Restless leg syndrome

What is Restless Leg Syndrome?

Restless legs syndrome, or Willis-Ekbom Disease, is a common, chronic, multifactorial, movement disorder of the limbs in which patients have an irresistible urge to move the legs. This condition starts with abnormal and non-painful sensations that start at rest and are improved by activity. The symptoms are worse at rest and during sleep.

In the idiopathic form of Restless Legs Syndrome, it is hypothesized that a dysfunction in the levels of dopamine and iron stores in the brain regions including substantia nigra and thalamus is associated with Restless Legs Syndrome.

Prevalence of RLS has been estimated to vary between 3.9% and 14.3% in general populations and generally increases by age.

Aetiology

There are two types of Restless Legs Syndrome- Primary Restless Legs Syndrome and Secondary Restless Legs Syndrome. Secondary Restless Leg Syndrome has underlying causes which are-

• Iron deficiency
• End-Stage Renal Disease
• Diabetes Mellitus
• Rheumatic disease
• Venous insufficiency
• Peripheral neuropathy
• Folate or magnesium deficiency
• Amyloidosis
• Lumbosacral radiculopathy
• Fibromyalgia
• Celiac disease

Sign and symptoms

Majority of the patient's complaints of periodic leg movements of sleep are characterized by involuntary, forceful dorsiflexion of the foot lasting 0.5 to 5 seconds and occurring every 20 to 40 seconds throughout sleep. Symptoms typically worsen towards the end of the day and are maximal at night, when they appear within 15 to 30 minutes of reclining in bed.

The patient describes the sensation as crawling, creeping, pulling, itching or stretching in the deep structures rather than the skin. No sensitivity is present to the touching of skin.

Diagnosis

There are no specific investigations to diagnose Restless Legs Syndrome. However, the secondary causes may be investigated. Polysomnography is often done to quantify the frequency of leg movements and characterize the pattern of sleep. EMG and nerve conduction tests are done to rule out radiculopathy or neuropathy.

Essential diagnostic criteria (all must be met):

• There is an uncontrollable urge to move the lower extremities and it may be accompanied by unpleasant and uncomfortable sensations.
• The urge to move the extremities is less during the day but gets progressively worse in the evenings and at night. The symptoms also appear at rest or during periods of sleep and inactivity.
• The urge to move the lower extremities may partially or completely be relieved by ambulation or stretching the legs. As long as the activity is continued, the symptoms are mild or absent.
• The urge to move the lower extremities are worse during the evenings and make it impossible to sleep. Thus, the patient is often fatigued during the day.
• The presence of these symptoms must not be attributed to other behavior conditions, such as tardive dyskinesia, leg cramps, muscle spasms or discomfort from the position.

General management

General measures include avoiding caffeine, antidepressants, antipsychotics, dopamine-blocking antiemetics, and centrally acting antihistamines. Short daily dialysis in renal failure patients, iron replacement, exercise, massage, and heat may ameliorate the symptoms.

Warning: Above information provided is an overview of the disease, we strongly recommend a doctor's consultation to prevent further advancement of disease and/or development of complications.

Disclaimer: The information provided herein on request, is not to be taken as a replacement for medical advice or diagnosis or treatment of any medical condition. DO NOT SELF MEDICATE. PLEASE CONSULT YOUR PHYSICIAN FOR PROPER DIAGNOSIS AND PRESCRIPTION.