Alternative Names : Nocturnal myoclonus; RLS
Definition
Restless leg syndrome (RLS) is a condition in which your legs feel extremely uncomfortable while you’re sitting or lying down. It makes you feel like getting up and moving around. When you do so, the unpleasant feeling of restless leg syndrome temporarily goes away.
Restless leg syndrome affects both sexes, can begin at any age and may worsen as you get older. Restless leg syndrome can disrupt sleep — leading to daytime drowsiness — and make traveling difficult.
It is a sleep disorder characterized by leg discomfort during sleep, which is only relieved by frequent movements of the legs.
A number of simple self-care steps and lifestyle changes may help you. Medications also help many people with restless leg syndrome.
Causes :
In many cases, no known cause for restless leg syndrome exists. Researchers suspect the condition may be due to an imbalance of the brain chemical dopamine. This chemical sends messages to control muscle movement.
Restless leg syndrome (RLS) occurs most often in middle-aged and older adults. It is worsened by stress.
The disorder consists of sensations in the lower legs that make the person uncomfortable unless the legs are moved. The sensations usually occur shortly after going to bed but may also occur during the daytime.
The abnormal sensations occasionally occur in the upper leg, the feet or the arms in addition to the lower leg. In some cases, no other medical or neurological condition is identified. However, restless leg syndrome may occur in patients with peripheral neuropathy or other neurological disorders.
There is an irresistible urge to walk or move the legs to relieve the discomfort, resulting in periodic episodes of leg movements during early sleep stages. The symptoms may last for 1 hour or longer.
Restless leg syndrome can result in a decreased quality of sleep (insomnia) with subsequent daytime sleepiness, anxiety or depression, and confusion or slowed thought processes from lack of sleep.
Heredity
RLS runs in families in up to half the people with RLS, especially if the condition started at an early age. Researchers have identified sites on the chromosomes where genes for RLS may be present.
Stress and pregnancy :
Stress tends to worsen the symptoms of RLS. Pregnancy or hormonal changes also may temporarily worsen RLS signs and symptoms. Some women experience RLS for the first time during pregnancy, especially during their last trimester. However, for most of these women, signs and symptoms usually disappear quickly after delivery.
Related conditions :
For the most part, restless leg syndrome isn’t related to a serious underlying medical problem. However, RLS sometimes accompanies other conditions, such as:
Peripheral neuropathy. This damage to the nerves in your hands and feet is sometimes due to chronic diseases such as diabetes and alcoholism.
Iron deficiency. Even without anemia, iron deficiency can cause or worsen RLS. If you have a history of bleeding from your stomach or bowels, experience heavy menstrual periods or repeatedly donate blood, you may have iron deficiency.
Kidney failure. If you have kidney failure, you also may have iron deficiency, often with anemia. When kidneys fail to function properly, iron stores in your blood can decrease. This, along with other changes in body chemistry, may cause or worsen RLS.
Symptoms:
Difficult to describe sensations
People typically describe restless leg syndrome (RLS) symptoms as unpleasant sensations in their calves, thighs, feet or arms, often expressed as:
*Deep-seated
*Creeping
*Crawling
*Jittery
*Tingling
*Burning
*Aching
*Sleeping difficulty
*Persistent leg movements during sleep hours
*Irresistible urge to move the legs
*Abnormal sensation in the legs (occasionally, feet, thighs, arms)
.Creeping sensations or discomfort (not pain, not cramps) relieved by movement of the legs
.May occur during the day
.Worse when lying down
Sometimes the sensations seem to defy description. People usually don’t describe the condition as a muscle cramp or numbness.
Note: Symptoms may be worse during stress or emotional upset.
Characteristics of signs and symptoms:-
Common characteristics of RLS signs and symptoms include:
*Starts during inactivity. The sensation typically begins while you’re lying down or sitting for an extended period of time, such as in a car, airplane or movie theater.
*Relief by movement. The sensation of RLS lessens if you get up and move. People combat the sensation of restless leg in a number of ways — by stretching, jiggling their legs, pacing the floor, exercising or walking. This compelling desire to move is what gives restless leg syndrome its name.
*Worsening of symptoms in the evening. Symptoms typically are less bothersome during the day and are felt primarily at night.
*Nighttime leg twitching. RLS may be associated with another condition called periodic limb movements of sleep (PLMS). Once called myoclonus, PLMS causes you to involuntarily flex and extend your legs while sleeping — without being aware you’re doing it. Hundreds of these twitching or kicking movements may occur throughout the night. If you have severe RLS, these involuntary kicking movements may also occur while you’re awake. PLMS is common in older adults, even without RLS, and doesn’t always disrupt sleep. More than four out of five people with RLS also experience PLMS.
