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Restless Leg Syndrome

Table of Contents

    What Is Restless Leg Syndrome?

    Restless leg syndrome (RLS), also known as Willis-Ekbom disease, is a neurological condition of the nervous system that causes a patient to have an irresistible urge to move their legs. RLS  symptoms commonly occur in the late afternoon or early evening hours, and may also occur when a patient is sitting or is inactive for an extended period of time. 

    However, most RLS patients experience the most severe symptoms while they sleep (or attempt to sleep). Because of this, Restless Leg Syndrome is considered a sleep disorder as well as a movement disorder — a distinction RLS shares with REM Behavior Disorder and other sleep disorders.

    RLS is not considered a neurodegenerative disease in its own right, however, restless leg can be a symptom of a neurodegenerative disorder such as Parkinson’s disease. Having RLS does not increase a patient’s risk of developing PD.

    Restless Leg Syndrome by the Numbers 

    • Reportedly between 5%-10% of the general population is affected by Restless Leg Syndrome, though it is more common in the elderly.
    • RLS symptoms tend to worsen at night but may be present in the daytime as well.
    • More than 80% of RLS patients also experience periodic limb movement of sleep (PLMS).
    • Primary RLS has no known cause but tends to run in the family; secondary forms of Restless Leg Syndrome are caused by an underlying condition.

    What Causes Restless Leg Syndrome?

    Restless Leg Syndrome may either be primary (the majority of RLS cases are primary) or secondary (which is also called symptomatic). In primary cases, there is no clear cause, though this type of RLS tends to run in families.

    Secondary forms of restless leg syndrome are caused by an underlying condition that may include iron deficiency, kidney failure, and some neuropathies (which describes diseases or dysfunction in one or more peripheral nerves). Secondary RLS symptoms may occur in some women during pregnancy. These pregnancy-related symptoms usually disappear immediately after giving birth. Some medications can also cause secondary RLS, including:

    • Certain antidepressants
    • Lithium
    • Some neuroleptics

    How Is Restless Leg Syndrome Diagnosed?

    There is no diagnostic test for Restless Leg Syndrome. Therefore, RLS is typically diagnosed via a doctor’s evaluation. A thorough evaluation will ideally include a complete neurological and physical exam, plus detailed information on the patient’s medical history, family history, and current medications.

    A diagnosis of RLS may be indicated if the following four signs and symptoms are present:

    • The patient has a practically irresistible urge to move their legs accompanied by uncomfortable sensations in the lower extremities.
    • The symptoms are worse or present only when the patient is at rest.
    • The symptoms are totally or at least partially relieved when the patient moves their legs.
    • The symptoms tend to get worse at night or in the evening.

    You Are More Than Your Symptoms

    Movement disorders are incredibly complex diseases affecting multiple systems in the body. At Neurology Solutions, we believe that these challenging diseases require a comprehensive approach that treats the whole patient— not a list of symptoms. 

    What Does Restless Leg Syndrome Feel Like?

    RLS causes uncomfortable or unpleasant sensations in the legs that patients have described as aching, throbbing, pulling, or itching. Other terms used to describe the unique sensation caused by RLS include stinging, burning, creeping, and/or painful tension deep within the legs. These sensations can occur on either side of the body, or alternate between the left and right. Most often, they affect both sides of the body.

    Typically, patients can relieve the discomfort caused by RLS by simply moving their legs (or the affected body part). Because of this, people with RLS tend to keep their legs in motion to minimize or prevent the unpleasant sensations — they may pace the floor, fidget their legs while sitting or toss and turn while in bed.

    Additionally, most people with RLS have leg movements while they sleep called periodic limb movement of sleep (PLMS). These movements typically happen at regular intervals and can involve the entire leg, the foot, or just the big toe.

    How Does Restless Leg Affect Your Quality of Life?

    One of the most common — and most significant — aspects of RLS is the negative impact it has on a patient’s ability to get a good night’s sleep. Some people with RLS have difficulty falling asleep and/or staying asleep. If the symptoms cause an RLS patient to wake up during the night, it’s common for them to have difficulty falling back to sleep.

    If these sleep problems are significant enough, the resulting lack of sleep can cause problems for the patient’s daytime function. The lack of sleep can itself cause the RLS symptoms to worsen leading to a downward cycle where getting rest is increasingly difficult.

    Also, the sleep disturbances and the PLMS movements experienced by RLS patients can also affect their spouse or partner who may be sleeping beside them in the same bed. This “collateral damage” can be a significant complication in families with a member who has RLS.

    Our Approach to Treating Restless Leg Syndrome

    When it comes to treating RLS, our focus is similar to the way we approach most movement disorders — first identify what is causing your symptoms, and then develop a specific treatment plan tailored to you.

    For restless leg syndrome, some of the treatment strategies we employ at Neurology Solutions may include:

    • Iron supplementation or iron infusions 
    • Magnesium 
    • Warm baths with Epsom salts
    • Medications such as Dopamine-agonist, which include Ropinirole (Requip), rotigotine (Neupro), and pramipexole (Mirapex). These work by altering levels of the chemical messenger dopamine in your brain. 
    • Medications that work on calcium channels, such as gabapentin (Neurontin, Gralise), gabapentin enacarbil (Horizant), and pregabalin (Lyrica) are beneficial in some patients with RLS.
    • Medications that convert to dopamine, such as carbidopa-levodopa, may also be used. 
    • Medications including muscle relaxers and sleep aids. (These do not directly address the underlying RLS but may allow them to be more tolerable and improve sleep quality. However, these may cause somnolence [sleepiness] the following day.)
    • Adjusting medications if the RLS symptoms are thought to be medication-induced
    • Opioids are not a preferred treatment option but may be considered if other traditional treatment options fail.

    Medications that affect dopamine may augment over time. This means that while the medication works at controlling symptoms for a while, over time symptoms may start to present earlier. This would then likely require a dose adjustment or addition.

    Unfortunately,  there is no single, universal medication that will be effective for all RLS cases and for every RLS patient. Therefore it may take several trials, or a combination of medications, before finding the right treatment.

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