Diseases & Conditions

RLS: Getting Rest when Your Legs Want to Keep Moving

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 What Causes Restless Leg Syndrome

Restless Leg Syndrome, commonly referred to as RLS, is a neurological disorder that is known by the creeping, pulling, throbbing, or other quite unpleasant sensations in the legs.

These sensations are often accompanied by an overwhelming, uncontrollable need to move them. In most cases, moving around can help to calm them down.

Most of the time, the symptoms occur at night when an individual is trying to relax and rest- and in some cases, the symptoms increase in severity as the night goes on.

The sensations are often referred to as dysesthesias (unpleasant/abnormal sensations) or paresthesias (abnormal sensations) and can range in severity from slightly uncomfortable to extremely painful and irritating.

The most unusual aspect of this particular condition is the fact that lying down and attempting to relax is what activates the symptoms. Often, individuals suffering from Restless Leg Syndrome have great difficulty in falling and staying asleep.

When the condition is left untreated, it can result in the individual experiencing daytime fatigue and exhaustion. Most individuals suffering with this condition report that personal relations, daily activities, and even their jobs are greatly affected due to the sleep deprivation they experience.

They are very often unable to focus/concentrate, fail to accomplish their daily activities, and have memory impairment.

In addition, it can result in depression and can make traveling very difficult. Due to the problems RLS causes with sleep, it is also considered to be a sleep disorder.

Who Suffers from this Condition?

Studies have shown that as many as ten percent of the population in the United States experience this condition.

Many of these studies have revealed that around two to three percent of adults, or more than five million people, experience moderate to severe symptoms of RLS. Additionally, around five percent of individuals seem to be suffering from a milder form of the condition.

Around one million school-age children are affected by what is known as childhood RLS and one-third of those are affected by a moderate to severe form of the condition.

In many cases, individuals who are suffering from this condition never seek medical attention because they don’t believe that they will be taken seriously, or their condition is not treatable, or even that their symptoms are not severe enough.

For those that seek medical attention, physicians often attribute the symptoms to arthritis, aging, insomnia, muscle cramps, nervousness, or stress.

Restless Leg Syndrome occurs in women and men- however, it occurs about as twice as often in women. It can begin at any age.

In most cases, those who are experiencing severe symptoms are middle-age or older. As the individual ages, the symptoms become much more frequent and last longer. This condition is considered a movement disorder, as those who experience the symptoms must move their legs in order to obtain relief.

Over eighty percent of individuals with restless leg syndrome also have a much more common condition that is referred to as Periodic Limb Movement of Sleep, or PLMS.

This condition is characterized by involuntary twitching of the legs or even jerking movements during sleep. These movements usually occur every fifteen to forty seconds, sometimes all through the night. In addition, these movements often result in extreme disruptions in sleep and repeated waking.

While it is true that many of those who have restless leg syndrome will develop periodic limb movement of sleep, those with PLMS don’t necessarily have RLS.

For those individuals who experience PLMS that is not accompanied by RLS or some other disorder that contributes to it, they are most often diagnosed with Periodic Limb Movement Disorder, or PLMD. It is possible that PLMD is a variant of RLS and therefore will respond to some of the same treatments.

What are some Common Signs/Symptoms of Restless Leg Syndrome?

Individuals suffering from restless leg syndrome experience extremely uncomfortable feelings in their legs- typically when they are sitting or lying down.

This uncomfortable feeling is often accompanied by an irresistible urge/desire to move the legs in order to find some relief. Less often, these sensations may affect other areas such as the head, arms, and trunk.

Additionally, it is possible for these sensations to occur only on one side, but most often they occur on both.

Since moving the legs often relieves the discomfort of RLS symptoms, many times the individuals with the condition will keep their legs moving in order to minimize or completely prevent the sensations.

They might be constantly moving their legs when sitting down, toss and turn when lying in bed, or even pace the floor.

One of the main features of restless leg syndrome is that the symptoms are much worse at night and the individual often has a very distinct period of time early in the mornings when they are symptom free. This may allow them to get a little bit of sleep.

Some other possible triggers for this condition are long car trips, long flights, relaxation exercises, sitting in a movie theater, or even being immobilized in a cast.

Additionally, individuals with this condition report that when their sleep is interrupted or reduced by other activities or events, their symptoms seem to be worse.

The symptoms of RLS can vary both in frequency and severity either from person to person and in one individual from day to day.

