What are common signs and symptoms of restless legs?

People with RLS feel uncomfortable sensations in their legs, especially when sitting or lying down, accompanied by an irresistible urge to move about. These sensations usually occur deep inside the leg, between the knee and ankle; more rarely, they occur in the feet, thighs, arms, and hands. Although the sensations can occur on just one side of the body, they most often affect both sides.

Because moving the legs (or other affected parts of the body) relieves the discomfort, people with RLS often keep their legs in motion to minimize or prevent the sensations. They may pace the floor, constantly move their legs while sitting, and toss and turn in bed.

Most people find the symptoms to be less noticeable during the day and more pronounced in the evening or at night, especially during the onset of sleep. For many people, the symptoms disappear by early morning, allowing for more refreshing sleep at that time. Other triggering situations are periods of inactivity such as long car trips, sitting in a movie theater, long-distance flights, immobilization in a cast, or relaxation exercises.

The symptoms of RLS vary in severity and duration from person to person. Mild RLS occurs episodically, with only mild disruption of sleep onset, and causes little distress. In moderately severe cases, symptoms occur only once or twice a week but result in significant delay of sleep onset, with some disruption of daytime function. In severe cases of RLS, the symptoms occur more than twice a week and result in burdensome interruption of sleep and impairment of daytime function.

Symptoms may begin at any stage of life, although the disorder is more common with increasing age. Sometimes people will experience spontaneous improvement over a period of weeks or months. Although rare, spontaneous improvement over a period of years also can occur. If these improvements occur, it is usually during the early stages of the disorder. In general, however, symptoms become more severe over time.

People who have both RLS and an associated condition tend to develop more severe symptoms rapidly. In contrast, those whose RLS is not related to any other medical condition and whose onset is at an early age show a very slow progression of the disorder and many years may pass before symptoms occur regularly.

What causes restless legs syndrome?

In most cases, the cause of RLS is unknown (referred to as idiopathic). A family history of the condition is seen in approximately 50 percent of such cases, suggesting a genetic form of the disorder. People with familial RLS tend to be younger when symptoms start and have a slower progression of the condition.

In other cases, RLS appears to be related to the following factors or conditions, although researchers do not yet know if these factors actually cause RLS.

People with low iron levels or anemia may be prone to developing RLS. Once iron levels or anemia is corrected, patients may see a reduction in symptoms.

Chronic diseases such as kidney failure, diabetes, Parkinson's disease, and peripheral neuropathy are associated with RLS. Treating the underlying condition often provides relief from RLS symptoms.

Some pregnant women experience RLS, especially in their last trimester. For most of these women, symptoms usually disappear within 4 weeks after delivery.

Certain medications-such as antinausea drugs (prochlorperazine or metoclopramide), antiseizure drugs (phenytoin or droperidol), antipsychotic drugs (haloperidol or phenothiazine derivatives), and some cold and allergy medications-may aggravate symptoms. Patients can talk with their physicians about the possibility of changing medications.

Researchers also have found that caffeine, alcohol, and tobacco may aggravate or trigger symptoms in patients who are predisposed to develop RLS. Some studies have shown that a reduction or complete elimination of such substances may relieve symptoms, although it remains unclear whether elimination of such substances can prevent RLS symptoms from occurring at all.

How is restless legs syndrome diagnosed?

Despite a clear description of clinical features, the condition is often misdiagnosed or underdiagnosed. Currently, there is no single diagnostic test for RLS. The disorder is diagnosed clinically by evaluating the patient's history and symptoms.

In 1995, the International Restless Legs Syndrome Study Group identified four basic criteria for diagnosing RLS:
(1) a desire to move the limbs, often associated with paresthesias or dysesthesias,
(2) symptoms that are worse or present only during rest and are partially or temporarily relieved by activity,
(3) motor restlessness, and
(4) nocturnal worsening of symptoms.

Although about 80 percent of those with RLS also experience PLMD, it is not necessary for a diagnosis of RLS. In more severe cases, patients may experience dyskinesia (uncontrolled, often continuous movements) while awake, and some experience symptoms in one or both of their arms as well as their legs. Most people with RLS have sleep disturbances, largely because of the limb discomfort and jerking. The result is excessive daytime sleepiness and fatigue.

