Restless Legs Syndrome: From Pathophysiology To Clinical Diagnosis And Management
- 1Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- 2Department of Psychiatry, Harvard Medical School, Belmont, MA, United States
- 3Division of Alcohol and Drug Abuse, Mailman Neuroscience Research Center, McLean Hospital, Belmont, MA, United States
Association Between Rls And Type 2 Diabetes
In 2007, Italian researcher Giovanni Merlino and colleagues were the first investigators to demonstrate an association between RLS and type 2 diabetes and demonstrate that peripheral neuropathy is a primary risk factor for RLS in diabetic patients. They compared the prevalence of RLS among diabetic outpatients versus among nondiabetic controls who were diagnosed with other endocrine diseases. They also assessed the diabetic patients for peripheral neuropathy to determine whether it was a risk factor for RLS.
They found that RLS was approximately three times more prevalent among the diabetic patients than among the control patients . Statistical tests further revealed that RLS was independently and significantly associated with type 2 diabetes.
Other researchers have similarly corroborated an association between diabetes and RLS. For example, Zobeiri and Shokoohi found that the prevalence of RLS was approximately four times higher among the diabetic patients than among the control patients , and that this difference was significant.
Sabic and colleagues also noted an association between diabetes and RLS, but with an interesting finding. They examined the frequency of RLS among patients with hypertension and among diabetic patients with and without hypertension versus its frequency among healthy controls. There was a greater frequency of RLS among patients with hypertension and among diabetic patients with or without hypertension , compared to the controls .
Restless Legs Syndrome Faqs
Q: Is restless legs syndrome painful?A: Not generally. People tend to describe the sensations caused by restless legs syndrome as uncomfortable, such as feelings of crawling or itching. In severe cases, people may report feeling pain.
Q: Does restless legs syndrome get worse with age?A: Primary restless legs syndrome has no cure. Although symptoms may worsen with age, treatment and therapy can bring symptoms under control and minimize disruption to everyday life.
Q: What vitamin and/or mineral supplements are good for restless legs syndrome?A: Sometimes restless legs syndrome is caused by an iron deficiency, in which case iron supplements can ease or reverse symptoms. If a person has a healthy and balanced diet, there is usually no need for supplements. A medical professional can assess whether symptoms of RLS are caused by a vitamin or mineral deficiency and can recommend supplements where necessary.
Q: Does magnesium help restless legs syndrome?A: Although some people with restless legs syndrome report that products like magnesium oil spray have been helpful, and others report magnesium supplements helped with insomnia,, Harvard Menâs Health Watch notes that studies on magnesium and sleep have, to date, been small and of short duration. A well grounded scientific basis for using magnesium to help with restless legs syndrome is currently lacking.
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Risk Factors For Periodic Limb Movement Disorder
About 6% of the general population has PLMD. However, the prevalence in older adults is much higher, reaching almost 60%. Studies suggest that PLMD may be especially common in older women. As with RLS, there are many conditions that are associated with PLMD. They include sleep apnea, spinal cord injuries, stroke, narcolepsy, and diseases that destroy nerves or the brain over time. Certain drugs, including some antidepressants and anti-seizure medications, may also contribute to PLMD. About a third of people with PLMD also have RLS.
Relieving Restless Legs In The Moment
Sometimes, despite your best self-help efforts, the symptoms of restless legs flare up. The following tips will help you find quick relief:
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Repetitive Transcranial Magnetic Stimulation
A noninvasive procedure thats typically used to treat depression could be helpful in relieving RLS symptoms. So far, studies have been limited and more research is needed, but the results are promising (4, 41,
Repetitive transcranial magnetic stimulation sends magnetic impulses to certain areas of the brain.
Its not entirely clear why rTMS could help relieve RLS symptoms. One theory is that the impulses increase the release of dopamine in the brain. Another suggests that rTMS could help calm the hyperarousal in parts of the brain that are associated with RLS .
In one 2015 study, 14 people with RLS were given 14 sessions of rTMS over 18 days. The sessions significantly improved their RLS symptoms and improved their sleep. The results lasted for at least two months after the treatment ended .
Restless Leg Syndrome Vs Sciatica
- Sciatica, also called sciatic nerve pain, causes pain running down the legs, usually from the lower back all the way to the feet. RLS and sciatic nerve pain are often confused.
- The primary cause of sciatica is a pinched nerve or herniated disc in the lower spine running along the sciatic nerve. Other causes of sciatica are spinal stenosis, infection, a broken pelvis or thighbone, or a tumor.
- According to Harvard Medical School, the biggest difference between these two conditions is that sciatica doesnt tend to get worse during sleep and then better again during the daytime, like restless leg syndrome usually does. Sciatica symptoms are also usually worsened from moving, coughing, bending, exercising, sneezing and physical activities that tug on the sciatic nerve.
- Some choose pain-reducing medications or even surgery to correct sciatic, but less invasive treatment options can also be very helpful. Treatments for sciatica include chiropractic spinal adjustments or spinal manipulation, stretching, acupuncture, yoga, and massage therapy.