Those who have a mild case of RLS could experience a little bit of sleep deprivation and slight interference in their day to day activities.

On the other hand, those who have moderately severe RLS where they experience symptoms once or twice a week may have significant disruption in sleep and some disruptions in their daily activities.

Still, those with severe RLS often experience symptoms more than twice a week and have an extreme disruption in their sleep and significant impairment of day to day activities.

Many times, especially when the condition is in the early stages, an individual with RLS will experience remission, or improvement, in their condition.

It may be weeks or even months before the symptoms resurface. However, as time goes on, the condition is likely to become much worse.

Individuals who are suffering from RLS along with another medical condition often develop severe symptoms much quicker.

On the other hand, those who have RLS that is unrelated to any other conditions may notice that the disorder progresses very slowly- especially if they begin to experience symptoms at an early age.

What are some Causes of Restless Leg Syndrome?

While it’s true that in many cases, physicians are unable to pinpoint a cause for RLS, chances are there is some genetic component to it.

In families where the condition of RLS sets in before the age of 40, RLS is often found to run in families. There are some very specific variants of genes that have been found.

Additionally, some research suggests that low iron levels in the brain could be responsible for this condition.

Additionally, there is some evidence suggesting that this condition is somehow related to a malfunction in the basal ganglia circuits in the brain that utilize dopamine.

This neurotransmitter is necessary in order to promote smooth and purposeful movement and muscle activity.

When there is a disruption in these pathways, involuntary movements result. Individuals suffering from Parkinson’s disease often suffer from RLS as well because it is also a disorder of these pathways.

Though researchers are not clear on whether or not the following factors/conditions cause restless leg syndrome, there has been a connection found:

  • Chronic disease (diabetes, kidney failure, etc.) – individuals often find that by treating the underlying issue, they are able to find relief for their RLS.
  • Medications such as antidepressants that cause increased serotonin levels, cold/allergy medications containing antihistamines, antipsychotic medications, and anti-nausea drugs can aggravate the symptoms of RLS.
  • Women who are pregnant- especially in their last trimester may experience increased RLS symptoms, which will usually dissipate approximately 4 weeks after birth.
  • Sleep deprivation and alcohol use could aggravate the symptoms of RLS.

 What Causes Restless Leg Syndrome

Diagnosing Restless Leg Syndrome

While there is no specific test for diagnosing RLS, there are four basic criteria:

  • The symptoms are typically negligible or even absent in the early part of the day and flare up at night.
  • There is an overwhelming and even uncontrollable need to move the limbs that are affected.
  • The symptoms are typically triggered by sleep, relaxation, and/or rest.
  • The symptoms are often relieved with movement of the limbs and as long as movement continues, the relief persists.

When diagnosing RLS, the physician mainly focuses on the patient’s description of their symptoms, as well as what the triggers are and what helps them or makes them worse. Additionally, the physician will likely ask about the symptoms throughout the duration of the day.

The physician will then collect a medical history on the patient as well as the family, and perform a physical and neurological examination.

The physician often asks about the frequency, intensity, and duration of the symptoms as well as whether they are causing a disturbance in daytime functioning or sleep.

There may be some lab tests performed that will rule out any other possible conditions. A simple blood test can identify any vitamin or mineral deficiency, such as iron as well as any other possible medical conditions associated with RLS.

In some cases, sleep studies could provide information necessary to determine if there are other things causing disturbances in sleep, such as apnea because this could have an effect on managing the disorder.

When it comes to children, diagnosis of RLS is difficult because it is often difficult for a child to be able to describe the symptoms like an adult would be able to. Often, pediatric RLS is diagnosed as attention deficit disorder or even just simple “growing pains.”

Treating Restless Leg Syndrome

When it comes to treating RLS, the attention is mainly focused on relieving the symptoms. As we have said, often just moving the affected limb could offer some temporary relief. In some cases, if there are other underlying medical conditions, treatment is focused on those conditions.

If an individual is experiencing mild to moderate symptoms, the answer is usually to make some lifestyle changes such as decreasing alcohol, caffeine, and tobacco use; taking supplements to correct any vitamin or mineral deficiencies in the blood; changing or even simply maintaining a regular sleep schedule; participating in a moderate exercise program; taking a hot bath, massaging the legs, or using a heating pad or ice pack.

If an individual has low iron levels in their blood, a trial of iron supplements will be recommended. However, keep in mind that though these can offer some relief, they are not likely to completely eliminate symptoms.

