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Restless legs syndrome (RLS)

Zespół niespokojnych nógIt is not a pain or tingling. It is a huge tension forcing you to move legs rapidly, and any attempts to stop this reflex make you feel like your legs are about to explode. Until recently this disease has not been highly popular and patients have had difficulties in describing their unpleasant feelings.

Today the Restless Legs Syndrome (RLS) is more popular and recognizable by doctors. About 5% of the population experience this sort of complaint. The frequency of occurrence rises with age, and speaking of persons aged over 60, this problem may apply to every tenth person.

Symptoms
Restless Legs Syndrome is a neurological disorder which entails unpleasant feeling in lower limbs, particular when sitting and lying. This unpleasant sensation deep in the muscles causes you to feel forced to move your legs or walk rapidly. Symptoms usually intensify in the evening, disturb your dream, may recur at night and lead to insomnia. The restless legs syndrome also entails log journeys. A discomfort we experience when sitting in the car or plane causes the symptoms to intensify considerably. Paresthesis force you to move your legs rapidly and massage them. This leads to temporary relief, however when you stop doing so, the symptoms recur. Sometimes symptoms are so strong that you need to stand up and walk around the room in order to relieve.

The restless legs syndrome is most frequently experienced by:
– middle-aged or older persons
– women when compared to men
– pregnant women who are to give birth in a few months
– members of family

Causes
Causes of restless legs syndrome are not unambiguous and have not been fully explained. According to numerous sources, they may be inherited (primary) or a consequence of other neurological disorders (secondary). It is estimated that RLS is 50% more frequent among persons whose close relatives suffered from this issue as well. A family-type restless legs syndrome emerges most frequently when a person is about 35 years of age. If symptoms emerge later, this may mean that it accompanies other disorders.

The most frequent causes of secondary forms of restless legs syndrome are iron deficiency, magnesium or vitamin B12 deficiencies, as well as rheumatoid arthritis, polyneuropathies (peripheral neuropathy syndrome), renal insufficiency and taking medicaments which may aggravate symptoms. Factors which aggravate RLS are surely the following: alcohol abuse, nicotine and caffeine abuse, as well as chronic stress. The restless legs syndrome also occurs when women are pregnant, especially in the third trimester, and subsides automatically a few weeks after delivery.

It is however necessary to differentiate between restless legs syndrome and night muscle spasms which result from fatigue and shortage of electrolytes. To treat spasms, muscle relaxing drugs are prescribed, but they do not work with regard to restless legs syndrome.

Diagnosis
Although symptoms of the restless legs syndrome are very distinctive and it is virtually impossible to mistake it with other diseases, RLS is rarely diagnosed. Many people do not look for specialist advice because they find it difficult to describe their symptoms and are afraid of being ridiculed. It is a big mistake because if you do not treat symptoms for a long time, they may develop and occur also during the day. It may lead to increased insomnia, increased fatigue and in effect depression. If you notice early symptoms, we suggest that you visit a neurologist who will confirm or exclude the diagnosis and therefore help you choose a suitable treatment.

There is no laboratory examination dedicated to restless legs syndrome. The diagnosis is made primarily on the basis of medical history, physical examination and laboratory tests which exclude other disorders responsible for similar symptoms.

Treatment
The most important principle when undertaking treatment – explains PhD Aneta Szymkiewicz-Rogowska, a neurologist from Rehasport Clinic in Gdańsk  – is to diagnose properly and exclude disorders which may cause similar symptoms (backbone disorder, diabetes, atherosclerosis, kidney diseases, tumors, thyroid gland issues). Non-pharmacological methods can be used, e.g. lower limb massage, baths (hot and cold), prevention of extensive physical effort in the evening, suitable “rescheduling” of night rest, getting rid of addictive substances (alcohol, nicotine) and some medicaments (e.g. antihistamines).

Pharmacological treatment is based on the confirmed disorder mechanism in the dopamine system of the central nervous system. Therefore L-DOPA preparations or its agonists are used (medicaments used for Parkinson’s disease), soothing drugs, opioids, drugs used for epilepsy, myorelaxants. We have to remember that the medicaments mentioned above must be prescribed and control by a doctor, especially neurologist.

Rafał Czepułkowski