Restless legs syndrome (Willis-Ekbom disease) is a neurological disorder characterized by an urge to move the limbs, paresthesias, motor restlessness and worsening of symptoms by relaxation. It most commonly affects the legs.
Presentation
Affected individuals complain of restlessness, feeling of unpleasant sensation in their legs and calf muscles. Restless legs syndrome presents with the following signs and symptoms:
Workup
Diagnosis of restless legs syndrome primarily begins with a detailed history of sleep pattern of the affected individuals. In addition, individuals with such a syndrome must meet the following criteria given by International Restless Legs Syndrome Study Group:
- Individuals have a very strong desire to move the legs due to uncomfortable sensations. The sensations that cause compulsive movement of the legs include tingling, itching, gnawing, creeping and crawling.
- The symptoms tend to worsen when the individual is either taking rest or sitting; in other words when the legs are in resting position, the symptoms get severe.
- Symptoms generally are relieved by carrying out activities such as walking, moving or stretching.
In addition, to the above mentioned criteria, certain blood tests like ferritin levels may also be carried out to rule out organic other causes [8]. Nerve conduction and electromyographic studies may prove to be useful even with a normal neurologic exam [9].
Treatment
Treating underlying conditions can in majority of the cases correct the condition. However, when restless legs syndrome presents as a sole problem then the treatment regime involves medications along with changes in lifestyle factors. For mild symptoms the doctors may advice some light exercises clubbed with massage and certain relaxation techniques. These methods in a great way help effectively manage the mild symptoms of RLS.
In case of severe symptoms, medications are prescribed to help individuals sleep comfortably and manage other symptoms. The commonly prescribed medications include ropinirole, gabapentin, opioids and clonazepam [10].
Prognosis
If left untreated, RLS can lead to severe mental and physical exhaustion. Numerous people with this condition describe serious consequences in their daily lives, including job difficulties, relationship problems, and a lack of mental acuity. Additionally, others have reported difficulty concentrating, poor memory, and an inability to perform simple activities of daily living. Untreated RLS may also cause problems while traveling and can result in depression.
Complications
Restless legs syndrome seldom causes any serious life threatening conditions. However, the symptoms often get severe during the night hours making life miserable for the affected individuals. Many individuals complain of sleep disturbances during night time, which in turn causes drowsiness during the day. But, development of nausea during the day often prevents the individuals from taking a short nap.
Sleep disturbance also gravely affects the concentration of the individuals and when experienced for long periods, can cause psychiatric disturbances as well.
Etiology
In many situations, the cause of RLS is unidentified. There may be a genetic basis for it, however, since it is often noted to run in families when the symptoms are first noted before age 40. Research has also shown that a cerebral iron deficiency may have in influence on RLS [2]. Additionally, there is substantial support from scientific studies that seems to indicate a connection between dysfunction in the brain’s basal ganglia circuits and RLS. Interference in these neural conduits often leads to uncontrolled movements.
Research has shown that patients who suffer from Parkinson’s disease, which is also characterized by dysfunction in the basal ganglia, frequently have restless legs syndrome. Although scientists do not know conclusively if these components actually cause RLS, there appears to be a definite connection between these issues and RLS: Chronic diseases such as peripheral neuropathy, diabetes, and renal failure, the use of certain antipsychotic, antidepressant, antihistamine, and anti-nausea medications or being in the last trimester of pregnancy. Lack of restorative sleep and alcohol use may also cause RLS symptoms in some patients.
Epidemiology
Restless legs syndrome is a rather common disorder, approximately one in ten people suffer from restless legs syndrome. Various studies regarding the prevalence of RLS in women versus men have been inconclusive.
Pathophysiology
About 25-30% of individuals with anemia, renal failure, or late-stage pregnancy that exhibit some form of impairment of iron hemostasis are likely to develop restless legs syndrome [3]. Patients who are pregnant or have renal failure may not necessarily also have anemia. The diminished state of serotonin ferritin transporters in the brainstem may give rise to RLS [4].