There are some medications that could be beneficial for treating RLS, but rarely does one single medication offer full management of symptoms for everyone. Often, physicians take their patients through trials of various drugs and drug combinations.

Plus, when an individual takes a medication on a regular basis, over time it will likely lose its effect, which means that they will need to change medications every now and then.

Common RLS Medications

Dopaminergic Agents: these are medications that cause an increase in dopamine levels and are mostly used to treat Parkinson’s. In some cases, they have been proven to be effective for treating PLMS and RLS symptoms when taken at bedtime and are usually the “go-to” treatment when starting out.

The United States FDA has approved medications such as rotigotine, ropinirole, and pramipexole to treat moderate to severe restless leg syndrome.

These medications are usually tolerated well, but can have side effects such as dizziness or nausea. Some patients have had very good short-term results when using carbidopa along with levodopa.

Though these dopamine-related drugs are often very effective in RLS management, using them for the long term may actually have the opposite effect. This worsening of symptoms over time has been termed as “augmentation.”

When an individual has used these for a period of time, they could begin to experience symptoms much earlier in the evening and eventually they will find that they are suffering twenty-four hours a day.

They will likely notice that the bedtime dose seems to be less effective and the night-time symptoms will get much more intense or may affect other parts of the body. However, this is reversible by simply taking the patient off of all dopamine medications.

Another potential effect is that the individual may develop some impulsive/obsessive behaviors such as shopping or gambling. If these do occur, they can be reversed by simply taking the patient off of the medication.

The United States FDA has also approved gabapentin enacarbil for treating cases of moderate to severe RLS. Additionally, other medications that are not specifically made to treat RLS could be prescribed as “off-label” in order to relieve the symptoms.

Benzodiazepines could be beneficial for those who have very mild or even intermittent symptoms of RLS to get restful sleep. However, when taken only at bedtime, they can possibly result in daytime sleepiness.

Typically, benzodiazepines are prescribed to treat insomnia, muscle spasms, and even anxiety. Since they are known to either cause or increase sleep apnea, they should not be used by individuals who have this condition.

Opioids, such as oxycodone, propoxyphene, or codeine may be used to help decrease pain and help with relaxation for those who have severe symptoms. However, like with other medications, these have some side effects, including: risk of addiction, aggravation of sleep apnea, nausea, and even dizziness.

Anticonvulsants such as pregabalin or gabapentin can work for decreasing sensory disturbances such as the nerve pain and the creepy/crawly sensations. Again, side effects for these medications include sleepiness, fatigue, and dizziness.

Finally, the FDA has also approved a device called the Relaxis pad for treating the symptoms of RLS. This can be placed where the discomfort is and offers 30 minutes of vibrations that decrease after 30 minutes.

 What Causes Restless Leg Syndrome

Prognosis of Restless Leg Syndrome

In most cases, this condition is a lifelong one that has no cure. However, there are many therapies available that can help to control the condition by minimizing the symptoms experienced and increasing restful sleep.

As an individual gets older, their symptoms are likely to increase, though for those individuals with an underlying or related medical condition, this decline could be much faster.

Some individuals may experience remissions from time to time where their symptoms seem to decrease or even disappear for a few days, a few weeks, or even a few months- but sadly, they typically reappear at some point.

Something you should know is that being diagnosed with RLS does not mean onset of other neurological disorders such as Parkinson’s.

Research on RLS

NINDS, The National Institute of Neurological Disorders and Stroke, which is a division of NIH is the primary researcher on nervous system and brain disorders.

NINDS is looking to increase the scientific community’s understanding of RLS and to find improved diagnosis and treatment methods, as well as find ways to prevent the condition.

Researchers at NINDS are also looking at the potential role of dopamine in regards to RLS. They have a suspicion that an impairment in the transmission of dopamine signals in the brain could play a role in this condition.

Additionally, research should be able to offer information on the occurrence of RLS and could help them to find more options for successful treatment.

Many conferences sponsored by NINDS and other organizations are showing that there is a need for more research on the roles of dopamine with iron levels in the blood.

Finally, NINDS is looking into trying to understand the physiological mechanisms of PLMS in conjunction with RLS.

Sources

http://www.rls.org/

http://www.ninds.nih.gov/disorders/restless_legs/detail_restless_legs.htm

http://www.webmd.com/brain/restless-legs-syndrome/tc/restless-legs-syndrome-rls

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