Can we do anything about restless leg syndrome?

A sailboat in New York City. (Dr. Noorali Bharwani)
A sailboat in New York City. (Dr. Noorali Bharwani)

Restless legs syndrome (RLS) is a common condition that is frequently unrecognized, misdiagnosed and poorly managed.
Restless leg syndrome: is it a real problem?
Paul E Cotter and Shaun T O’Keeffe
Ther Clin Risk Manag. 2006 Dec; 2(4): 465–475.

Restless Leg Syndrome (RLS) is a neurologic disorder and is the most common movement disorder, characterized by an irresistible urge to move the legs when at rest. This affects sleep, daytime productivity and mood. It can affect your personal health and can cause harm to others. It is usually a long-term disorder.

RLS is also known as Willis-Ekbom Disease. In 1672, Sir Thomas Willis first described RLS. It was not until almost three centuries after Willis, in 1945, that Karl-Axel Ekbom provided a detailed and comprehensive report of this condition.

Ekbom described the essential diagnostic symptoms, differential diagnosis from other conditions, prevalence, relation to anemia, and common occurrence during pregnancy.

RLS affects about 10 per cent of the population, most commonly in women older than 35 years of age. I know some men suffer from this as well. The prevalence increases with age. There may be a family history of the condition.

There are no tests to confirm the diagnosis. Symptoms of RLS are classical. Mostly the symptoms start in the evenings when a person is trying to relax. There is urge to move the legs. This is associated with a burning and prickling sensation. Symptoms ease up if the person gets up and starts moving.

Some people may not have any cause for RLS, some have the condition secondary to medical conditions like iron deficiency or kidney disease. Symptoms of RLS may be associated with many other medical conditions.

Dopamine deficiency may be implicated in RLS. Dopamine is a neurotransmitter made in our brain. It plays a role as a “reward center” and in many body functions, including memory, movement, motivation, mood, attention and more. Imbalances in dopamine can lead to a variety of disorders, including Parkinson’s disease, ADHD, addiction, and schizophrenia.

Since there is no cure for RLS, treatment may be required for life. None of the treatment is going to relieve symptoms all the time. But it may provide some relief.  Treatment requires lifestyle changes and medication to improve quality of life, improve sleep, and correct underlying conditions or habits that trigger or worsen RLS symptoms.

If your symptoms are mild, a few lifestyle changes may be enough to control your symptoms. Avoid tobacco, alcohol, and caffeine. Regular exercise, massage to the legs, heat or ice packs can help. Taking calcium and magnesium before bed may help. Patients whose serum iron level is low may benefit with iron therapy.

If your symptoms are more severe, specific medication may help control the urge to move and help you sleep. There are different types of medications and you may have to try a few to find the one that works best.

The best evidence exists for use of dopaminergic agonists such as Ropinirole (Reequip) and Pramipexole (Mirapex) and anticonvulsant such as Gabapentin (Neurontin) agents in treating primary RLS with dopamine agonists favoured. In some cases, opioid (tramadol, codeine, oxycodone) pain medication may be required.

If the medications do not help or you are having side effects, you may have to try other treatments, such as a pneumatic compression device. This device pumps air in and out of sleeves to make them tight and loose around your legs while you are resting.

In conclusion, I will take a quote from John Hopkins (Neurology and Neurosurgery) website, “Unfortunately, there is no known cure for restless legs syndrome. At present, there is no one drug which works for everybody, but most individuals with restless legs syndrome will find some benefit and relief with the currently available medications for treating this disorder…”

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