Restless Leg Syndrome
Restless legs syndrome (RLS) is a disorder of part of the nervous system which causes an intense, uncontrollable urge to move your legs usually while at rest. This urge is caused by unpleasant sensations, often described as "pins and needles," or "creepy crawly" feeling deep in the legs.
Moving your legs sometimes provides temporary relief. Restless legs syndrome often interferes with sleep, and that can lead to severe fatigue and problems functioning during the day. Restless legs syndrome affects about 8-10% of the US population. Men and women are affected equally. It can begin at any age.
Causes of Restless legs syndrome (RLS)
The cause of restless legs syndrome is unknown. It tends to run in families, suggesting a genetic relationship. About 50% of sufferers have a family member who also suffers from RLS.
There does seem to be some relationship between RLS and other conditions such as iron deficiency or iron deficiency anemia, kidney failure, pregnancy, rheumatoid arthritis, diabetes, and Parkinson's disease.
Restless legs syndrome may result from abnormal balances of iron in your blood and of the brain chemical dopamine. However, more research is needed to prove a connection.
Certain medications, such as antinausea drugs (prochlorperazine or metoclopramide), anticonvulsant drugs (eg, methsuximide, phenytoin), antidepressant drugs (eg, amitriptyline, paroxetine), beta-blockers, H2 blockers, lithium, and neuroleptics (antipsychotics) can cause RLS.
Substances, such as alcohol, caffeine, & tobacco can cause or worsen RLS symptoms.
Symptoms of Restless Leg Syndrome
Symptoms vary in severity and duration from person to person. They may come and go over long periods of time or they may occur daily.
Restless leg syndrome may only occur temporarily, in relation with another medical issue such as pregnancy. As many as 40% of pregnant women experience RLS symptoms.
The symptoms usually fade within a few weeks after delivery.
- An uncomfortable feeling in the legs. It is sometimes difficult for patients to describe this feeling but it is often described as itching, "creepy-crawly" feeling, or tingling. The feeling most often occurs in the lower legs, between the knee and the ankle.
- An Uncontrollable urge to move the legs
- Restlessness: since moving the legs can provide temporary relief, RLS sufferers usually can't stay still for long periods of time.
- Sensations may occur only with lying or sitting.
- Sleep disturbances
- Involuntary, repetitive, periodic, jerking limb movements which occur when sleeping or when awake but at rest.
Treatment for Restless Leg Syndrome
For many people, RLS is caused by an underlying medical condition. Often, treating the associated medical condition, such as peripheral neuropathy (damage to the nerves of the arms and legs) or diabetes, will alleviate many symptoms.
For those with no underlying medical condition, many doctors will suggest certain lifestyle changes and activities to reduce or eliminate symptoms. Limiting use of use of caffeine, alcohol, and tobacco may alleviate symptoms.
Your health care provider should do blood tests to check for iron and other vitamin or mineral deficiency, and if there are any treat them. Your doctor should also review any medications (prescription and over-the-counter) to see if they could be causing your symptoms.
Physical therapy, exercise and relaxation techniques can also be helpful. For patients suffering from severe RLS (symptoms at least three nights a week), and when all other methods have been tried with no success, medications may be recommended by your health care provider.
It is important to remember that the medication will not cure RLS, but will relieve symptoms.
Medications Used to Treat Restless Leg Syndrome
- Dopamine precursors and agonists, such as levodopa (Sinemet, Madopar), pramipexole (Mirapex), and ropinirole (Requip). These drugs increase the level of the neurotransmitter dopamine in the brain, which helps relieve the uncomfortable sensations that occur in the legs with RLS.
- Opiates, such as oxycodone (Percocet), hydrocodone (Lortab) and tramadol (Ultram). Because these drugs are very addictive, they are usually used only when other drugs don't work, and at the lowest doses possible.
- Anticonvulsants, such as gabapentin (Neurontin), which are used mainly for people who have pain, neuropathy, or daytime symptoms.
- Benzodiazepines, such as alprazolam (Xanax), temazepam (Restoril), and clonazepam (Klonopin). These agents are sedatives and are often prescribed in combination with the other medications listed above.
It is important to let your doctor know about all of the other medications you are taking. There are many medications that when taken in combination with those prescribed for RLS, can cause negative interactions.
It is also important to talk to your doctor about all of the risks and side effects of the medications you are prescribed. Follow up with your doctor if your symptoms do not improve.
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