The Restless legs syndrome (RLS), acromelalgia or Willis-Ekbom disease, is a sensory-motor neurological disorder, characterized by an uncontrollable need to move the lower extremities due to the presence of annoying and unpleasant sensations (Baos Vicente et al., 2008).
People often describe these uncomfortable sensations as burning, irritating, stinging, or painful (National Institute of Neurologial Disorders and Stroke, 2015). These symptoms occur mainly when the individual is relaxed (AESPI, 2015). Thus, they tend to get worse in a state of rest or at night, and improve with movement (Fraguas Herráez el al., 2006).
This type of syndrome is usually associated with sleep disorders, especially conciliation insomnia (Fraguas Herráez el al., 2006), since most people have difficulty falling asleep and maintaining sleep (Martínez García, 2008). It can also be associated with depressive or anxious disorders (Fraguas Herráez el al., 2006).
The symptoms of restless legs syndrome will greatly affect the quality of life of people who suffer from it, since they influence both professional and family life and even their mood (AESPI, 2015).
Many individuals with this syndrome offer subjective complaints about the impairment of their work, personal relationships, and daily activities as a result of fatigue. They also tend to show concentration difficulties, memory deficits or ineffectiveness in the relationship of daily tasks (National Institute of Neurologial Disorders and Stroke, 2015).
Article index
Restless legs syndrome is a neurological movement disorder characterized by the irresistible need or desire to move the legs due to the presence of unpleasant sensations in the lower extremities, generally very annoying, and which some patients describe as painful (AESPI, 2015).
Individuals often have a burning, painful, stabbing sensation, or as if something is sliding down their legs. Patients often describe symptoms as very uncomfortable tingling, burning, itching, pain, bubbling, a sensation of running water, or worms down the legs (Martínez García, 2008).
The sensations perceived by individuals are usually called paresthesias (abnormal sensations) or dysesthesias (abnormal sensations of an unpleasant type), and vary both in the severity of presentation and in the degree of irritability and / or pain (National Institute of Neurologial Disorders and Stroke, 2015).
Most of the time these annoying sensations tend to diminish or disappear with the voluntary movement of the area, at least while the movement is being executed. Relief can be partial or complete and is more likely to occur early in the movement (AESPI, 2015).
Annoying sensations and pain tend to worsen when the patient is resting and in a situation of rest (Baos Vicente et al., 2008). Symptoms tend to be worse when lying down or trying to relax; they appear only at rest and are not related to previous activities (Martínez García, 2008).
The sensations usually predominate in an evening or night stage, so that the periodic movements of the extremities will cause both difficulty in falling asleep and frequent “micro-awakenings” that will impair the ability to maintain sleep (Baos Vicente et al., 2008).
The periodic movements of the legs that will cause the “micro-awakenings” are called nocturnal myclones. Individuals will perform flexion movements of the legs at the knee and ankle, with an extension of the thumbs.
The movements are presented in an organized and repetitive manner in intervals of 20 to 40 seconds and usually last between 0, 5 and 5 seconds (Martínez García, 2008).
In summary, the main symptoms of restless legs syndrome are:
Current research on determining the causes of restless legs syndrome is limited so there is little conclusive experimental evidence. This syndrome is said to be idiopathic, that is, it does not have a known cause (AESPI, 2015). Thus, most cases are considered idiopathic, especially those with early onset (Fraguas Herráez el al., 2006).
However, in approximately 50% of cases, there is a family history related to the disorder (National Institute of Neurologial Disorders and Stroke, 2015). Thus, restless legs syndrome can present a hereditary or genetic component, in this case it is primary or familial (AESPI, 2015).
Generally, people who have a hereditary restless leg syndrome are usually younger at the time of onset of symptoms and have a slower progression of the disease (National Institute of Neurologial Disorders and Stroke, 2015).
On the other hand, restless legs syndrome can also be related to other types of diseases, which lead to its presentation or worsening, it is known as secondary RLS (AESPI, 2015).
The National Institute of Neurologial Disorders and Stroke (2015), relates the following factors or conditions with restless legs syndrome:
Among these, the most important and most frequent cause is iron deficiency (Fraguas Herráez el al., 2006). Iron is an essential component of dopamine receptors (D2), which are widely located in the basal ganglia. Its lack can interfere with the function of these receptors and cause this type of movement disorder (Martínez García, 2008).
