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A condition of unknown etiology characterized by an intolerable, internal itching sensation occurring in the lower extremities and causing an almost irresistible urge to move the legs. It is also known as Ekbom's syndrome.
About 15 percent of people over age 50 have restless leg syndrome (RLS), a condition that frequently makes it difficult for sufferers to sit still or lie down because of involuntary movement of the legs. Patients frequently use word such as "creepy," "crawly," and "weird" to describe these sensations, which - although not usually painful - are extremely unpleasant.
In about half of all patients, however, episodes occur so persistently that they cause serious sleep deprivation leading to fatigue, depression, susceptibility to infection due to a depressed immune system, and an increased risk of accidents due to slowed reflexes. In these instances, medication can be used to suppress symptoms. Although drug therapy is not without side effects, research is revealing better ways to maximize the benefits without causing additional discomfort.
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The cause is unknown. RLS is sometimes associated with the onset of renal colic due to the attempt to pass, or actual passage of, a renal stone and is sometimes seen as a side effect of psychotropic drugs.
About 10 percent of pregnant women and 25 percent of people with iron-deficiency anemia will experience this condition. Also, the condition may be associated with intake of caffeine.
Whether they occur during the day or at night, symptoms may be related to low brain levels of dopamine, a chemical that helps transmit nerve impulses. Low dopamine levels are also associated with Parkinson's disease, although patients with RLS are no more likely to develop Parkinson's than anyone else. The manner in which the body processes dopamine can be affected by heredity (about half of patients have a family history of RLS), hormone fluctuations (especially around menopause and during pregnancy), and many other factors.
Some researchers suspect that RLS may begin in childhood but does not usually become disruptive until later in life when for unknown reasons it worsens. It may also be associated with poor circulation in the legs, and with certain vitamin and mineral deficiencies (especially of vitamins E and B, iron, and magnesium).
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Symptoms can occur during the day or night when sufferers are trying to sleep (nighttime symptoms are referred to as periodic leg movements in sleep). All patients who have day-time episodes also have nighttime discomfort, but the reverse is not true.
Episodes can last from a few minutes to several hours, and typically occur many times during the day or night, especially when sufferers relax or are trying to fall asleep (although they are not the same as "night starts," the sudden, jerky movements that sometimes occur when falling asleep). Symptoms are worse at the end of the day when the patient is either seated or in bed.
Regardless of when an episode strikes or how often it lasts, the only way to obtain relief is to get up and walk around - although symptoms usually resume once patients sit or lie down again. In addition to walking, those with RLS can make certain that adjustments to keep their daily routines as normal as possible.
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The diagnosis is made based on the medical history including symptoms and the physical examination. (Return to Top)
When symptoms disturb sleep so much that fatigue affects overall health and interferes with normal daily activities, patients can be treated with anti-parkinsonian drugs that contain dopamine (such as L-dopa) or opiates (pain medications derived from opium). If these fail, anti-anxiety medications and benzodiazepines can sometimes be added to the regimen. However, there are side effects, such as the possibility of addiction, nausea, mood changes, and muscle spasms, associated these drugs.
Vitamin and mineral supplementation is usually not effective, despite the fact that RLS is sometimes associated with vitamin and mineral deficiencies. Some patients get temporary relief with home remedies (such as massage and hot wraps), possibly because these therapies increase blood flow to the legs or distract patients from their underlying discomfort. Ironically, over-the-counter sleep medications may worsen symptoms and should not be used.
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Measures to consider in coping with RLS are:
1. Moderate exercise in the early evening
2. Sitting on a tall stool that allows one to stretch and move the legs
3. Requesting aisle seats at the theater or on an airplane, so that you can get up easily
4. Standing in the back of the room at public events so that you can walk around
5. Sleeping later in the morning, when symptoms are less likely to occur.
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What are the causes of restless legs syndrome?
Is there evidence of low dopamine levels?
Would anti-parkinsonian drugs help?
Is the use of pain medications indicated?
What are the side effects of these drugs?
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