Restless Leg Syndrome (Constant Urge to Move Legs)

Moving the position of your legs is a normal habit when one is sitting for long periods, or even when standing. In fact it helps with blood circulation in the legs and feet when stationary or we may find that our legs ‘fall asleep’ so to speak. However, there is certain disorders where leg movements are considered uncharacteristic and abnormal. It can reach a point where it affects normal sleeping patterns and negatively impact on a person’s life.

What is restless leg syndrome?

Restless leg syndrome, often simply referred to as RLS, is a condition where a person finds it difficult to not move their legs when sitting or lying down. In other words, a person with RLS has to move their legs or they experience an uncomfortable sensation in the legs. This prompts a person to stand up, move around or just change position and sometimes kick around during sleep. Restless leg syndrome (RLS) is a type of nerve disorder associated with muscle movement and since it persists during sleep, often disturbing normal sleep patterns, it is also known as a parasomnia.

Restless leg syndrome affects up to 15% of Americans. It is not a life threatening condition but has been associated with diseases such as headaches, migraines and hypertension (high blood pressure). The reason for this link is not always clear. Patients with restless leg syndrome may also experience difficulty concentrating, poor memory and even slight personality changes but this seems to be largely due to the disturbance of sleep. Most RLS patients experience significant psychological stress as a result of the condition disturbing the quality and duration of sleep.

Restless Leg Syndrome Causes

The exact cause of restless leg syndrome is unknown. It tends to occur more frequently in patients with anemia and during pregnancy but these are not causes. Even the exact disease process is not known but it appears that the root of the problem does not always lie in the legs, but rather in the brain. It appears to be linked to dopamine, a type of brain hormone. There is some evidence to suggest that the problem may lie with the dopamine receptors rather than just the hormone dopamine on in its own. Similarly a problem with the iron levels have been detected yet the mechanism by which it may contribute to restless syndrome is unclear.

Primary Restless Leg Syndrome

Primary RLS is where the condition occurs on its own and no abnormality can be found. The cause appears to be genetic as there is a familial tendency to inherit restless leg syndrome. In these instances the onset of restless leg syndrome may occur much earlier in life.

Secondary Restless Leg Syndrome

Secondary RLS is when the condition arises as a result of some underlying diseases or factors. Even in these cases, the way the abnormality or disease leads to RLS is not fully understood. However, most of these underlying diseases either affect iron levels in the body or cause nerve diseases known as peripheral neuropathy. These conditions include :

  • Amyloidosis
  • Diabetes mellitus (diabetic neuropathy)
  • Donating blood frequently.
  • Folate or magnesium deficiency
  • Lyme disease
  • Kidney failure
  • Monoclonal gammopathy
  • Pinched nerve (lower back)
  • Rheumatoid arthritis
  • Sj√∂gren syndrome
  • Uremia
  • Vitamin B12 deficiency

Restless Leg Syndrome in Pregnant Women

RLS may also occur in pregnancy. This may be in part due to changes in the iron levels and hormone changes with pregnancy. However, RLS usually subsides within weeks after delivery although there is a greater chance of these women developing permanent RLS later in life.

Medication Causing Restless Leg Syndrome

The following medications may be associated with restless leg syndrome. However, it is unclear whether these medication causes, triggers or exacerbates existing RLS. Only certain types of these medication may be responsible for RLS.

  • Antidepressants
  • Antipsychotic drugs
  • Allergy medication
  • High blood pressure drugs

Alcohol and caffeine are also known to worsen RLS.

Restless Leg Movement Video

Restless Leg Syndrome Symptoms

The two main symptoms are strange sensations in the leg and an irresistible urge to move the legs.

Abnormal Leg Sensations

Most RLS patients have difficulty clearly describing the abnormal sensation they experience in the legs. It is almost never a pain of sorts nor is it muscle cramps. However, some patients may find that the words ‘pain’ and ‘cramps’ are the only way to describe the sensation despite it not being an actual pain or cramp. Some of the more common descriptions of the sensation includes :

  • Creeping crawling
  • Internal itch
  • Vague pins and needles
  • Pulling and tugging
  • Gnawing ache
  • Deep burning

Urge to Move Legs

The uncontrollable desire to move the legs is the other main symptom that is reported in restless leg syndrome. Features associated with this urge includes :

  • Triggered or worsened by inactivity like sitting and lying down.
  • Compels a person to pace, rub the limbs, wriggle the legs or toss and turn in bed.
  • Activity eases the abnormal leg sensations and the uncontrollable desire may subside with movement,
  • Symptoms worsen in the evening and night.

Wriggling of the legs during sleep is not the same as muscle twitching. RLS may occur with a twitching disorder known as periodic leg movement disorder where there is involuntary leg muscle movements.

Restless Leg Syndrome Diagnosis

Restless leg syndrome is usually diagnosed by the patient’s report of the symptoms. Various tests may be conducted to either find a cause or connection with other disorders where the restless leg syndrome may be secondary. Blood tests will assess micronutrients levels (vitamins and minerals), kidney function and thyroid activity. Other tests are also done to exclude certain disorders which may be mistaken with restless leg syndrome as is the case with period leg movement disorder. Nerve and muscle testing specific for these disorders will also be considered.

Restless Leg Syndrome Treatment

Where restless leg syndrome is associated with other conditions (secondary RLS), the treatment will be directed at the underlying disease. Restless leg syndrome may then ease or even subside once these existing diseases are effectively treated and managed. With primary RLS, where there is no link to other diseases, the main option is lifestyle changes such as :

  • Bathing before sleeping.
  • Avoiding alcohol, caffeine and nicotine either entirely or at least a few hours before bedtime.
  • Massaging of the legs frequently and a short while before bedtime.
  • Relaxation techniques such as yoga and meditation may be of some use.
  • Exercising frequently may help ease the symptoms.

If any causative medication is identified as a possible cause, then this should also be attended to either by stopping the medication or changing the type of drug. This should only be done under the strict supervision of a doctor.

Restless Leg Syndrome Medication

Medication to treat primary restless leg syndrome is only considered once lifestyle measures have failed to provide relief and the loss of sleep is causing severe adverse effects on the patient’s life. These drugs include :

  • Dopamine agonists commonly used for Parkinson’s disease.
  • Antiepileptics used mainly for epilepsy.
  • Opioid analgesics used for pain relief.
  • Muscle relaxants.
  • Sleeping tablets.

References :

  1. http://emedicine.medscape.com/article/1188327-overview
  2. http://www.mayoclinic.com/health/restless-legs-syndrome/DS00191
  3. http://my.clevelandclinic.org/disorders/restless_leg_syndrome/hic_restless_legs_syndrome.aspx

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