HealthyCanada.com

Restless legs syndrome (RLS) is a neurological disorder that makes your legs feel very uncomfortable unless you move them especially at night. Most people with RLS feel discomfort shortly after going to bed or after sitting for long periods of time. Sometimes the sensation is so strong they have an uncontrollable urge to get up and walk around.

RLS is generally a lifelong condition for which there is no cure. Between 2 and 5 percent of Canadians are believed to have RLS. If you are one of them it's unlikely you have a serious medical problem. However some people who suffer from RLS may have iron deficiency neuropathy (nerve damage caused for example by diabetes) or uremia (kidney failure).

A family history of the condition is seen in approximately 50 percent of people with RLS suggesting a genetic form of the disorder. 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 anti-nausea drugs anti-seizure drugs anti-psychotic drugs and some cold and allergy medications may aggravate symptoms.

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.

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.

Although the exact cause of RLS remains elusive alterations in dopamine functioning appear to be important. For this reason the first line of treatment has often been levodopa/carbidopa or "dopamine agonists" such as bromocriptine pergolide or more recently pramipexole and ropinirole. These are somewhat effective.

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.

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.

Physicians also may suggest a variety of medications to treat RLS. Dopaminergic agents largely used to treat Parkinson's disease have been shown to reduce RLS symptoms and are considered the initial treatment of choice. Other drugs including benzodiazepines (central nervous system depressants) opioids and anticonvulsants are also sometimes prescribed.

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.

Prevention

While there is no way to prevent RLS itself you may be able to reduce the frequency and severity of symptoms by:

• cutting back on caffeine alcohol and tobacco
• taking supplements to correct deficiencies in iron folate and magnesium.
• maintaining a regular sleep pattern
• taking a hot bath massaging the legs or using a heating pad or ice pack

Although many people with RLS find some relief with such measures rarely do these efforts completely eliminate symptoms.