The alteration of cerebral iron metabolism will lead to a dopaminergic dysfunction in a group of neurons that projects from the midbrain to the spinal cord, the limbic system and the cerebral cortex (Fraguas Herráez el al., 2006).
Iron concentrations below 45µg / L can increase symptoms of restless leg syndrome. In addition, the administration of dopaminergic drugs generally improves symptoms..
All this suggests that both iron and dopamine are involved in the appearance of this clinical picture and that it is related to a dopaminergic hypo-function (Martínez García, 2008).
The main consequence of suffering from restless legs syndrome is the alteration of normal and regular sleep patterns.
Insomnia is the main consequence of this syndrome. Approximately 80% of patients experience periodic movements of the lower extremities during sleep (AESPI, 2015).
A significant number of patients report sleep disturbances or disturbances such as conciliation and / or maintenance insomnia and daytime sleepiness. Often, there is an increase in sleep latency and a notable decrease in efficiency due to the presence of successive micro-awakenings (Martínez García, 2008).
In addition, the presence of an unsatisfactory or restful sleep will negatively affect the patient's functionality and daily activities. Daytime sleepiness will cause a deficiency in the execution of work or daily tasks.
On the other hand, lack of sleep can have a significant impact on the cognitive component of the person. There may be alterations in memory, attention, difficulty in concentration, in executive functions, etc..
This as a whole is going to have important consequences in the life of the person who suffers from it. A study carried out by Baos Vicente and colleagues (2008) shows that approximately 25% of patients with restless legs syndrome report that their symptoms have a negative and harmful effect on the person with whom they share the bed, affecting the need of special sleeping arrangements in 73% of the cases or affecting the couple's relationship in 20% (Baos Vicente et al., 2008).
In general, continuous or chronic sleep deprivation and its consequences on the ability to concentrate, can affect the ability to work and the ability to participate in social and leisure activities. Likewise, it can cause mood swings that affect personal relationships (AESPI, 2015).
At present we cannot find a specific diagnostic test for restless legs syndrome. This pathology is diagnosed clinically by integrating both the patient's history and the symptoms that he refers and presents (National Institute of Neurologial Disorders and Stroke, 2015).
Generally, the diagnostic criteria described by the International Restless Legs Syndrome Study Group (IRLSSG) are used:
In addition to these criteria, some laboratory tests can also be used to rule out other diseases and support the diagnosis of restless legs syndrome as described by the National Institute of Neurologial Disorders and Stroke (2015), as follows:
Blood tests should be done to exclude anemia, reduced iron storage, diabetes, and kidney dysfunction.
Electromyography and nerve conduction studies may also be recommended to measure electrical activity in the muscles and nerves, and a Doppler ultrasound may be used to assess muscle activity in the legs..
These tests can document any collateral damage or disease to the nerves and nerve roots (such as peripheral neuropathy and radiculopathy) or other movement disorders related to the legs. Negative results of these tests may indicate that the diagnosis is RLS.
In some cases, sleep studies such as a polysomnogram (a test that records a patient's brain waves, heart rate, and breathing throughout the night) are done to identify the presence of PLMD..
Treatment of restless legs syndrome is generally symptomatic, not etiological. For mild conditions, with moderate symptoms that in most cases tend to disappear with movement, many specialists recommend changes in lifestyle and daily activities (National Institute of Neurologial Disorders and Stroke, 2015).
Thus, the Spanish Association of Restless Legs Syndrome (2015), recommends the following lifestyle changes:
On the other hand, doctors can also prescribe a variety of medications for the treatment of restless legs syndrome (National Institute of Neurologial Disorders and Stroke, 2015).
- Dopaminergic agents dopamine receptor agonists, such as pramipexole and ropirinol. They are usually prescribed in low doses and increasing very slowly in order to reduce possible side effects, such as nausea, and hypotension (AESPI, 2015).
- Sedatives: They are usually used to alleviate symptoms that appear aggravated at night. It is not usually used continuously since it can cause diurnal sedition and cognitive problems (AESPI, 2015).
- Analgesics: used in people with severe symptoms of restlessness. Their use is controversial since they present the possibility of addiction (AESPI, 2015).
