What Is It?
Restless
legs syndrome is a movement disorder that causes uncomfortable sensations in
the legs. These sensations typically are worse during periods of rest,
especially just before sleeping at night, but they may happen during daytime
periods of inactivity, such as watching a movie, attending a long business
meeting, or flying in a plane. Whenever the discomfort of restless legs
syndrome occurs, it is usually accompanied by an overwhelming urge to move the
legs, and this movement may relieve leg discomfort temporarily. At night,
people with restless legs syndrome often find that their leg symptoms make it
difficult to fall asleep. Because of this, insomnia is common, together with
extreme drowsiness and fatigue during the daytime.
The
cause of restless legs syndrome remains unknown. However, evidence suggests
that there is dysfunction in dopamine pathways in the brain. Since restless
legs syndrome tends to occur in several generations of an affected family,
scientists suspect that there is some genetic (inherited) risk for the problem.
In some people with restless legs syndrome, anemia or vitamin deficiency may be
a contributing factor, while in others restless legs syndrome has been linked
to pregnancy, diabetes, rheumatoid arthritis, kidney failure, varicose veins or
peripheral neuropathy (nerve damage in the hands and feet). High caffeine
intake (coffee, tea, cola beverages, chocolate) also may be related to restless
legs syndrome. Although restless legs syndrome tends to be more common and more
severe in people over age 50, it can occur in men and women of any age group,
even in young people who may be misdiagnosed as hyperactive. Currently, tens of
thousands of people in the
Symptoms
Restless
legs syndrome causes a wide range of uncomfortable leg sensations, which may be
described as any of the following: tingling, prickly, wormy, boring, crawling,
pulling, drawing and, sometimes, pain. Although the muscles of the lower legs
are affected most often, restless legs syndrome occasionally can cause symptoms
in the arms as well. The discomfort of restless legs syndrome is almost always
accompanied by an irresistible need to move the legs, and leg movement, such as
walking, stretching and deep knee bends, seems to bring temporary relief. A leg
massage or a warm bath also may help.
In
addition to leg discomfort, restless legs syndrome also can cause periodic
jerking leg movements during sleep. These involuntary leg movements often
disturb both the patient and the patient's bed partner. Also, because symptoms
of restless legs syndrome tend to be worse at bedtime, people with restless
legs syndrome may find it hard to fall asleep and to stay asleep. This can
cause chronic insomnia and severe daytime drowsiness that may interfere
significantly with work, school and social life.
Diagnosis
Your
doctor will diagnose restless legs syndrome based on your symptoms, medical
history, family history, and a physical examination. Your doctor also will
perform a neurological examination to rule out nerve damage, and he or she will
order routine blood tests to check for anemia, iron or vitamin deficiency,
diabetes, and kidney problems. If the body's stores of iron are low, iron
supplements may relieve the restless legs syndrome symptoms. In some cases, an
overnight sleep study at a sleep clinic may be necessary.
Expected Duration
In women who first
develop restless legs syndrome during pregnancy, symptoms often disappear after
delivery. In other people with restless legs syndrome, the disorder may be a
lifelong problem.
Prevention
Although there is no
way to prevent restless legs syndrome, it may be helpful to avoid caffeine,
alcohol and cigarette smoking.
Treatment
Treatment
of restless legs syndrome depends on the severity of your symptoms. If your
symptoms are mild, simply exercising, stretching, or massaging your legs, or
taking a hot bath may bring relief. Lifestyle changes also may help, especially
following a balanced diet and avoiding caffeine, alcohol and cigarette smoking.
If your restless legs syndrome is linked to anemia or a low iron level, your
doctor may prescribe iron.
When medication is
used to treat restless legs syndrome, the following drugs are used individually
or in combination:
… Dopaminergic
agents ó These drugs usually relieve the discomfort of restless
legs syndrome symptoms and improve sleep quality. They include carbidopa / levodopa
(Sinemet), pergolide (Permax), pramipexole (Mirapex) and ropinirole (Requip).
… Benzodiazepines
ó These drugs are sedatives that improve sleep quality. They include clonazepam
(Klonopin), temazepam (Restoril), triazolam (Halcion) and diazepam (Valium).
… Opioids
ó These are narcotics, such as codeine (several brand names), propoxyphene
(Darvon) or oxycodone (OxyContin), that relieve pain and suppress restless legs
syndrome in people with severe, unrelenting symptoms.
… Anticonvulsants
ó These medicines are especially useful in patients whose symptoms are painful.
They include gabapentin (Neurontin), carbamazepine (Tegretol, and others) and
valproic acid (Depacon, Depakene, Depakote).
… Others
ó Clonidine (Catapres), amantadine (Symadine, Symmetrel) and propranolol
(Inderal) also may be useful to treat this condition.
Many
people with restless legs syndrome also have periodic limb movement disorder
(PLMD), a common movement disorder that causes involuntary, periodic, jerking
leg movements during sleep. The movements occur one to 10 times per minute. The
degree of periodic limb movement and how it affects sleep is best assessed with
a sleep study (polysomnogram).
When To Call A Professional
Call your doctor
whenever you have long-lasting, unexplained discomfort in any part of your
body, especially if this discomfort prevents you from sleeping normally.
Prognosis
Symptoms of restless
legs syndrome often become more severe with age, although the disorder tends to
come and go. In some cases, avoiding caffeine can dramatically decrease
restless legs syndrome symptoms.