What is restless legs syndrome?
Restless legs syndrome (RLS) is a neurological disorder that is characterized by an uncomfortable sensation in the legs and rarely the arms. This leads to an overwhelming urge to move them continuously.
These movements may,
- happen to partially or totally relieve discomfort.
- begin or worsen during periods of rest such as lying or sitting
- worsen during sleep, causes time to time movements also known as “periodic leg movements”.
It has also been suggested that RLS would be called “Willis-Ekbom disease”, as an homage to the two pioneers Thomas Willis and Karl-Axel Ekbom who first reported this condition.
What causes RLS?
- Unknown cause
- Genetic cause
RLS symptoms are related to hyperexcitability of the central nervous system- brain and spinal cord due to a possible deficiency of a chemical called dopamine. Dopamine plays a role in controlling muscle movement and may be responsible for the involuntary leg movements associated with RLS.
- Disorder of the peripheral nervous system
The peripheral nervous system involves the nerves that carry signals from different parts of the body to the brain. The most likely possibility is the presence of hypoxia (lack of oxygen) caused by changes in blood flow or metabolism in the lower limbs that irritates the sensory nerves of the legs causing restlessness.
- Iron-deficiency anaemia – low levels of iron in the blood can lead to a drop in dopamine, triggering restless legs syndrome
- Chronic (long-term) health conditions – such as chronic kidney disease, diabetes, Parkinson’s disease, rheumatoid arthritis, an underactive thyroid gland or fibromyalgia.
- Radiculopathies: Radiculopathies are problems with the nerves and occur due to nerve compression at the spine caused by disc herniation and protrusion and/or disc degeneration. It is most commonly seen in the lower back regions (Lumbar spine). Nerve compression could cause referred pain and tingling sensations along the back of the leg to the feet that may be a secondary cause for RLS.
- Pregnancy – particularly from week 27 until birth; in most cases, the symptoms disappear within four weeks of giving birth
- Side effects of certain medication: Antidepressants, Antipsychotic medicine, Lithium (used in the treatment of bipolar disorder), Calcium channel blockers (used in the treatment of high blood pressure), Antihistamines, Metoclopramide (used to relieve nausea).
- Lifestyle problems: Excessive smoking, caffeine/ alcohol, obesity, stress and lack of exercise.
Who can be affected with RLS?
- Both the genders are affected but women are twice as likely to develop RLS than men which is still unknown and is suggested to be related to genetics, body functions or emotional differences.
- People of all ages can be affected but more commonly seen among middle-aged people secondary to other health conditions.
What are the signs and symptoms of RLS?
Signs and symptoms may vary from day to day, in severity and frequency from person to person during rest and most often during sleep.
- Abnormal sensations (Paresthesias)- pulling, creeping etc.
- Unpleasant abnormal sensations (Dysesthesias)- the sensations range in severity from uncomfortable to irritating to painful example, tingling, burning, aching or like electric shocks.
- Periodic leg movements during sleep
- Typical movements like pacing and walking, jiggling the legs, stretching and bending, tossing and turning, rubbing the legs.
- Inability to sleep leading to sleep disorders like insomnia (lack of sleep) due to increased urge to move or sudden waking up from sleep due to periodic leg movements.
- Hyperactivity may be seen among children with RLS.
- Fatigue/tiredness, lack of concentration, problems with cognitive function (related to thinking, attention and decision making) due to lack of sleep and excessive movements in the leg most often felt throughout the day.
How is RLS diagnosed?
There are no diagnostic tests that can diagnose RLS.
A thorough clinical assessment of the patient is necessary to be able to diagnose this condition.
- Clinical history: The history of the patient about signs and symptoms associated with RLS will be important for the diagnosis. The frequency, duration, and intensity of symptoms the aggravating and relieving factors as well as their tendency to occur during day and night time will be noted.
- Family and Medical History: Family history and problems of other health conditions and the use of medications will be noted that may be the suggestive cause for RLS.
- Neurological and physical examination: Examination of other underlying conditions related to muscle or nerve problems.
- Blood tests: blood test can be done to identify iron and vitamin deficiencies as well as other medical disorders associated with RLS.
- Sleep studies such as polysomnography (a test that records the individual’s brain waves, heartbeat, breathing, and leg movements during an entire night of sleep) may identify the presence of periodic leg movements and other problems of sleep.
- RLS in children: This may be difficult since it may be hard for a child to describe any uncomfortable sensations in the leg and the urge for leg movements, when and how often the symptoms occur, and how long they last.
- Misdiagnosis: RLS may be often misdiagnosed as “growing pains” or “Attention Deficit Hyperactivity disorder” (ADHD) in children and may be mistaken to be an onset of another neurological disease, such as Parkinson’s disease in adults.
How can this condition be treated?
- Most symptoms can be treated by therapeutic treatments that improve the blood circulation of the legs, muscle flexibility and allow the nerves of the legs to relax. This can help diminish the uncomfortable sensations caused by restless legs syndrome.
- Identification and treatment of other health problems are important to reduce the symptoms of RLS.
- Intake of diet rich in iron and vitamins will be beneficial.
- Reducing smoking and alcohol consumption.
- Stress management will help reduce symptoms and improve sleep.
Severe problems with RLS can be also be treated along with prescribed medications that improve the dopamine levels in the body. However, RLS may generally be a lifelong condition.There may be periods of no symptoms but may eventually reappear sooner or later. Adhering to the treatment methods can help reduce the symptoms at all times.