Precautions Regarding Restless Leg Syndrome
For some people, RLS gets worse with age, especially if underlying causes arent treated. Most of the time restless legs syndrome wont lead to a more serious health problem or pose any major risks, but its still important to keep an eye on progress of symptoms.
- Dizziness and signs of low blood sugar
- Chronic fatigue thats severe
- Numbness and tingling in your limbs thats severe
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Restless Arm Restless Body And Other Related Conditions
Its called restless leg syndrome, but it can also affect your arms, trunk, or head. Both sides of the body are usually involved, but some people have it on only one side. Despite these differences, its the same disorder.
About 80 percent of people with RLS also have periodic limb movement of sleep . This causes involuntary leg twitching or jerking during sleep that can last all night long.
Peripheral neuropathy, diabetes, and kidney failure cause symptoms like RLS. Treating the underlying condition often helps.
Many people with Parkinsons disease also have RLS. But most people who have RLS dont go on to develop Parkinsons. The same medications can improve symptoms of both conditions.
Its not uncommon for people with multiple sclerosis to have sleep disturbances, including restless legs, limbs, and body. Theyre also prone to muscles spasms and cramps. Medication used to combat fatigue associated with chronic diseases can also cause this. Medication adjustments and home remedies may help.
Pregnant women are at higher risk of RLS. It usually resolves on its own after the baby is born.
Anyone can have occasional leg cramps or strange sensations that come and go. When symptoms interfere with sleep, see your doctor for a proper diagnosis and treatment. Be sure to mention any underlying health conditions.
Periodic Limb Movements In Sleep
Up to 80% of people with restless legs syndrome also have periodic limb movements in sleep .
If you have PLMS, your leg will jerk or twitch uncontrollably, usually at night while you’re asleep. The movements are brief and repetitive, and usually occur every 10 to 60 seconds.
PLMS can be severe enough to wake up both you and your partner. The involuntary leg movements can also occur when you’re awake and resting.
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Periodic Limb Movement In Sleep
Periodic limb movement in sleep , also known as periodic limb movement disorder , is experienced by about 80 percent of people with restless legs syndrome.
Periodic limb movement in sleep causes limbs, commonly the legs but also sometimes the arms, to jerk or twitch involuntarily during sleep. It can be so severe as to wake the sleeper and disturb anyone sharing the bed. Involuntary limb movements may also occur during waking hours, when it is known as periodic limb movement during awakening .
Most people with restless legs syndrome have PLMS, but many people with PLMS do not also have restless legs syndrome.
Twitching When You Sleep
More than 80 percent of people with RLS also experience periodic limb movement of sleep , a condition that causes your legs to twitch and kick while you sleep, sometimes throughout the night.
RLS symptoms may occur once or twice a week, or more often in severe cases. They may disappear for a period of time, then come back. But in general, they worsen over time.
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Other Conditions Associated With Restless Legs Syndrome
The following medical conditions are also associated with RLS, although the relationships are not clear. In some cases, these conditions may contribute to RLS. Others may have a common cause, or they may coexist due to other risk factors:
- Osteoarthritis . About three-quarters of patients with RLS also have osteoarthritis, a common condition affecting older adults.
- Varicose veins. Varicose veins occur in about 1 in 7 patients with RLS.
- Diabetes. People with type 2 diabetes may have higher rates of secondary RLS. Nerve pain related to their diabetes cannot fully explain the higher rate of RLS.
- Hypertension .
- Chronic obstructive pulmonary disease .
- Chronic alcoholism.
- Sleep apnea and snoring.
- Chronic headaches.
- Brain or spinal injuries.
- Many muscle and nerve disorders. Of particular interest is hereditary ataxia, a group of genetic diseases that affects the central nervous system and causes loss of motor control. Researchers believe that hereditary ataxia may supply clues to the genetic causes of RLS.
- Attention-deficit hyperactivity disorder .
- Psychiatric disorders, such as depression.
Associations Between Msk Pain And Rls
Univariable analysis per MSK pain region showed that all pain regions, except for the upper back region and the other region, were significantly associated with RLS . The strongest associations were with pain reported in the shoulder/arm region and pain reported in the leg . In multivariable logistic regression analysis, BMI and smoking status were tested for confounding, but were not added to the regression models, as they were not significantly associated with both MS pain and RLS. Interaction between sex and MSK pain variables was tested but did not prove to be significant. Final regression models were adjusted for sex, DASS-21 scores and sleep quality and significant associations between several MSK pain characteristics and RLS were found . RLS was associated with reporting long duration of pain , and medium pain frequency in the last three months. In addition, RLS tended to associate with mild and moderate pain intensity during the last week. Lastly, RLS was associated with both reporting one pain site and three or more pain sites .
Table 4 Odds ratios for RLS diagnosis with musculoskeletal pain variables as the input variablea
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Where’s The Rest Of Me
Posted March 19, 2009
Restless leg syndrome is a common and sometimes devastating condition. I see it quite frequently in many of my chronic pain patients. In fact, it contributes to quite a bit of chronic pain, because of the difficulty it causes in terms of getting a good night’s rest, and because it in and of itself can be rather painful. And there are diseases associated with chronic pain which can result in so-called secondary RLS.