Most people with RLS find it difficult to get to sleep or stay asleep. Insomnia may lead to excessive daytime drowsiness, but RLS may prevent you from enjoying a daytime nap.
Although RLS doesn’t lead to other serious conditions, symptoms can range from bothersome to incapacitating. In fact, it’s common for symptoms to fluctuate in severity, and occasionally symptoms disappear for periods of time.
RLS can develop at any age, even during childhood. Many adults who have RLS can recall being told as a child that they had growing pains or can remember parents rubbing their legs to help them fall asleep. The disorder is more common with increasing age.
Diagnosis:
Some people with restless leg syndrome never seek medical attention because they worry that their symptoms are too difficult to describe or won’t be taken seriously. Some doctors wrongly attribute symptoms to nervousness, stress, insomnia or muscle cramps. But RLS has received more media attention and focus from the medical community in recent years, making more people aware of the condition.
There is no specific examination for restless leg syndrome. No structural or other abnormalities are usually discovered unless peripheral nerve disease is also present. A blood test may be done to rule out anemia, which rarely has been associated with restless leg syndrome.
Examination and testing may be used to rule out other disorders that may cause similar symptoms, especially disorders associated with claudication of the legs.
Reviewing your signs, symptoms and medical history :-
If you think you may have RLS, consult your doctor. Doctors diagnose RLS by listening to your description of your symptoms and by reviewing your medical history.
Your doctor will ask you questions such as:
*Do you experience unpleasant or creepy, crawly sensations in your legs, associated with a strong urge to move?
*Does movement help relieve the sensations?
*Are you more bothered by these sensations when sitting or at night?
*Do you often have trouble falling asleep or staying asleep?
*Have you been told that your legs or your arms jerk while you sleep?
*Is anyone else in your family bothered by restless legs?
*Ruling out other conditions
There’s no blood or lab test specifically for the diagnosis of RLS. Your answers help your doctor clarify whether you have RLS or whether testing is needed to rule out other conditions that may explain your symptoms. Blood tests or muscle or nerve studies to exclude other possible causes may be necessary to pinpoint RLS.
Your doctor may refer you to a sleep specialist for additional evaluation. This may require that you stay overnight at a sleep clinic, where doctors can study your sleep habits closely and check for leg twitching (periodic limb movements) during sleep — a possible sign of RLS. However, a diagnosis of RLS usually doesn’t require a sleep study.
Treatment :
There is no known cure for restless leg syndrome.
Treatment is aimed at reducing stress and helping the muscles relax. Warm baths, gentle stretching exercises, massage or similar techniques may help.
Sometimes, treating an underlying condition, such as iron deficiency or peripheral neuropathy, greatly relieves symptoms of restless leg syndrome. Correcting the iron deficiency may involve taking iron supplements. However, take iron supplements only with medical supervision and after your doctor has checked your blood iron level.
If you have RLS without any associated condition, treatment focuses on lifestyle changes, and, if those aren’t effective, medications.
Lifestyle changes
Making simple lifestyle changes can play an important role in alleviating symptoms of RLS. These steps may help reduce the extra activity in your legs:
Take pain relievers. For very mild symptoms, taking an over-the-counter pain reliever such as ibuprofen (Advil, Motrin, others) when symptoms begin may relieve the twitching and the sensations.
Try baths and massages. Soaking in a warm bath and massaging your legs can relax your muscles.
Apply warm or cool packs. You may find that the use of heat or cold, or alternating use of the two, lessens the sensations in your limbs.
Leg massage may work to calm restless leg. A warm bath or an over-the-counter pain reliever such as ibuprofen before bed also may help. For severely bothersome cases, you may need prescription medication for symptom relief.
Try relaxation techniques, such as meditation or yoga. Stress can aggravate RLS. Learn to relax, especially before going to bed at night.
Establish good sleep hygiene. Fatigue tends to worsen symptoms of RLS, so it’s important that you practice good sleep hygiene. Ideally, sleep hygiene involves having a cool, quiet and comfortable sleeping environment, going to bed at the same time, rising at the same time, and getting enough sleep to feel well rested. Some people with RLS find that going to bed later and rising later in the day helps in getting enough sleep.
Exercise. Getting moderate, regular exercise may relieve symptoms of RLS,(exercise of calf muscle specially) but overdoing it at the gym or working out too late in the day may intensify symptoms.
