RESTLESS
LEG SYNDROME.
Many of the medical topics that we cover are either the talk of the media
or illnesses that we have all heard about. How many of us have either heard of
or suffer from Restless Legs Syndrome (RLS)? The numbers are probably low on
both counts.
People suffering from RLS may experience an urge to move their legs followed
by an uncomfortable feeling such as a creeping or crawling feeling or even tingling,
cramping, burning or flat-out pain. And for those of you wanting a good night
sleep, that might be a problem, because RLS often takes place late in the day
or at night. Let's look more closely at the seldom heard of ailment, Restless
Legs Syndrome.
What is Restless Legs Syndrome? RLS is a neurological
disorder that is characterized by unusual sensations in the thighs and calves.
The sensations may feel like
insects crawling on the skin, burning or tugging. The abnormal sensation may
be bothersome, irritating and even painful. The best way to alleviate these sensations
is to move the legs in a rapid and repetitive fashion. Activity seems to lessen
the symptoms and many times, the symptoms are worse at night.
How common is RLS? About eight percent of all Americans
suffer from RLS, which equates to about 12 million people. This figure may be
low, as this is a fairly
common condition that may go undiagnosed and unreported. It is interesting to
note that there is a hereditary factor associated with RLS and that 50 percent
of all cases have a genetic association among family members.
What causes RLS? There continues to be research into
the causes of RLS and several answers are speculative. There are no known specific
causes. As previously noted,
there is a hereditary predisposition.
It has been shown that patients with RLS may suffer from anemia and low levels
of iron. There may be some underlying medical conditions that contribute to the
symptoms such as kidney disease, diabetes, Parkinson's disease and peripheral
neuropathy (numbness). During pregnancy, women may experience the symptoms during
their last trimester. Lastly, certain cold medications, antiseizure medications,
psychiatric medications, some blood pressure medications and antinausea medicines
may also worsen the condition.
How is this diagnosed? At present, there is no specific
diagnostic test that will confirm RLS. A patient must have a comprehensive history
taken and a physical
examination by a health care provider. There are no blood tests that will aid
the diagnosis. After all underlying medical conditions have been ruled out, four
basic criteria must be met.
These criteria include: 1) desire to move limbs when there is an associated unusual
sensation 2) symptoms that are worse at rest and improved with activity 3) motor
restlessness 4) symptoms that are worse at night when trying to sleep. The International
RLS Study Group has developed these criteria.
How is this treated? There is not a standard treatment regimen
for RLS. It is important to treat any underlying disease. This would include
the use of iron
in the treatment of anemia. There may be an electrolyte imbalance of potassium
or calcium, and this would need to be addressed. Some high blood pressure medications
such as calcium channel blockers may worsen RLS, so they would need to be changed.
A patient may need to work with a doctor that specializes in sleep disorders.
A sleep study may be completed and recommendations for sleep hygiene will be
made. It is important to develop a regular pattern for sleep, avoid exercise
just prior to bedtime, avoid the use of alcohol, and be sure to allow for relaxation
at bedtime, avoiding complicated mental tasks.
Research has shown that some medications may help. These medicines include the
medicines used to treat Parkinson's disease, sedatives, pain relievers and anticonvulsants.
None is considered a standard of treatment, but they may help in improving the
condition.
What should I do? Most importantly, an appropriate
diagnosis must be made. Once that is accomplished, it essential to develop a
support network. Do not fight
the disease, but develop ways to deal with it. Keep a sleep diary and maintain
good sleep hygiene. Occupy your mind. Remain active. But most importantly, reach
out and help others with a similar problem.