It is a nighttime condition which has a huge impact on daytime functioning for those afflicted.
The diagnosis of RLS is mostly arrived at through interviews with the patient, and basically involves 4 important features:1. There is a compelling need to move, usually associated with unpleasant sensations in the legs, which have been described variously as painful or electric or “creepy-crawly”.2. These sensations of RLS are worse or exclusively present at rest.3. These sensations are at least partially and temporarily relieved by activity.4. The sensations of RLS follow a circadian pattern, which in this case translates into being worse late in the evening.
Interestingly, other body parts may be affected, but usually the problems begin with the legs. The other body parts which have been reported to be involved in rare patients include the genitals, hips, back, and even the neck and chin.
Tip : Get Daily Exercise
Daily activity, including aerobic exercise and lower-body resistance training, can significantly reduce the symptoms of restless legs syndrome in most people. Choose activities you enjoy, especially those that emphasize using the legs. Try to exercise for at least 30 minutes on most days, although not too close to bed time.
The exercise doesnt need to be intense. Simple daily activities such as walking can often deliver all the benefits youre looking for. In fact, highly vigorous exerciselike training for a marathoncan sometimes backfire and make RLS symptoms worse.
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What Is Restless Leg Syndrome And Is It Treatable
Restless Legs Syndrome
A nervous disorder that causes an uncontrollable urge to move legs.
is a serious, but treatable condition. The key to living with RLS is managing the symptoms. Lifestyle changes, like limiting caffeine and alcohol, taking iron supplements or a hot bath, or initiating an exercise plan, and seeing a heath care professional to discuss treatment options can help.
How Do I Know If I Have Restless Leg Syndrome
The diagnosis of restless leg syndrome is established on four criteria established by The National Institutes of Health.
Treatment of restless leg syndrome is first directed toward any underlying illness, if known. For example:
- Blood testing to reveal underlying iron deficiency anemia may reveal the underlying cause.
- If varicose veins are thought to be the cause, then surgery to repair the circulation may be considered.
- Reduction or elimination of caffeine, nicotine, and alcohol from a person’s diet can be very helpful.
- Stopping smoking can significantly diminish or prevent symptoms.
- Getting better sleep and exercise can help some persons affected by restless legs.
- Pregnant women who do not sleep well at night and other people with sleep disorders may develop RLS.
There is no cure for restless leg syndrome however, the condition usually responds well to home remedies and medications. The outlook is excellent for people with restless leg syndrome as long as it does not weaken or damage the function of the legs.
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Secondary Restless Legs Syndrome
There are a number of factors that appear to be linked to restless legs syndrome. These may include:
Iron deficiency anemia
A lack of iron in the body, leading to iron deficiency anemia, appears to be linked to restless legs syndrome. Iron plays a role in the functioning of dopamine and other neurotransmittersâ function in the brain.
Restless legs syndrome and pregnancy
Pregnant women may develop restless legs syndrome, with symptoms more common in the final trimester. Between 10 percent and 25 percent of pregnant women are thought to experience symptoms.
Nobody is quite sure why pregnancy can trigger restless legs syndrome. There are suggestions it may be connected to:
- Low iron levels
- Circulation problems
- Increase in estrogen
Restless legs syndrome that develops during pregnancy very often goes away within a month after birth.
Conditions often observed alongside restless legs syndrome
There are several conditions that can lead to restless legs syndrome as a complication, or have been linked to it, sometimes without yet fully understanding the mechanisms behind the link, such as:
- End-stage kidney disease, particularly when needing dialysis
- Nerve damage. This includes peripheral neuropathy, which may itself be a complication caused by diabetes
- Spinal cord disease
- Smoking tobacco
Signs And Symptoms Of Restless Legs Syndrome
Not only do the signs and symptoms of restless legs syndrome differ from person to person, but they can be tricky to describe. Common descriptions include: a creepy-crawly feeling, tingling, itching, prickling, burning, pulling, tugging, and aching. Some people have said it feels like bugs are crawling up their legs, a fizzy soda is bubbling through their veins, or they have a deep bone itch. Sometimes the symptoms are painful, but usually they are simply uncomfortable and disturbing.
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Periodic Limb Movement Disorder
Periodic limb movement disorder is also known as nocturnal myoclonus. Characteristics of PLMD include:
- Nighttime episodes that usually peak near midnight .
- Contractions and jerking of the leg muscles every 20 to 40 seconds during sleep. These movements may last less than 1 second, or as long as 10 seconds.
- Movements of PLMD do not wake the person who actually has it, but they are often noticed by their bed partner. This condition is distinct from the brief and sudden movements that occur just as people are falling asleep, which can interrupt sleep.
- Association with RLS: Four out of five people who have RLS also report having PLMD, but only a third of people with PLMD report having RLS.
While treatments for the two conditions are similar, PLMD is a separate syndrome. PLMD is also very common in narcolepsy, a sleep disorder that causes people to fall asleep suddenly and uncontrollably.