Restless Leg Syndrome – Treatments, Cure, Causes

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Restless Leg Syndrome

Restless legs syndrome (RLS) is a neurological disorder characterized by unpleasant sensations in the legs and an uncontrollable urge to move when at rest in an effort to relieve these feelings. RLS sensations are often described by people as burning, creeping, tugging, or like insects crawling inside the legs. It is also sometimes called paresthesias (abnormal sensations) or dysesthesias (unpleasant abnormal sensations).

The most distinctive or unusual aspect of the condition is that lying down and trying to relax activates the symptoms. As a result, most people with RLS have difficulty falling asleep and staying asleep.

Some physicians wrongly attribute the symptoms to nervousness, insomnia, stress, arthritis, muscle cramps, or aging.

More than 80 percent of people with RLS also experience a more common condition known as periodic limb movement disorder (PLMD). PLMD is characterized by involuntary leg twitching or jerking movements during sleep that typically occur every 10 to 60 seconds, sometimes throughout the night.

Because moving the legs (or other affected parts of the body) relieves the discomfort, people with RLS often keep their legs in motion to minimize or prevent the sensations. They may pace the floor, constantly move their legs while sitting, and toss and turn in bed.

Most people find the symptoms to be less noticeable during the day and more pronounced in the evening or at night, especially during the onset of sleep. For many people, the symptoms disappear by early morning, allowing for more refreshing sleep at that time. Other triggering situations are periods of inactivity such as long car trips, sitting in a movie theater, long-distance flights, immobilization in a cast, or relaxation exercises.

The symptoms of RLS vary in severity and duration from person to person. Mild RLS occurs episodically, with only mild disruption of sleep onset, and causes little distress. In moderately severe cases, symptoms occur only once or twice a week but result in significant delay of sleep onset, with some disruption of daytime function. In severe cases of RLS, the symptoms occur more than twice a week and result in burdensome interruption of sleep and impairment of daytime function.

Symptoms may begin at any stage of life, although the disorder is more common with increasing age. Sometimes people will experience spontaneous improvement over a period of weeks or months. Although rare, spontaneous improvement over a period of years also can occur. If these improvements occur, it is usually during the early stages of the disorder. In general, however, symptoms become more severe over time.

In most cases, the cause of RLS is unknown (referred to as idiopathic). A family history of the condition is seen in approximately 50 percent of such cases, suggesting a genetic form of the disorder.

Currently, there is no single diagnostic test for RLS. The disorder is diagnosed clinically by evaluating the patient's history and symptoms.

In 1995, the International Restless Legs Syndrome Study Group identified four basic criteria for diagnosing RLS: (1) a desire to move the limbs, often associated with paresthesias or dysesthesias, (2) symptoms that are worse or present only during rest and are partially or temporarily relieved by activity, (3) motor restlessness, and (4) nocturnal worsening of symptoms.

If a patient's history is suggestive of RLS, laboratory tests may be performed to rule out other conditions and support the diagnosis of RLS. Blood tests to exclude anemia, decreased iron stores, diabetes, and renal dysfunction should be performed. Electromyography and nerve conduction studies may also be recommended to measure electrical activity in muscles and nerves, and Doppler sonography may be used to evaluate muscle activity in the legs. Such tests can document any accompanying damage or disease in nerves and nerve roots (such as peripheral neuropathy and radiculopathy) or other leg-related movement disorders. Negative results from tests may indicate that the diagnosis is RLS. In some cases, sleep studies such as polysomnography (a test that records the patient's brain waves, heartbeat, and breathing during an entire night) are undertaken to identify the presence of PLMD.

Although movement brings relief to those with RLS, it is generally only temporary. However, RLS can be controlled by finding any possible underlying disorder. Often, treating the associated medical condition, such as peripheral neuropathy or diabetes, will alleviate many symptoms. For patients with idiopathic RLS, treatment is directed toward relieving symptoms.

For those with mild to moderate symptoms, prevention is key, and many physicians suggest certain lifestyle changes and activities to reduce or eliminate symptoms. Decreased use of caffeine, alcohol, and tobacco may provide some relief. Physicians may suggest that certain individuals take supplements to correct deficiencies in iron, folate, and magnesium. Studies also have shown that maintaining a regular sleep pattern can reduce symptoms.

Physicians also may suggest a variety of medications to treat RLS. Generally, physicians choose from dopaminergics, benzodiazepines (central nervous system depressants), opioids, and anticonvulsants. Dopaminergic agents, largely used to treat Parkinson's disease, have been shown to reduce RLS symptoms and PLMD and are considered the initial treatment of choice. Good short-term results of treatment with levodopa plus carbidopa have been reported, although most patients eventually will develop augmentation, meaning that symptoms are reduced at night but begin to develop earlier in the day than usual. Dopamine agonists such as pergolide mesylate, pramipexole, and ropinirole hydrochloride may be effective in some patients and are less likely to cause augmentation.

In 2005, ropinirole became the only drug approved by the U.S. Food and Drug Administration specifically for the treatment of moderate to severe RLS. The drug was first approved in 1997 for patients with Parkinson’s disease.

Benzodiazepines (such as clonazepam and diazepam) may be prescribed for patients who have mild or intermittent symptoms. These drugs help patients obtain a more restful sleep but they do not fully alleviate RLS symptoms and can cause daytime sleepiness. Because these depressants also may induce or aggravate sleep apnea in some cases, they should not be used in people with this condition.

For more severe symptoms, opioids such as codeine, propoxyphene, or oxycodone may be prescribed for their ability to induce relaxation and diminish pain. Side effects include dizziness, nausea, vomiting, and the risk of addiction.

Anticonvulsants such as carbamazepine and gabapentin are also useful for some patients, as they decrease the sensory disturbances (creeping and crawling sensations). Dizziness, fatigue, and sleepiness are among the possible side effects.

Unfortunately, no one drug is effective for everyone with RLS. What may be helpful to one individual may actually worsen symptoms for another. In addition, medications taken regularly may lose their effect, making it necessary to change medications periodically.

RLS is generally a lifelong condition for which there is no cure. Symptoms may gradually worsen with age, though more slowly for those with the idiopathic form of RLS than for patients who also suffer from an associated medical condition. Nevertheless, current therapies can control the disorder, minimizing symptoms and increasing periods of restful sleep. In addition, some patients have remissions, periods in which symptoms decrease or disappear for days, weeks, or months, although symptoms usually eventually reappear. A diagnosis of RLS does not indicate the onset of another neurological disease.

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