Despite these efforts to establish standard criteria, the clinical diagnosis of RLS is difficult to make. Physicians must rely largely on patients' descriptions of symptoms and information from their medical history, including past medical problems, family history, and current medications. Patients may be asked about frequency, duration, and intensity of symptoms as well as their tendency toward daytime sleep patterns and sleepiness, disturbance of sleep, or daytime function. If a patient's history is suggestive of RLS, laboratory tests may be performed to rule out other conditions and support the diagnosis of RLS. Blood tests to exclude anemia, decreased iron stores, diabetes, and renal dysfunction should be performed. Electromyography and nerve conduction studies may also be recommended to measure electrical activity in muscles and nerves, and Doppler sonography may be used to evaluate muscle activity in the legs. Such tests can document any accompanying damage or disease in nerves and nerve roots (such as peripheral neuropathy and radiculopathy) or other leg-related movement disorders. Negative results from tests may indicate that the diagnosis is RLS. In some cases, sleep studies such as polysomnography (a test that records the patient's brain waves, heartbeat, and breathing during an entire night) are undertaken to identify the presence of PLMD.

The diagnosis is especially difficult with children because the physician relies heavily on the patient's explanations of symptoms, which, given the nature of the symptoms of RLS, can be difficult for a child to describe. The syndrome can sometimes be misdiagnosed as "growing pains" or attention deficit disorder.

DO NOT disregard medical advice or delay in seeking it because of something you have read on the Internet.

What is the prognosis?

RLS is generally a lifelong condition for which there is no cure.

Symptoms may gradually worsen with age, though more slowly for those with the idiopathic form of RLS than for patients who also suffer from an associated medical condition.

Nevertheless, current therapies can control the disorder, minimizing symptoms and increasing periods of restful sleep.

In addition, some patients have remissions, periods in which symptoms decrease or disappear for days, weeks, or months, although symptoms usually eventually reappear.

A diagnosis of RLS does not indicate the onset of another neurological disease.

How is restless legs syndrome treated?

Although movement brings relief to those with RLS, it is generally only temporary. However, RLS can be controlled by finding any possible underlying disorder. Often, treating the associated medical condition, such as peripheral neuropathy or diabetes, will alleviate many symptoms. For patients with idiopathic RLS, treatment is directed toward relieving symptoms.

For those with mild to moderate symptoms, prevention is key, and many physicians suggest certain lifestyle changes and activities to reduce or eliminate symptoms.
Decreased use of caffeine, alcohol, and tobacco may provide some relief.
Physicians may suggest that certain individuals take supplements to correct deficiencies in iron, folate, and magnesium.
Studies also have shown that maintaining a regular sleep pattern can reduce symptoms. Some individuals, finding that RLS symptoms are minimized in the early morning, change their sleep patterns.
Others have found that a program of regular moderate exercise helps them sleep better; on the other hand, excessive exercise has been reported by some patients to aggravate RLS symptoms.
Taking a hot bath, massaging the legs, or using a heating pad or ice pack can help relieve symptoms in some patients.

Although many patients find some relief with such measures, rarely do these efforts completely eliminate symptoms

Physicians also may suggest a variety of medications to treat RLS. Generally, physicians choose from dopaminergics, benzodiazepines (central nervous system depressants), opioids, and anticonvulsants. Dopaminergic agents, largely used to treat Parkinson's disease, have been shown to reduce RLS symptoms and PLMD and are considered the initial treatment of choice. Good short-term results of treatment with levodopa plus carbidopa have been reported, although most patients eventually will develop augmentation, meaning that symptoms are reduced at night but begin to develop earlier in the day than usual. Dopamine agonists such as pergolide mesylate, pramipexole, and ropinirole hydrochloride may be effective in some patients and are less likely to cause augmentation.

In 2005, ropinirole became the only drug approved by the U.S. Food and Drug Administration specifically for the treatment of moderate to severe RLS. The drug was first approved in 1997 for patients with Parkinson’s disease.
Benzodiazepines (such as clonazepam and diazepam) may be prescribed for patients who have mild or intermittent symptoms. These drugs help patients obtain a more restful sleep but they do not fully alleviate RLS symptoms and can cause daytime sleepiness. Because these depressants also may induce or aggravate sleep apnea in some cases, they should not be used in people with this condition.

For more severe symptoms, opioids such as codeine, propoxyphene, or oxycodone may be prescribed for their ability to induce relaxation and diminish pain. Side effects include dizziness, nausea, vomiting, and the risk of addiction.
Anticonvulsants such as carbamazepine and gabapentin are also useful for some patients, as they decrease the sensory disturbances (creeping and crawling sensations). Dizziness, fatigue, and sleepiness are among the possible side effects.

Unfortunately, no one drug is effective for everyone with RLS. What may be helpful to one individual may actually worsen symptoms for another. In addition, medications taken regularly may lose their effect, making it necessary to change medications periodically.

