Restless Leg Syndrome

Restless Leg Syndrome (RLS) is described as a “creepy, crawly” sensation that occurs in the legs when patients are sitting or lying still, especially at bedtime. Lying down and trying to relax usually activates the symptoms. It occurs when a patient is awake and can affect the ability to fall asleep and stay asleep thus causing extreme fatigue and excessive sleepiness during the day.

RLS sensations usually occur in the calf area, but may be felt anywhere from the thigh to the ankle. One or both legs may be affected. For some people, the sensations are also felt in the arms. People with RLS have an irresistible urge to move the affected limb when the sensations occur. Moving often relieves the limb discomfort.

RLS is classified as a movement disorder, as individuals must move their legs in order to gain relief from symptoms. RLS symptoms are generally worse at night with a symptom-free period in the early morning. Other triggering situations are periods of inactivity characterized by sitting for long periods of time, such as during long car trips, during a movie or long-distance flights.

RLS occurs in both men and women, although the incidence is about twice as high in women. It may begin at any age. Persons with RLS may have iron deficiency. Individuals with Parkinson’s disease often have RLS as well.

Other chronic diseases may cause "secondary RLS", such as kidney failure, diabetes and peripheral neuropathy. Treating the underlying condition may help with RLS symptoms.

Diagnosis

Although there is no specific test for RLS, there are four basic criteria for diagnosing the disorder:

  • Symptoms that are worse at night and are absent or negligible in the morning, at least initially
  • A strong and often overwhelming need or urge to move the affected limb(s)
  • Sensory symptoms that are triggered by rest, relaxation, or sleep
  • Sensory symptoms that are relieved with movement

Physicians focus largely on the individual’s history and description of his/her symptoms, triggers and relieving factors. In addition, a neurological and physical exam and reviews of current medications, is necessary.

Laboratory tests may be performed to rule out other conditions, and blood tests can identify iron and vitamin deficiencies as well as other medical disorders associated with RLS. In some cases, sleep studies may identify the presence of other causes of sleep disruption that may impact management of the disorder.

Treatment

RLS is treated with certain lifestyle changes and activities that reduce symptoms of mild to moderate severity. Among the these changes are decreased caffeine, alcohol, and tobacco use; adding vitamin/iron supplements; changes to sleep habits; a program of moderate exercise during the day; and massaging the legs, taking a hot bath, or using a heating pad or ice pack.

Medications are also usually helpful while there is not a single medication that works for all individuals with RLS, primary medication treatment includes dopamine agonists, benzodiazepines and drugs that affect the brain chemical GABA.

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