Restless legs syndrome is a condition that causes an overwhelming urge to move your legs. It is also known as Willis-Ekbom disease.It is experienced by more women than men in the general population and can be a common problem for people who have Parkinson’s. Symptoms can start at any age, but it is more common as you get older.
Restless legs syndrome can be mild, moderate, severe or very severe based on the strength of the symptoms, how often the person may experience them and if they affect the ability to carry out daily tasks. Most people’s symptoms are not severe or frequent enough to need medical treatment. When it happens can vary from person to person. Some people experience it occasionally, while for others it happens every day. It happens most often when you are resting – for example, when you are sitting watching the TV or lying in bed.
People with RLS often have periodic limb movements, a closely related sleep disorder that occurs when muscles
involuntarily tighten, twitch or flex while you are still. Periodic limb movements in sleep occur in 80 percent to 90 percent of people who have RLS.RLS is found in 2 to 5% of people (both men and women). The risk of it goes up as you grow older, and it tends to be more serious in the elderly. But it can start at any age. It can be associated with pregnancy.
Restless Legs Syndrome affects approximately 10% of adults in the U.S. Researchers believe that RLS is commonly unrecognized or misdiagnosed as insomnia or other neurological, muscular or orthopedic condition.RLS also affects about 2% of children, according to a study of more than 10,000 families in the U.S. There is also evidence suggesting that children with attention deficit hyperactivity disorder (ADHD) and a family history of RLS are at risk for more severe ADHD.
Features of RLS
There are four primary features of RLS –
- Uncomfortable sensation in the legs with a clear need or urge to move the legs
- The symptoms are worse at night
- The symptoms come on with rest
- The symptoms are relieved with movement
Types of RLS
- Early-onset RLS starts before the age of 45 years, producing symptoms that progress gradually. The daily occurrence of symptoms usually is not present until the age of 40 to 65 years.
- Late-onset RLS advances more quickly and occurs more often. Symptoms may appear daily from the time that they begin, or they may progress rapidly over a period of about five years until they occur with regularity.
- Primary RLS occurs independently of other disorders but may be exacerbated or triggered by other factors.
- Secondary RLS is precipitated by other disorders and resolves when the other disorders are treated.
Causes
Genetic Factor– The simplest concept is when a specific gene is damaged, for example, hemophilia or sickle cell disease. In these diseases, the damaged gene results in an abnormal protein being made or in no protein at all being made. When we talk about how genes are related to blood pressure, heart disease, Alzheimer’s disease, or RLS then the role of the gene is more difficult to understand because usually these common disorders do not result from one damaged gene but rather from interaction of several genes under certain environmental conditions.More than 50 percent of people with primary RLS report a pattern of the disorder in their family. First-degree relatives of a person with RLS are three times to six times more likely to have it.
Most of the people are born with normal hearts but over time, because of the interaction between environmental factors (aging, high cholesterol, smoking, increased blood pressure, diabetes, etc) and genes, some people will progress to having a bad heart. RLS is also related to environmental factors and genes. The single largest know environmental factors is low iron levels. Low iron may occur before birth, during infancy, as a child, during pregnancy or later in adult life. The low iron may resolve long before one even develops RLS symptoms, but the low iron condition may set into motion set of conditions that eventually lead to getting RLS.
Underlying Health Condition – Restless legs syndrome can sometimes occur as a complication of another health condition, or it can be the result of another health-related factor. This is known as secondary restless legs syndrome.
- Iron deficiency anaemia – low levels of iron in the blood can lead to a fall in dopamine, triggering restless legs syndrome
- A long-term health condition – such as chronic kidney disease, diabetes, Parkinson’s disease, rheumatoid arthritis, an underactive thyroid gland, or fibromyalgia
- Pregnancy – particularly from week 27 until birth; in most cases the symptoms disappear within four weeks of giving birth
Dopamine – Because of the marked improvement in RLS symptoms seen with drugs that stimulate the dopamine system and because of the RLS-like symptoms produced with drug that block the dopamine system, the dopamine system has been implicated RLS. CSF has also been used to evaluate dopamine system, and although this is a crude method for assessing the dopamine system in the brain, the data indicated possible increase in brain dopamine production. Imaging studies using special radioactive chemicals have found reduced receptor and transporter function in the brain of more severely affected RLS patients.