RLS and MS

High prevalence of restless legs syndrome in multiple sclerosis. Manconi M; Fabbrini M; Bonanni E, Filippi M, Rocca M, Murri L, Ferini-Strambi L. European Journal of Neurology. 2007;14:534-9.
Background:
Multiple sclerosis (MS) is a chronic disease that affects the central nervous system. It can cause a variety of symptoms involving sensation, vision, speech, strength, mobility, and pain. “Secondary RLS” is a term used to describe RLS that has either a known cause or a known association. Some of the neurological diseases associated with RLS are peripheral neuropathy, spino-cerebellar ataxia, and Parkinson’s disease. Patients with MS often complain of RLS symptoms. This has always been viewed more as coincidence than as a real association between these two conditions.
Research:
The researchers wanted to see how common RLS was in patients with MS. Over the course of one year, every patient with MS that came to one of the two neurology clinic research sites was evaluated for this study. Patients were not allowed to be in the study if they had any other neurological condition or other medical condition that could cause secondary RLS. They were also excluded if they were on dopaminergic or neuroleptic drugs or clonazepam, and if they: (1) were diagnosed with MS within 6 months; (2) their MS had relapsed within the last 6 months; (3) had any drug or alcohol abuse; (4) had any dementia; (5) or if they were younger than 18 or older than 65 years old. In total, 156 patients (100 females and 56 males) were enrolled in this study. Each patient was examined by two physicians and evaluated for MS and RLS. They each had an MRI as well.
The results of this study showed:• 91 (58.3%) patients never had RLS symptoms.• 51 (32.7%) patients had RLS symptoms more than once a week in the last 6 months.• 12 (7.7%) patients had RLS symptoms less than once a week in the last 6 months.• 2 (1.3%) patients had prior history of RLS but no active symptoms.
The Bottom Line: In patients with MS, the rate of RLS is three times higher than the average population. The researchers in this study suggest that MS be considered a cause of secondary RLS.
New Questions: The brain lesions of MS can be found in many places, but there was no association between the locations of the brain lesions and whether the patient also had RLS or not—why is this? What is it about MS that makes a person at higher risk for RLS?

Local RLS Physicians and Specilists

Click here for a list of specialistss in the local area

Our Medical Advisor ~

Dr. Scott Fromherz
Westside Sleep Center
7450 SW Beveland Street, Suite 120
Tigard, OR 97223
Phone: (503) 639-7000



If you have other physicians or specialists who you would like to recommend, please contact Delores at surplad@yahoo.com and/or 360-892-5907.

Click through the calendar and find out what's going on...

If you would like to post something on the calendar (IE - walk, coffee, etc), contact Delores at 360-892-5907 or surplad@yahoo.com.

RLS (Restless Leg Syndrome)

What is restless legs?
What are common signs and symptoms of restless legs?
What causes restless legs syndrome?
How is restless legs syndrome diagnosed?
How is restless legs syndrome treated?
What is the prognosis of people with restless legs?
What research is being done?
Where can I get more information?

Information provided by NINDS which is part of the National Institutes ofHealth

Books and Recommended Reading

SLEEP THIEF, Restless Legs Syndrome

First book on RLS - Virginia N. Wilson (who had RLS herself) wrote this book on RLS edited by Arthur Walters, M.D. This is the first book published on RLS and has a wealth of information helpful for both doctors treating RLS and patients with the disorder. Get more information and order the book directly from Galaxy Books.



Relief and Hope for Sleepless Victims of a Hidden Epidemic

This book is written by Robert H. Yoakum, who is an RLS sufferer, past member of the RLS Foundation's Board of Directors and a newspaper columinist. He spent years researching information from all availiable sources on RLS in order to make this one of the most reliable and comprehensive books on the topic. This book should be an extremely helpful guide for RLS patients, their family and friends.



The RLS Rebel's Survival Guide

Jill Gunzel, aka the RLS Rebel, wrote this book. It can be purchased from her website or from other book retailers. This book is recommended reading for all RLS sufferers.



Coping With Your Sleepless Nights

This book was written by three well known expert doctors in the RLS field.

Dr. Mark J. Buchfuhrer, M.D.,
Dr. Wayne A. Hening, M.D., and
Dr. Clete A. Kushida, M.D.


Discussion includes the basic science of RLS, causes, diagnosis and management (including non-drug and drug therapy, lifestyle changes, how to avoid triggers, coping with relationships and work), how to apply for disability and much more (including RLS in children and in other medical conditions).


This book should answer almost all of your RLS questions. It contains additional RLS resources and guides the reader on how to research RLS. This book will help RLS sufferers understand this condition so that they can take control of their lives and make informed decisions. It also will be a useful resource for families, caregivers, and health care providers.


You can purchase these book from Amazon.com (teamed up with Borders.com.