.
  • The sensations may start usually by the end of day, in the evening, night.
  • One may get relief from the sensation by movement of legs, walking, stretching, etc.
  • Symptoms can’t be explained exclusively by a medical condition.

The symptoms may also be accompanied by a condition called Periodic Limb Movement of Sleep (PLMS) in 80% of individuals with Restless Leg Syndrome. This may cause repetitive and brief but uncontrollable episodes of twitches, jerks of legs during sleep, often disturbing sleep of self and partner.

The symptoms may be mild to severe but if symptoms are severe, it may be disturb sleep and often causes daytime sleepiness, drowsiness, difficulty in concentration and focus at work, stress, anxiety, etc.

Causes

Restless Leg Syndrome is usually idiopathic (unknown cause) but it can also be associated with a few medical conditions (secondary).

  • Researches show association with Dopamine (a chemical messenger in the body, that connects the brain and nerves to regulate muscle movements) levels in the brain. Low dopamine levels may cause loss of control over the muscle movements leading to spasms and involuntary movements of leg.
  • Hereditary factors also play a role, especially if symptoms are experienced before 40 years of age.
  • Symptoms may be seen in about 1 in 5 pregnant women but mild and may go unnoticeable. It may be severe sometimes but subsides usually by delivery or after 4 weeks of childbirth.

Medical conditions, that are commonly associated with Restless Leg Syndrome (secondary RLS) are

  • Iron deficiency with/without anemia following excessive bleeding after an injury, low iron intake in diet, heavy menstrual bleeding in women, repeated blood donations, etc.
  • Kidney failure- This may lead to decreased iron stores in the body.
  • Peripheral Neuropathy- Nerve disorders involving hands and legs, seen in individuals with Diabetes, alcoholism.
  • Parkinson’s disease, Fibromyalgia, Rheumatoid arthritis, etc.

Risk factors triggering the symptoms are

  • Certain medications for allergy (cold, cough), nausea/vomiting, medications such as antidepressants, antipsychotics, calcium channel blockers to control high blood pressure, etc.
  • Stress, insomnia with sleep disturbances and irregular sleep cycles.
  • Drinking more caffeinated drinks, alcohol, smoking.
  • Overweight/obesity, sedentary lifestyle/lack of exercises.

Diagnosis

Diagnosis is made by the doctors based on symptoms, habits such as alcohol intake, smoking, known medical conditions, family history of RLS but no specific tests are done.

  • Details regarding severity and frequency of symptoms, its affect on sleep, sleep cycle, stress levels, etc. may be asked by the doctor to assess the severity of the condition and to work around the effective treatment options.
  • A few blood tests to confirm/rule a possible underlying cause such as iron deficiency, diabetes, kidney disorders, etc. may be done.
  • A sleep study, polysomnography (study to monitor muscle movements, blood pressure and heart rate, brain waves) overnight during sleep may also be done, if symptoms are severe. This usually helps in the diagnosis of Periodic Limb Movements of Sleep.

Treatment

Treatment of Restless Leg Syndrome is primarily focused on lifestyle changes and treatment of underlying and associated medical conditions.

Treatment of diabetes, kidney disorders with medications, treatment of iron deficiency with iron rich diet, iron supplements either orally or intravenously may help, if detected.

Lifestyle changes are important to be made irrespective of severity of symptoms.

  • Regular exercises, walking.
  • Avoiding alcohol intake, drinking caffeinated drinks (coffee, tea, aerated drinks), especially before going to bed at night.
  • Cessation of smoking.
  • Working on stress management by practicing yoga, meditation, hobbies, etc.
  • Sleeping at the same time everyday, getting adequate sleep at least 6-7 hours a day, maintaining good and calm environment to sleep, taking a warm shower before going to sleep, maintaining a sleep diary.
  • Avoiding medications, that may trigger an episode or worsen symptoms such as medications for allergy, nausea, antidepressants, antipsychotics, etc.

A few measures, that may help during an episode are

  • Massages of legs for about 10-15 minutes in the morning and evening before going to bed, if possible with aromatic oils.
  • Applying warm compresses/hot bags, ice packs on legs.
  • Trying to deviate mind during an episode by watching a movie, going for a walk, listening music, etc.
  • Relaxation techniques such as yoga, meditation, etc.
  • Stretching exercises, walking.
  • Avoiding the resistance against leg movements as it may worsen the symptoms. But walking, stretching of legs may help.

Medications:

  • Dopamine agonists, Opioids and Hypnotics and muscle relaxants are the available treatments for restless leg Syndrome.
  • The benefits are weighed against the risks by the doctor, before prescribing these medicines.

Complications

Restless Leg Syndrome may not have any complication but the symptoms may become severe and more frequent, disturbing sleep and activities in a daily routine.

There is also a risk of depression, anxiety on a long run.

References:

https://www.nhs.uk/conditions/restless-legs-syndrome/

https://www.webmd.com/brain/restless-legs-syndrome/restless-legs-syndrome-rls#1

https://www.mayoclinic.org/diseases-conditions/restless-legs-syndrome/symptoms-causes/syc-20377168

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Restless-Legs-Syndrome-Fact-Sheet

https://www.sleepfoundation.org/sleep-disorders-problems/restless-legs-syndrome

https://www.rls.org/

http://brainfoundation.org.au/disorders/restless-legs-syndrome
By,

Dr. Divya Teja

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