Restless Leg Syndrome
Restless leg syndrome, also referred to as Willis-Ekbom disease, is characterized by an uncontrollable urge to move the legs. Symptoms of restless leg syndrome include:
- Uncontrollable urge to move the legs
- Uncomfortable sensations in the legs, such as: tingling, itching, burning or throbbing
- Painful cramps in the legs, especially in the calves
The sensations can also affect the chest, arms, and face. They can be mild or severe, and are usually worse during the night and in the evening. Often times, these symptoms can be relieved by rubbing or moving the legs. Some people experience them daily, others occasionally. The condition can affect any person, although it is more common in women. The majority of cases are diagnosed in during midlife, but it can begin as early as childhood. Restless leg syndrome is also associated with involuntary jerking of the arms and legs during sleep.
What Causes Restless Leg Syndrome? Evidence suggests that restless leg syndrome occurs due to a problem in the basal ganglia. This is a region located in the brain that utilizes dopamine in order to adequately control movement and muscle activity. If the cells within this region become damaged, dopamine levels in the brain drop, leading to muscle spasms and uncontrollable movements of the extremities. At the end of the day, dopamine levels naturally fall, which may account for the fact that the symptoms of this condition worsen during the evening and at nighttime.
Primary Restless Leg Syndrome: In the majority of cases, the exact cause of restless leg syndrome cannot be determined. This is called primary restless leg syndrome. Research has linked this primary form to specific genes that can be transmitted from parents to children. In such cases the symptoms of restless leg syndrome appear before the age of 40.
Secondary Restless Leg Syndrome Secondary restless leg syndrome is when the disease is caused by another underlying disease or health factor. Some conditions that can cause restless leg syndrome include:
- Pregnancy – Symptoms usually occur during the last trimester and disappear a month after giving birth
- Anemia – Low Iron levels in the blood can cause low levels of dopamine and restless leg syndrome
- Chronic conditions: Diabetes, fibromyalgia, Parkinson’s Disease, Chronic Kidney Failure, Hypothyroidism all are associated with restless leg syndrome
- Chronic Venous Insufficiency – Chronic venous insufficiency is the most common cause of secondary restless leg syndrome
The following are factors that can aggravate symptoms of restless leg syndrome:
- Medication: certain antidepressants, antipsychotics, lithium, antihistamines, metoclopramide. If you believe that your medication is aggravating your symptoms, speak with your physician
- Excessive intake of alcohol and caffeine
- Vein disease, including chronic venous insufficiency
- Excessive smoking
- Obesity or being overweight
- A sedentary lifestyle
Diagnosis and Testing:
Establishing a diagnosis of restless leg syndrome requires careful analysis of your symptoms, family and medical history, a full physical examination and additional tests. The 4 main diagnostic criteria include:
- The presence of an overwhelming need to move the legs, accompanied by uncomfortable sensations such as tingling, crawling or itching
- Symptoms occur or worsen when inactive or resting
- Symptoms lessen when rubbing or moving the affected leg
- Symptoms worsen at night or in the evening
In order to rule out or confirm a possible underlying cause of restless leg syndrome some of the following tests might be required:
- Blood tests (blood count, hemoglobin levels, iron levels, liver and kidney function studies, blood glucose, electrolytes et.)
- Ultrasound to examine various organs, tissues and blood vessels (to rule out chronic venous insufficiency)
- Electrocardiogram – those suffering from restless leg syndrome are more inclined to develop a cardiovascular condition
- Sleep tests – recommended for those that have trouble sleeping in order to diagnose the presence of periodic limb movements in sleep
Treatment: If restless leg syndrome is caused by an underlying disease, treating that condition may also resolve the restless leg syndrome. In mild cases of restless leg syndrome that is not linked to any other medical condition, a few lifestyle changes may help manage the syndrome.
- Do not consume caffeine, alcohol or tobacco in the evening
- Do not exercise close to bedtime
- Quit smoking
- Exercise daily
- Adopt and maintain good sleeping habits (going to bed and waking up at the same hour every day, meditate or relax before going to bed, do not watch TV before going to bed etc.)
What to do during an episode of restless leg syndrome in order to relieve symptoms:
- Massage the affected leg/legs
- Take a hot bath
- Apply a cold or hot compress to your affected leg
- Do an activity that you enjoy and that keeps your mind occupied (reading, watching TV etc.)
- Perform exercises that help you relax such as tai chi, yoga etc.
- Stretch your legs or go out for a walk
Dopamine agonists – Such as Ropinirole, Pramipexole and Rotigotine, are prescribed for those that frequently experience symptoms of restless leg syndrome.
Painkillers – Light opiate-based painkillers, such as tramadol or codeine can be prescribed in order to lessen pain associated with restless legs syndrome.
Sleep aids – short-term courses of hypnotics such as Loprazolam or Temazepam can be prescribed to aid with sleep disruption caused by restless leg syndrome
Levodopa – supplements your dopamine levels. Can be prescribed for those that suffer only occasionally from symptoms of restless leg syndrome