- Anticonvulsants: they are particularly effective for the treatment of painful symptoms that do not respond to dopaminergic drugs (AESPI, 2015).
On the other hand, due to the consequences that lack of sleep and chronic pain can have on the cognitive functioning of many individuals suffering from restless legs syndrome, it is likely that in many cases some type of neuropsychological intervention is required..
Intervention on memory, attention and executive functions through the development and enhancement of capacities and compensation for deficits can have an important positive impact on the quality of life of patients.
First, look at these four basic diagnostic criteria:
If you feel identified with this description, then you should consult your doctor. There is no test that can make the diagnosis, the doctor must be guided by the symptoms that you report.
It will ask you how frequent they are, their duration and intensity and if they prevent you from sleeping properly at night. Your doctor will likely order some tests to rule out other possible causes..
It is important that you make the medical consultation. Don't think that your symptoms are too mild or that they have no solution. Some doctors mistakenly think symptoms are due to nervousness, stress, insomnia, or muscle cramps, but don't give up.
If you have restless leg syndrome, your symptoms may find relief.
First of all, what you should do is promote a good night's rest. By reducing your intake of caffeine, alcohol, and tobacco, your symptoms may ease and you can rest better.
On the other hand, if you always go to bed and get up at the same time, this can also help you sleep better at night..
Visit this article for other tips to combat insomnia.
Some people with restless leg syndrome have been able to relieve strange sensations in their legs by applying hot or cold compresses before going to sleep..
You can do this by applying a hot water bottle or an ice pack on your legs, a while before going to bed..
Taking a hot shower and massaging your legs can also help..
It is possible that doing light or moderate exercises, especially those that strengthen the lower part of the legs, can help reduce unpleasant sensations.
But you must be careful, excessive exercise can be counterproductive and worsen symptoms instead of alleviating them.
If these simple measures don't help your symptoms, don't worry. There are still many other treatments you can follow to control the syndrome..
For example, elastic compression stockings can be helpful in eliminating the tingling or dragging sensation. They are made of strong elastic material, which will gently compress your legs and stimulate blood circulation, while avoiding strange sensations.
Another good option may be pneumatic compression devices. They are leg covers that are inflated by a small pump to compress the legs.
This is a treatment that can be very effective in eliminating the sensations and so that you can leave your legs still. So you can get a good night's rest. There is also data that infrared light therapy can help.
An infrared light device applied to the legs helps improve circulation and may also be effective in preventing restless leg symptoms, although more research is still needed to show how effective it is. Anyway, you lose nothing by trying.
If you have not been able to avoid the sensations with the previous treatments, do not despair, the doctor can prescribe some medications to alleviate the annoying sensations in your legs and help you sleep better.
However, not all medications are equally effective in all patients and you may have to try different medications before finding the most effective treatment for you..
They are commonly used for Parkinson's disease, but can also be helpful in relieving restless legs.
Both pramipexole, ropinirole, and rotigotine skin patches have been shown to be effective in relieving symptoms, improving the patient's quality of life, and improving sleep..
In general, these are the drugs that are recommended as the initial treatment of preference, in patients who have not been able to relieve their legs by changing their lifestyle or applying other therapies without medication.
You do not have to have seizures for your doctor to prescribe these types of medications.
It has been seen that pregabalin, gabapentin and gabapentin enacarbyl are also able to improve the patient's symptoms and night's rest, which of course improves their quality of life..
They are medicines that will help you sleep better. Not that they exactly relieve the symptoms of restless legs, but they will relax your muscles and you will be able to rest properly..
Clonazepan, diazepam, oxazepam, and temazepam are some examples of this class of drugs. If you take them at night, you may feel a bit lethargic the next day..
If you have sleep apnea, then this type of medication does not suit you, as the symptoms can be aggravated.
If the symptoms of restless legs are severe and not easily relieved, your doctor may prescribe strong pain relievers so that you can rest at night, such as opioids..
Oxycodone, codeine, and morphine are some examples. The downside is that they can cause adverse symptoms, such as dizziness, nausea and dependence or addiction..
It is indicated only for those who have low levels of iron in their body. As you may have read at the beginning, being low on iron can trigger the symptoms of restless legs..
Therefore, a treatment with intravenous iron or iron pills can be effective in these cases..
Yet No Comments