Restless Legs Syndrome


Introduction

The restless legs syndrome (RLS) is a disorder characterized by abnormal and uncomfortable sensations in the legs. One gets an irresistible urge to move their legs constantly to rid the sensation. This condition occurs in the evening and night time when a person is sitting or lying down. It can disrupt sleep since the patients experience unpleasant sensations causing them to wake up. The syndrome is caused by a malfunction in the nervous system that leads to unusual sensations in the limbs. The condition is chronic and cannot be cured. There are, however, different methods of managing it including using dopamine agonists, taking iron supplements, and making some lifestyle changes.

Symptoms

The main symptom of the restless legs syndrome is the unusual sensation and irresistible urge to move one’s legs. The sensations reported by people with the disorder include:

  • Itching
  • Pulling
  • Aching
  • Throbbing
  • Pins and needles

One feels the need to move their legs frequently to get rid of these sensations. Other than the legs, the condition can also affect other areas including the arms, chest, or head. The sensations normally occur on only one side of the body but they can also affect both sides in rare occurrences. Restless Legs Syndrome worsens in the evening or night time and affects a person’s daily life by causing symptoms such as:

1. Sleep deprivation

The condition poses a difficulty in falling asleep, thus a person does not get adequate restorative sleep. The uncomfortable sensations and the overwhelming urge to move the limbs will usually wake one up at night. Thus, the individual faces frequent disturbances throughout the night and, therefore, does not get sufficient sleep, which in the long term leads to sleep deprivation.

2. Excessive daytime sleepiness

The direct consequence of the sleep disturbances caused by restless legs syndrome is insufficient night time restorative sleep. Since one is frequently awakened by the unusual feelings in the legs, they, do not sleep soundly at night and end up feeling tired during the day. The person might require frequent naps during the day to offset the sleepiness.

3. Insomnia

An individual who has restless legs syndrome has difficulty falling asleep. The feelings in the legs, such as itching, aching, and pulling, can keep one awake through the night. The person is, therefore, unable to fall asleep or maintain sleep throughout the night due to the irritating sensations.

4. Fatigue

Due to the lack of sufficient sleep caused by restless legs syndrome, one does not get enough rest. The body requires restorative night time sleep for an individual to feel refreshed and energized. When a person has insufficient sleep due to the unpleasant sensations, they are constantly fatigued. They feel exhausted and have trouble carrying out their daily tasks.

5. Charley horse (Muscle spasm)

Charley horse, also known as a muscle spasm, is an unpleasant muscle contraction that commonly occurs in the legs. It usually lasts for a few seconds and resolves on its own. The contractions can also last for longer causing severe pain to the person. Restless legs syndrome triggers Charley horses and the two conditions commonly occur together.

6. Dysesthesia

Dysesthesia is a condition involving abnormal sensations affecting the sense of touch. One gets sensations such as itching, burning, and prickling. The condition is commonly caused by damages to the nervous system. It occurs as the main symptom of restless legs syndrome and it causes a significant urge to move one’s legs to get rid of the unusual sensations. Movement of the limbs usually eliminates the sensations but only partially.

Causes

The restless legs syndrome is caused by different factors, including:

1. Low levels of dopamine

The disorder is associated with the hormone dopamine, which functions as a neurotransmitter. It transmits information through the nerve cells to the basal ganglia, a part of the brain that controls muscle activity. When there is a low level of dopamine production, signalling in the brain reduces. Normal movement is affected and the individual experiences muscle spasms and compulsive movements. The main cause of a reduction in dopamine levels is nerve damage that affects neurotransmission.  Dopamine levels also tend to fall naturally in the evening hours and this causes an increase in the symptoms of the restless legs syndrome.

2. Genetic factors

The restless legs syndrome is a hereditary disorder because it is common in people who have a family history of the condition. Genetic influences play a significant role in the condition especially when it begins at a young age. The condition is considered to be a dopamine-dependent disorder. Therefore, genes that are associated with the dopaminergic system cause the condition. Damages in these genes, which are carried on to offspring, cause problems in muscle control leading to unusual sensations and involuntary movements.

