Restless Leg Syndrome

Dear Dr. B: My mother-in-law is 60 years old. She is quite healthy. But she is having cramps in her legs. From the toes to the side of her legs, inside and up to her hips. What can she do to relieve this pain?

A concerned daughter-in law sent me this question. It is not an uncommon complaint among women and some men. My own mother has had a similar complaint for many years.

So, I was quite interested in a recent issue of the New England Journal of Medicine (NEJM) which had a clinical practice article called Restless Legs Syndrome (RLS).

The article gives an example of a 45-year-old woman having had nightly insomnia for years. She reports having uncomfortable sensations in her legs when she lies down at night. She describes a feeling of needing to move her legs, which is relieved only by getting up and walking around.

This lady has RLS. It is also known as Ekbom’s syndrome. It is a neurological disorder. About three to 15 per cent of the population is affected. It is more common in women than men. The prevalence increases with age. There may be a family history of the condition.

The following features should be present to make a diagnosis of RLS:
-A distressing need or urge to move the legs, usually accompanied by an uncomfortable, deep-seated sensation in the legs that is brought on by rest (sitting or lying down), relieved with moving or walking, or worse at night or in the evening.
-Features frequently associated with the syndrome are: involuntary limb movements while patient is awake and/or periodic limb movements while patient is asleep.

The diagnosis of RLS is based on the clinical history. RLS may be a symptom of iron deficiency therefore the iron status should be assessed. No other laboratory tests are routinely indicated.

What about our reader’s mother-in-law?

She may have RLS – but we do not know all her symptoms. There are many other conditions which cause leg pains and cramps especially at the end of the day or at night.

Some common causes are: muscle fatigue, strain, injury, or depletion of certain minerals such as potassium, calcium, sodium, and magnesium (particularly when taking diuretics). Trouble with the veins and arteries; arthritis or gout; neuropathy (nerve damage) or Sciatic nerve pain (radiating pain down the leg) caused by a slipped disk in the back. There may be other causes as well. Medications like steroids can induce leg pain.

The article says that despite the distinctive clinical features of RLS, there remains substantial variability in responses to treatment and in clinical progression and outcome.

It seems all patients with RLS do not present with classical symptoms. Therefore, my impression is, many patients with leg pain go undiagnosed or inadequately treated.

Is there good treatment for the condition?

For RLS, there are few medications in the market. But the NEJM article says that there is currently inadequate information on the efficacy of medications other than the group of drugs known as dopaminergic drugs. The management of RLS in patients who are pregnant or undergoing dialysis is not clear.

For unexplained leg pain, rest as much as possible. Elevate the leg and take pain medications which you are familiar with. Gentle massage may improve comfort. Heat or cool soaks may help. If pain persists or swelling develops, see your family physician.

For leg pain caused by varicose veins, leg elevation and compression with elastic bandages or support hose can help. Walking is the best way to keep the blood flowing back to the heart from the legs.

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