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Restless Legs Syndrome: symptoms, causes, diagnosis and treatment
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Restless Legs Syndrome: symptoms, causes, diagnosis and treatment

Lifestyle changes can go a long way in managing mild to moderate symptoms of RLS
RLS
Representational image | Shutterstock

Restless Legs Syndrome (RLS) is a common condition in which a person has an irresistible urge to move the legs due to unpleasant or uncomfortable sensations in their feet and thighs. 

RLS is also called Willis-Ekbom disease and is often classified as a sleeping disorder because it is triggered at rest, and while attempting to sleep. It has also been referred to as a movement disorder. However, RLS is best described as a neurological sensory issue as the symptoms originate from within the brain. 

RLS typically affects middle-aged people, with the frequency and duration of the symptoms increasing with age. Women are more likely to be affected by this condition. 

Symptoms 

There may be mild to moderate symptoms, with some people being affected occasionally and others experiencing these sensations daily. Sometimes the arms are also affected.  Many people experience involuntary jerking or twitching of the limbs during sleep, called periodic limb movements (PLMs).  

  • The sensations are described as throbbing, itching, or feeling like an insect is crawling on one or both legs. They can range in severity from being irritating to an almost painful sensation. 
  • These sensations create an irresistible urge to move your legs. This provides relief to people who are often seen moving their legs while sitting or walking briskly.  

 The symptoms worsen when the person is lying in bed. A long period of rest such as on a plane, or at the movies can trigger the symptoms.  

Causes

 Most cases do not have a cause for RLS and are called primary RLS. Sometimes, familial or genetic components cause RLS, especially when the symptoms start before the age of 40. 

It is suspected that RLS may be caused due to a deficit of dopamine. Any damage to these cells leads to a reduction in dopamine levels. As dopamine acts as a messenger between the brain and nervous system to control and coordinate body movements, a fall in dopamine levels can lead to dysfunctional limb movements.  

When RLS occurs as a complication of an existing medical condition, it is called secondary RLS. It has been associated with -  

  • Renal disease and individuals undergoing dialysis 
  • Iron deficiency and nerve damage 
  •  Parkinson’s disease as the dopamine pathway is disturbed  
  • Other chronic conditions like diabetes and rheumatoid arthritis 

Pregnancy – Temporary RLS during the last trimester is quite common, and it usually disappears within a few weeks after delivery. 

Symptoms of RLS can also be triggered by -  

  • Excessive use of alcohol, caffeine, and heavy smoking 
  • Medications prescribed for nausea, antidepressants, and other antipsychotic drugs 

Diagnosis 

 There is no single test to make a definitive diagnosis, however, the medical and family history and a physical examination are important.  

To diagnose RLS, the following criteria must be met –  

  • The individual has an overwhelming urge to move the legs due to tingling, itching, or pulling sensation 
  • The symptoms get worse at rest 
  • There is relief on moving or stretching the legs 
  • The symptoms worsen late in the evening or at night
  • There are no associated medical or psychological conditions causing these symptoms

Treatment 

No treatment is needed when RLS does not affect a person’s sleep and there is not much discomfort. For secondary RLS, which causes rapid decline and worsening of symptoms, one requires treatment for the symptoms and  the underlying medical conditions.  

The focus of treatment is to relieve symptoms of RLS.  

  • Leg massages, vibrator pads, and hot compress for the leg muscles, hot showers, regular exercise, walking, and stretching can help during episodes of RLS 
  • Mild cases can be managed by lifestyle changes that include avoiding alcohol, tobacco, and caffeine, especially in the evening  
  • Maintaining a regular sleeping pattern 

Medication 

  • A doctor might suggest consuming iron-rich foods. People with severe iron deficiency need to take iron supplements as prescribed by the doctor  
  • In some cases, after proper clinical evaluation, a doctor might suggest anti-epileptic drugs.  
  • Dopamine agonists (substitutes), increase the levels of dopamine.  However, they have certain side effects like drowsiness, addiction, and gambling. 
  • Mild painkillers as prescribed the doctor.  
  • In severe cases, doctors may prescribe hypnotics or sleeping pills. However, individuals must exercise  caution and care when using these. 

Sources: 

1.https://www.nhs.uk/conditions/restless-legs-syndrome/ 

2.https://www.ninds.nih.gov/restless-legs-syndrome-fact-sheet 

3.https://www.ncbi.nlm.nih.gov/books/NBK430878/ 

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