3. Underlying health conditions

In many cases, the restless legs syndrome is secondary to other underlying health conditions. Most of these conditions are long-term and have the restless legs syndrome as a symptom. Some common health conditions that are associated with RLS include:

  • Parkinson’s disease
  • Kidney failure
  • Diabetes
  • Peripheral neuropathy

4. Iron deficiency

Low levels of iron in the body lead to a reduction in dopamine production. Reduced dopamine levels affect neurotransmission to the brain, thus muscle control is impaired and RLS is triggered.

5. Pregnancy

Pregnancy triggers the restless legs syndrome, whereby expectant women suddenly get abnormal sensations in their legs especially in the last trimester. The condition can occur in women who did not previously have the disorder. The symptoms, however, resolve on their own a few weeks after birth.

6. Lifestyle

An individual’s habits can trigger the symptoms of the restless legs syndrome. Insufficient sleep due to irregular sleep schedules and active nightlife can trigger the condition. Taking alcohol, nicotine, and caffeine is known to aggravate the symptoms of the syndrome. These substances stimulate the nigrostriatal dopaminergic pathway and increase the level of dopamine in the striatum. Withdrawal from these substances also causes symptoms similar to the restless legs syndrome.

Diagnosis

There is no specific test for RSL and most of the diagnosis is based on the information provided by a patient. The condition can be diagnosed by a general physician but in some cases, a neurologist is involved to eliminate any uncertainties. Some of the tools that are used in diagnosing the condition include:

1. Interviews

The doctor can interview the patient to learn more about their symptoms. The interviews have questions based on the main symptoms that are associated with restless legs syndrome cases, which are:

  • Unpleasant sensations in the legs
  • An overwhelming urge to move one’s legs
  • The exacerbated of symptoms when one sits or lays down
  • Temporal relief of the symptoms by movement
  • Symptoms worsening in the evening

2. Severity scale

The clinical severity of the condition is commonly graded using the Johns Hopkins RLS Severity Scale. The scale is easy to use and reliable in determining the severity of a restless legs syndrome case. It is based on an analysis of the time of day that the symptoms begin to appear. The symptoms occur in the evening hours but at different times depending on the severity. Based on the symptom onset, the scale gives three scores:

  • Mild – The symptoms begin to appear when in bed
  • Moderate – The symptoms begin after 6 pm but before one is in bed
  • Severe – The symptoms appear before 6 pm

This scale is subjective and is used as a quick screening device for the disorder. It is also useful in monitoring progress during the treatment of the condition.

3. Family history

The restless legs syndrome is a hereditary disorder and, therefore, a person’s family history can be used in diagnosis. It is helpful to evaluate family members, both with or without the condition, to identify whether genes may have played a role in the manifestation of the condition. The restless legs syndrome is considered a dopaminergic-dependent disorder, and therefore, the genes that are involved in the dopaminergic system play a major role in its expression. When faults in these genes are inherited, they can be expressed in the form of the restless legs syndrome. Doctors, therefore, ask about a person’s family history to know whether the condition is hereditary.

4. Reviewing medical history

The restless legs syndrome is commonly a symptom of an underlying health condition, therefore, doctors use a person’s medical history in diagnosis. Different medical conditions, including Parkinson’s disease, diabetes, peripheral neuropathy, and kidney failure, can cause the symptoms of the restless legs syndrome to occur. It is usually a symptom of other health conditions, thus secondary in many cases. Doctors analyze the patient’s past and present health conditions to identify any medical problems that may cause or trigger the syndrome.

5. Blood tests

Blood tests are used to identify the presence of other medical conditions. Through these tests, other health complications that may be contributing to the condition’s symptoms are identified. Some of the medical conditions that are identified through blood tests are diabetes, kidney failure, and iron deficiency anemia.

