Restless legs syndrome (RLS) is a disorder of the nervous system that, as the name implies, commonly affects the legs but may also affect the arms. It causes an uncontrollable urge to move the extremities and can affect males and females of any age, generally worsening with time. Sensations can include a burning, throbbing pain and a feeling the skin is itching or crawling. Symptoms can vary in intensity and disappear for periods of time. Sleep can be interrupted for hours, making daytime activities difficult to get through. The myriad of symptoms that may vary from person to person often begins following a period of lying down or sitting for extended periods of time.
RLS is an inherited disorder that may be due to an imbalance of dopamine in the brain. Most individuals so diagnosed find it difficult to fall asleep and stay asleep. They suffer from insomnia, since the way to help the non-stop symptoms is to get out of bed and walk, even in the middle of the night.
Diagnosis may be made through four criteria established by the International Restless Legs Syndrome Study Group: the individual will have an irresistible urge to move his or her legs; symptoms begin to exacerbate when the person is resting or beginning to settle down for the evening; symptoms worsen at night; and lastly, they are relieved to some degree by walking, stretching, twisting or wiggling.
RLS may be present without any associated condition but when an underlying cause such as iron deficiency or peripheral neuropathy can be found, treatment will initially focus on controlling the condition(s). Iron deficiency can result in iron deficiency anemia, a condition in which the body’s reserve of iron has been depleted and the body is unable to maintain levels of hemoglobin in the blood. Iron deficiency can be determined through simple lab testing and treatment is accomplished with iron supplements. Peripheral neuropathy results from nerve damage. It may present as a tingling or burning sensation that can result from such things as infection, toxin exposure, metabolic issues, or traumatic injury. Diagnosis may be difficult and may require a full neurological examination, nerve function testing, CT or MRI, lab testing, and more. Treatment may include pain relievers, capsaicin, anti-seizure drugs, electrical nerve stimulation, and a number of other possibilities.
There are a number of medications that might be prescribed for control. Mirapex and Requip have both been approved by the FDA for the treatment of moderate to severe RLS. Sinemet is commonly prescribed for Parkinson’s patients; however it is also prescribed, as is gabapentin and a number of other drugs for the treatment of RLS. It may take a trial and error period before a physician can determine which, if any, drug is right for you; however a drug that appears to work for a period of time may become ineffective, necessitating a review and substitution. Opioids are generally avoided because of their addictive traits.
On the home front, exercise is important, as is incorporating relaxing techniques such as meditation, yoga, tai chi and others. Avoid caffeine, eat a well-balanced diet, reduce alcohol consumption and cut back on the smoking habit if appropriate.