However, intravenous and oral iron therapy may significantly relieve RLS symptoms in many of these individuals, whether there is substantiated anemia or not. Anemia, particularly cerebrospinal anemia, has been assumed a substantially causal factor in RLS symptoms for over half a century. Although the exact pathogenesis of the disorder remains elusive till this date [5].
Prevention
The exact etiology behind the development of RLS is not very well understood and therefore, no guidelines have been postulated to prevent the development of such a syndrome. Researchers however state that making certain lifestyle changes can in a great way help manage the symptoms effectively.
Summary
Restless legs syndrome (RLS) is a neurological condition described as aching, crawling, cramping, or other unpleasant feelings in the lower extremities frequently accompanied by an overpowering compulsion to move one’s legs [1]. These symptomsare usually more prominent when someone is resting and may become more severe at night. As reported by patients, paresthesia and/or dysesthesia may range in severity from slightly unpleasant to extremely agonizing.
Patient Information
Definition
Restless legs syndrome (RLS), a neurological disorder is characterized by development of unpleasant sensations in the legs and calf muscles. The sensations include feeling of creeping, tingling, tugging and pain. These symptoms are known to get worse when the legs are in resting position. Also, the condition gets severe during the night hours disrupting the sleep of the affected individuals.
Cause
The exact cause behind the development of RLS is not yet known. However, the RLS can accompany certain disease conditions such as anemia, Parkinson’s disease, peripheral neuropathy and other chronic disease conditions.
Symptoms
Symptoms of RLS include creeping, gnawing, crawling, tugging, tingling and pain in the legs and calf muscles. The symptoms tend to get severe during the night hours when the individual is at rest.
Diagnosis
Diagnosis of RLS comprises of gathering a detailed history of the symptoms experienced by the patient. In addition, information about the sleep pattern is also gathered. Blood tests are done to rule out underlying conditions.
Treatment
Treatment of RLS is geared towards making certain life style changes to cope with the mild symptoms. Severe forms of symptoms are managed with medications and lifestyle changes.
References
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 5th. Arlington, VA: American Psychiatric Association; 2013:410-3.
- Restless legs syndrome. Detection and management in primary care. National Heart, Lung, and Blood Institute Working Group on Restless Legs Syndrome. Am Fam Phys. Jul 1 2000; 62(1):108-14.
- Winkelman JW. Considering the causes of RLS. Eur J Neurol. Oct 2006; 13 Suppl 3:8-14.
- Jhoo JH, Yoon IY, Kim YK, Chung S, Kim JM, Lee SB. Availability of brain serotonin transporters in patients with restless legs syndrome. Neurology. Feb 9 2010; 74(6):513-8.
- Takaki J, Nishi T, Nangaku M, et al. Clinical and psychological aspects of restless legs syndrome in uremic patients on hemodialysis. Am J Kidney Dis. Apr 2003; 41(4):833-9.
- Krueger BR. Restless legs syndrome and periodic movements of sleep. Mayo Clin Proc. Jul 1990; 65(7):999-1006.
- Restless legs syndrome. Detection and management in primary care. National Heart, Lung, and Blood Institute Working Group on Restless Legs Syndrome. Am Fam Phys. Jul 1 2000; 62(1):108-14.
- Hening WA. Restless Legs Syndrome. Curr Treat Options Neurol. Sep 1999; 1(4):309-319.
- Ferreri F, Rossini PM. Neurophysiological investigations in restless legs syndrome and other disorders of movement during sleep. Sleep Med. Jul 2004; 5(4):397-9.
- Bogan RK, Bornemann MA, Kushida CA, Trân PV, Barrett RW. Long-term maintenance treatment of restless legs syndrome with gabapentin enacarbil: a randomized controlled study. Mayo Clin Proc. Jun 2010; 85(6):512-21.