6. Sleep tests

When the disorder causes significant disruptions to a person’s sleep, sleep tests are recommended by the doctor. The immobilization test is the most commonly carried out for restless legs syndrome cases. It involves lying and remaining still in bed. Involuntary movements are then monitored. Polysomnography, which is an overnight sleep study, is also recommended in some situations. It involves measuring and recording the different elements that are involved in sleep, including breathing rates, heartbeat, brain waves, and muscle activity.

Treatment

There is no specific treatment for the restless legs syndrome, especially when there is no underlying health condition involved. The condition can, however, be managed in different ways, including:

1. Dopamine agonists

The condition is a dopamine-dependent disorder and its symptoms occur due to low levels of dopamine in the body. Dopamine agonists are, therefore, used in treatment to increase the levels of dopamine. The transmission of signals to the brain is improved using these medications thus enabling better muscle control. Some of the dopamine agonists used in treatment include:

  • Ropinirole
  • Pramipexole
  • Rotigotine skin patch

2. Painkillers

The symptoms of the restless legs syndrome can be painful, thus painkillers are prescribed to relieve the pain. A person experiences painful sensations such as burning, aching, and itching. Some of the painkillers used in treating these symptoms include:

  • Opiate-based painkillers such as codeine
  • Gabapentin
  • Pregabalin

3. Iron supplements

The lack of iron is a major cause of the disorder, and extreme deficiency significantly aggravates the symptoms. Iron supplements are, therefore, useful in treating the restless legs syndrome. Studies show that oral iron supplements improve the symptoms of RLS significantly. Oral iron supplements are available over the counter and they are recommended for mild and moderate RLS cases. In severe cases, iron can be delivered into the body intravenously. Individuals who have normal levels of iron respond well to iron supplements as a form of treatment for the syndrome in some cases.

4. Increasing sleep efficiency

The condition commonly disrupts sleep because its symptoms worsen when a person is lying down. Medications can, therefore, be used to help a person sleep throughout the night without interruptions. These sleep medications, commonly known as hypnotics, improve sleep quality and reduce wakefulness. There are many types of hypnotics, including:

  • Benzodiazepines
  • Antidepressants
  • Antipsychotics
  • Antihistamines
  • Melatonin receptor agonists
  • Orexin antagonists
  • Supplements
  • OTC drugs

5. Lifestyle changes

Mild restless legs syndrome cases can be managed with some lifestyle changes, including:

  • Consuming a healthy diet that is rich in iron
  • Exercising regularly but not close to bedtime
  • Getting sufficient sleep by having proper sleep hygiene
  • Avoiding stimulants, such as nicotine and caffeine, that aggravate the symptoms of RLS
  • Avoiding alcohol

6. Natural remedies

When experiencing restless legs syndrome symptoms, some home remedies can be used to alleviate the symptoms, including:

  • Massaging the legs
  • Bathing with warm water
  • Applying a hot or cold compress on the affected areas
  • Carrying out other activities to keep the mind busy, such as reading
  • Relaxation exercises, such as yoga
  • Moving around

Conclusion

The restless legs syndrome is characterized by unpleasant sensations and an overwhelming urge to move one’s legs. The condition normally worsens in the evening and can adversely affect one’s sleep. It leads to fatigue, daytime sleepiness, and insomnia because they disrupt sleep. The restless legs syndrome is a dopaminergic disorder caused by low levels of dopamine in the body. Dopamine is required in the neurotransmission of signals between muscles and the brain. Low levels of dopamine affect muscle control causing involuntary movements and unusual sensations. It is, therefore, treated using dopamine agonists that improve muscle control. The condition can also be managed by using painkillers, iron and other supplements, and hypnotics. Some lifestyle changes can also help in managing the syndrome, including avoiding alcohol, avoiding stimulants, eating healthy foods, and having proper sleep hygiene.

 

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