Avoid caffeine. Sometimes cutting back on caffeine may help restless leg. It’s worth trying to avoid caffeine-containing products, including chocolate and caffeinated beverages such as coffee, tea and soft drinks, for a few weeks to see if this helps.
Cut back on alcohol and tobacco. These substances also may aggravate or trigger symptoms of RLS. Test to see whether avoiding them helps.
Stay mentally alert in the evening. Boredom and drowsiness before bedtime may worsen RLS.
Medication therapy :
Click to see:->Drugs for Restless Legs Syndrome Have Downsides
Several prescription medications, most of which were developed to treat other diseases, are available to reduce the restlessness in your legs. These include:
Medications for Parkinson’s disease. These medications reduce the amount of motion in your legs by affecting the level of the chemical messenger dopamine in your brain. They include pramipexole (Mirapex), ropinirole (Requip) and a combination of carbidopa and levodopa (Sinemet). However, people with RLS are at no greater risk of developing Parkinson’s disease than are those without RLS. Side effects are usually mild and include nausea, lightheadedness and fatigue.
Opioids. Narcotic medications can relieve mild to severe symptoms, but they may be addicting if used in too high doses. Some examples include codeine, the combination medicine oxycodone and acetaminophen (Percocet, Roxicet), and the combination medicine hydrocodone and acetaminophen (Lortab,Vicodin).
Muscle relaxants and sleep medications. This class of medications, known as benzodiazepines, helps you sleep better at night. But these medications don’t eliminate the leg sensations, and they may cause daytime drowsiness. Commonly used sedatives for RLS include clonazepam (Klonopin), eszopiclone (Lunesta), ramelteon (Rozerem), temazepam (Restoril), zaleplon (Sonata) and zolpidem (Ambien).
Medications for epilepsy. Certain epilepsy medications, such as gabapentin (Neurontin), may work for some people with RLS.
It may take several trials for you and your doctor to find the right medication and dosage for you. A combination of medications may work best.
One thing to remember with drugs to treat RLS is that sometimes a medication that has worked for you for a while becomes ineffective. Or you notice your symptoms returning earlier in the day. For example, if you have been taking your medication at 8 p.m., your symptoms of RLS may start at 6 p.m. This is called augmentation. Your doctor may substitute another medication to combat the problem.
Most of the drugs prescribed to treat RLS aren’t recommended for pregnant women. Instead, your doctor may recommend self-care techniques to relieve symptoms. However, if the sensations are particularly bothersome during your last trimester, your doctor may approve the use of pain relievers.
Some medications may worsen symptoms of RLS. These include most antidepressants and some anti-nausea drugs. Your doctor may recommend that you avoid these medications if possible. However, should you need to take these medications, restless leg can still be controlled by adding drugs that manage the condition.
Coping and support:-
RLS is generally a lifelong condition. Living with RLS involves developing coping strategies that work for you. The Restless Legs Syndrome Foundation recommends these approaches:
Talk about RLS. Sharing information about RLS will help your family members, friends and co-workers better understand when they see you pacing the halls, standing at the back of the theater, or walking to the water cooler many times throughout the day.
Don’t fight it. If you attempt to suppress the urge to move, you may find that your symptoms only get worse. Get out of bed. Find an activity that’s distracting. Stop frequently when traveling.
Keep a sleep diary. Keep track of the medications and strategies that help or hinder your battle with RLS, and share this information with your doctor.
Rise to new levels. You may be more comfortable if you elevate your desktop or bookstand to a height that will allow you to stand while you work or read.
Stretch out your day. Begin and end your day with stretching exercises or gentle massage.
Seek help. Support groups bring together family members and people with RLS. By participating in a group, your insights not only can help you but also may help someone else.
If sleep is severely disrupted, medications such as Sinemet (an anti-Parkinson’s medication) or tranquilizers such as clonazepam may be prescribed, but they may cause daytime sleepiness. Low doses of pramipexole or ropinirole (Requip) have been found to be very effective in controlling symptoms in some people.
Low doses of narcotics may sometimes relieve symptoms of restless leg syndrome.
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Prognosis:
Restless leg syndrome is not dangerous or life-threatening and does not indicate a serious disorder. It can be uncomfortable and can disrupt sleep.
Possible Complications :
Insomnia may occur.
When to Contact a Medical Professional
Call for an appointment with your health care provider if symptoms of restless leg syndrome are present and sleep is disrupted.
Prevention
Techniques to promote muscle relaxation and stress reduction may reduce the incidence of restless leg syndrome in people prone to the condition.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/000807.htm
http://www.mayoclinic.com/print/restless-legs-syndrome/DS00191/DSECTION=all&METHOD=print
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