Triggers – There are a number of triggers that don’t cause restless legs syndrome, but can make symptoms worse. These include medications such as –
- Some antidepressants
- Antipsychotics
- Lithium – used in the treatment of bipolar disorder
- Calcium channel blockers – used in the treatment of high blood pressure
- Some antihistamines
- Metoclopramide – used to relieve nausea
Other possible triggers include –
- Excessive smoking, caffeine or alcohol
- Being overweight or obese
- Stress
- Lack of exercise
Alcohol and sleep deprivation also may aggravate or trigger symptoms in some individuals. Reducing or completely eliminating these factors may relieve symptoms, but it is unclear if this can prevent RLS symptoms from occurring at all.
Symptoms
Not only are the signs and symptoms of restless legs syndrome different from person to person, but also they can be tricky to explain. Some describe the leg sensations as “creeping,” “prickling,” “burning,” “tingling,” or “tugging.” Others say it feels as if bugs are crawling up their legs, a fizzy soda is bubbling through their veins, or they have a “deep bone itch.”
The symptoms of RLS can range from mildly annoying to severely disabling. You may experience the symptoms only once in a while, such as when you’re under a lot of stress, or they may plague you every night.
Here are some signs and symptoms of RLS –
Leg discomfort and strong urge to move – Uncomfortable sensations deep within the legs, accompanied by a strong, often irresistible urge to move them. Many describe the sensations as tingling, jitteriness, a “creepy crawly” feeling, itching, or pulling.
Rest triggers the symptoms – Leg pain is normally trigged by activity and relieved by rest, but with restless legs syndrome, the reverse is true. Restless leg symptoms start or become worse when you’re sitting, relaxing, or trying to rest.
Symptoms get worse night – RLS typically flares up at night, especially when you’re lying down. In more severe cases, the symptoms may begin earlier in the day, but they become much more intense at bedtime.
Symptoms improve when you walk or move your legs – The uncomfortable sensations temporarily get better when you move, stretch, or massage your legs. The relief continues as long as you keep moving.
Nighttime leg twitching – Many people with restless legs syndrome also have periodic limb movement disorder (PLMD), a sleep disorder that involves repetitive cramping or jerking of the legs during sleep. These leg movements further disrupt your sleep.
Treatment
Dopamine-Related Medications – Dopamine is a chemical that is produced by certain cells in the brain and this group of drugs functions to either increase the amount of dopamine made by the cell (levodopa) or increase the dopamine signal to other surrounding cells by mimicking dopamine in the brain. The dopamine-related drugs include levodopa, pramipexole, ropinirole and rotigotine. These drugs are also used for Parkinson’s Disease. However, there is no indication that RLS is related to, or is a precursor of, Parkinson’s Disease. These medications are likely to be effective in reducing symptoms in 90% of patients with restless legs syndrome.
Excessive sleepiness, increased compulsive behavior and more commonly, paradoxical worsening of symptoms, referred to as “augmentation”, may occur with these medications after extended use.
Opiates – This category of medications includes codeine, hydrocodone, oxycodone, morphine, hydromorphone, methadone, buprenorphine and pentazocine. It is estimated that 85-90% of patients with RLS will respond very well to opiates.
Benzodiazepines Receptor Agonist (BRA) – This group of drugs is also known as sleeping pills and has valium-like effects. The structure of the parent compound was designated as a “benzodiazepine”. Later research identified the specific target of the benzodiazepine drugs and designated it as the “benzodiazepine receptor”.
Alpha-2 delta Drugs – These drugs have their affect by interacting with one of the calcium channel proteins, alpha-2 delta protein. Calcium channels allow the charged calcium ion to move into the nerve cell and are therefore important in activating, in deactivating and in stabilizing the electrical activity of the nerve cell. The alpha-2 delta drugs are also used to treat patients with nerve-damage related pain even in those without RLS.
Vein Treatment -98% of patients affected by RLS in a recent study found symptom relief after treating varicose veins in their legs with non-surgical sclerotherapy*. Many physicians believe that it is the underlying vein problems that are causing the Restless Leg Syndrome, and by treating this with an outpatient procedure, patients can get relief.
Alternative Treatment
Iron Supplements – Iron supplements may reduce symptoms in people with restless legs syndrome who are also iron deficient. Patients should use them only when dietary measures have failed. Iron supplements do not appear to be useful for RLS patients with normal or above normal iron levels.
