Do you have restless legs?

Summarized by Robert W. Griffith, MD
October 2, 2000 (Reviewed: February 1, 2003)

The restless legs syndrome (RLS) is quite common. Affected people have unpleasant sensations in their legs - creeping, crawling, tingling, or painful feelings. They usually occur in the calf, in one or both legs. Some persons have these sensations in the arms as well. RLS occurs more often when the person is lying down or sitting for a long period, and is more likely late in the day or at night. There is an irresistible urge to move the legs when this happens. Some people describe RLS as the "dancing legs syndrome".

Depending on how precisely it is diagnosed, RLS has been described in between 2% and 15% of the US population. Physicians are not as familiar with it as they probably should be, considering this frequency. This may be because patients don't always mention it to their doctors. A working group set up by the US National Institutes of Health has recently published a useful guideline on the detection and management of this disorder, which is summarized here.

Do you think that you, or someone you know, may have RLS? The diagnosis depends on the answers to these questions:

1. Do you get a tingling or creeping sensation in you legs, with a compelling urge to move them about?
2. Do these sensations cause you to pace the floor, toss and turn in bed, or vigorously massage your legs?
3. Are these attacks worse at rest, and usually relieved by activity?
4. Are they worse in the evening and/or at night?

The disorder can be quite distressing to sufferers. There is usually a loss of sleep, so that people with RLS often feel sleepy during the day. This may interfere with their job, social life and leisure activities. To make matters worse, many people with RLS also have a condition called "periodic limb movements in sleep" (PLMS). This involves uncontrolled jerking or bending of the legs during sleep, every 10 to 60 seconds. It is obviously disturbing to the subject's bed partner, and often wakens the sufferer, producing considerable loss of sleep.
The causes of RLS are not always obvious. The condition runs in some families, so that some forms of it are indeed hereditary. People with low blood iron levels or anemia are more likely to get RLS, as well as those with kidney failure, diabetes, rheumatoid arthritis and peripheral neuropathy. Increased caffeine consumption has been blamed, and some types of antidepressant drugs can precipitate the condition.

The physician must make a full physical exam to exclude other, similar, conditions, such as nocturnal leg cramps or peripheral neuropathy. Lab tests to be done include serum iron levels, blood sugar, and blood urea (testing for kidney failure).

Mild cases may not need any medication - they will respond to activities such as taking a hot bath, massaging the legs, using a heating pad or icepack, or exercising. Reducing coffee consumption can sometimes help. If drug treatment is required, the physician has a number of choices. As individual cases respond very differently in this condition, there may well be a period of trial and error. Sometimes a medication that works well to begin with can lose its effectiveness with nightly use, so that it may be necessary to alternate between different classes of medications.

The most commonly used medications are the benzodiazepines, which are central nervous system depressants, that, while not fully suppressing the RLS symptoms, allow subjects to get some sleep despite these problems; of course, they may cause daytime drowsiness.

Dopaminergic agents are drugs used to treat Parkinson's disease, which are also effective for many people with RLS and PLMS. There is a small risk that their use will actually make the symptoms worse, at least for a period of time.

If the symptoms are very bad, drugs from the opium class that are pain-killing and relaxing (such as codeine or tramadol), can suppress RLS and PLMS. However, as they may be habit forming, as well as having other side effects, such as severe constipation or depression of respiration, they should really only be used as a last resort.

A new approach, electric nerve stimulation has been helpful in some RLS sufferers who also have PLMS. It is applied to the skin of the leg and or feet before bedtime, for 15 to 30 minutes; nighttime leg jerking is reduced considerably.

It can be seen that there are a variety of treatments for this distressing condition. People with restless or dancing legs should not suffer in silence, but consult their physicians for appropriate management of their problem. Once diagnosed, treatment can be directed at removing any possible causes,

Source

• Restless legs syndrome. Detection and management in primary care.  National Center on Sleep Disorders Research Working Group., NIH Publication No 00-3788, 2000, vol. , pp. --

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