Magnesium mineral supplement – Magnesium therapy for periodic leg movements-related insomnia and restless legs syndrome: an open pilot study.Periodic limb movements during sleep (PLMS), with or without symptoms of a restless legs syndrome (RLS), may cause sleep disturbances. Anecdotal observations have shown that oral magnesium therapy may ameliorate symptoms in patients with moderate RLS.
5-HTP – If the iron levels are normal, then 5-HTP supplementation may significantly improve, or even eliminate, restless legs and myoclonus.
Folic Acid – If there is a family history of restless-legs syndrome (about one-third of all patients with this syndrome have a family history), high- dosage folic acid (35 to 60 mg daily) therapy can be helpful.
Vitamin E – Vitamin E supplements of 400 IU two or three times a day are extremely effective in alleviating RLS.
Chamomile– Studies show the herb chamomile has mild calmative effects (it has a calming effect on the whole body.
Ginkgo biloba – Studies show that the herb ginkgo biloba, which has been used in Chinese medicine for centuries, has beneficial effects on peripheral circulation and may help to improve symptoms.
Valerian – Studies show that the herb valerian is effective in inducing sleep as it has sedative effects that help to improve the quality of sleep. Valerian is often used in herbal preparations for insomnia.
Vitamin B1 (thiamin) – This vitamin assists the nervous tissue to perform correctly and reduces incidence of symptoms. Vitamin B1 (thiamin) may be more useful for reducing symptoms in combination with the rest of the B vitamins.
Vitamin B5 (pantothenic acid) – This vitamin helps the nervous system tissues perform properly and reduces incidence of symptoms. Vitamin B5 (pantothenic acid) may be more useful for reducing symptoms in combination with the rest of the B vitamins.
Vitamin B12 (cyanocobalamin) – A deficiency of vitamin B12 (cyanocobalamin) is known to cause secondary restless legs syndrome, so this vitamin is very important to help reduce symptoms.
Vitamin C – The antioxidant vitamin C helps to strengthen the capillary and other blood vessel walls, so it may help with those people that have peripheral neuropathy symptoms as the underlying reason for the restless legs syndrome.
Vitamin E – Studies show that the antioxidant vitamin E may help to reduce symptoms in people with peripheral neuropathy, as it helps to ensure there is proper circulation in the peripherals (legs/arms) and the blood in the veins and arteries is circulating properly.
Calcium – The mineral calcium is necessary to enable proper muscles contraction and to ensure the muscles work effectively, so it may assist with reduction of symptoms (in conjunction with other nutrients).
Potassium – The mineral potassium is also necessary for proper muscles contraction and ensuring the muscles work properly, so may assist with reduction of symptoms (especially in conjunction with the other nutrients).
Essential fatty acids – The omega 3 essential fatty acids are needed by the body to help reduce inflammation, especially in the muscles, tendons and nerves. The essential fatty acids may be especially useful in reducing severity of symptoms.
GABA – The amino acid GABA is also one of the neurotransmitters which helps the body to relax. GABA is also required to help make the important other neurotransmitter dopamine, which may not be functioning properly in people with restless legs syndrome.
Tryptophan – Studies show there is a link between low levels of the amino acid tryptophan and increased incidence of restless legs syndrome and this is most likely because tryptophan and vitamin B3 (niacin) are closely related and vitamin B3 (niacin) may be especially required to relieve restless legs syndrome symptoms.
Reference –
http://www.aasmnet.org/resources/factsheets/rls.pdf
http://sleephealthfoundation.org.au/pdfs/Restless-Legs.pdf
https://sleepfoundation.org/sleep-disorders-problems/restless-legs-syndrome/symptoms
http://www.helpguide.org/articles/sleep/restless-leg-syndrome-rls.htm#treatment
http://www.medicinenet.com/restless_leg_syndrome/article.htm
http://patient.info/health/restless-legs-syndrome-leaflet
http://www.besthealthmag.ca/best-you/home-remedies/natural-home-remedies-restless-legs-syndrome
http://www.mommypotamus.com/natural-remedies-for-restless-leg-syndrome/
http://www.nytimes.com/health/guides/disease/restless-leg-syndrome/treatment.html