Key Points About Restless Legs Syndrome
Restless legs syndrome is a disorder that causes unpleasant sensations in the legs. The cause of RLS is still unknown.
With RLS, you have an irresistible urge to move the affected limb when the sensations occur.
Your; healthcare provider can diagnose RLS based on your symptoms, a health history, and a physical exam, but there is no definitive test to diagnose RLS.
Medicine and lifestyle changes can help ease RSL symptoms.
The Cause Is Not Known In Most Cases
This is called primary or idiopathic RLS. Symptoms tend to become slowly worse over the years. It is thought that the cause may be a slight lack of, or imbalance of, some brain chemicals , especially one called dopamine. It is not known why this should occur. There may be some genetic factor, as primary RLS runs in some families.
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.
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Treatment Options For Restless Leg Syndrome
Everyone wants to know how to stop restless leg syndrome immediately, but this is usually not possible. RLS is considered a lifelong disorder, but much can be done to minimize its impact on your daily life. Your doctor will determine if theres an underlying medical condition thats causing or worsening your symptoms and begin with treating that.
Although there are some drugs that can treat associated conditions, there is not a single drug thats useful for all cases. You and your doctor will need to work together to find the right combination of drugs and therapy to manage your individual case. In addition, there will need to be ongoing case management as symptoms wax or wane and if drugs become ineffective over time.
Options for treatment of RLS include the following:
Inability To Sleep Well And Sleepiness During The Day
Because RLS sufferers feel the need to be constantly in motion, they can find it very hard to get restful sleep. This causes sleeplessness or poor-quality sleep, which can translate into daytime drowsiness, lack of concentration, irritability, moodiness, and problems at work and with personal relationships.
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What Is Restless Leg Syndrome
Restless leg syndrome is a common cause of painful legs. The leg pain of restless leg syndrome typically eases with motion of the legs and becomes more noticeable at rest. Restless leg syndrome also features worsening of symptoms and leg pain during the early evening or later at night.
Restless leg syndrome is often abbreviated RLS; it has also been termed shaking leg syndrome. Nighttime involuntary jerking of the legs during sleep are also known as periodic leg/limb movement disorder.
What is restless legs syndrome?
Restless legs syndrome , also known as Willis-Ekbom disease, is a condition that causes uncomfortable sensations, most often in the legs. These sensations have been described as tingly, crawling, creeping feelings, and cause the overwhelming urge to move the affected limb.
RLS symptoms typically occur when the person is sitting, resting, or sleeping, and often happen at night. The movements caused by RLS are called periodic limb movements of sleep . Because of these movements, RLS can cause serious sleep problems.
As a result of these problems, RLS can lead to anxiety and depression. And the longer you have the condition, the worse it can get. It can even spread to other parts of your body, such as your arms .
Magnesium May Relax Your Muscles
Like calcium, this mineral is critical for bone and muscle health.
Anecdotally, magnesium may be helpful to relieve restless legs, and it is a natural muscle relaxant, Dr. Vensel-Rundo says. She recommends taking magnesium separately rather than as part of a multivitamin.
Because magnesium can cause side effects, including diarrhea, its best to start at smaller doses of around 200 to 400 mg a day. If you dont have problems with those, you can go up to 1,000 mg daily. Magnesium glycinate seems to have fewer side effects for patients.
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Take Methyl B12 And Methyl Folate
Some studies suggest a vitamin B12 and folate deficiency may cause RLS. Both folate an essential B vitamin and B12 are required for proper brain function, and a deficiency in one usually means a deficiency in the other. Take 5 mg of methylcobalamim or hydroxocobalamim, and 800 mcg of methyl folate .
Levodopa And Other Dopaminergic Drugs
Dopaminergic drugs increase the availability of the chemical messenger dopamine in the brain and are one of the first-line treatments for severe RLS and PLMD. These drugs reduce the number of limb movements per hour and improve the subjective quality of sleep. People with either condition who take these drugs have experienced up to 100% initial reduction in symptoms.
Dopaminergic drugs, however, can have severe side effects . They do not appear to be as helpful for RLS related to dialysis as they do for RLS from other causes.
Dopaminergic drugs include dopamine precursors and dopamine receptor agonists.
The dopamine precursor levodopa was once a popular drug for severe RLS, although today it is usually recommended only for patients with occasional symptoms who may take it nightly as needed. It may also be helpful for long car rides or plane trips. The standard preparations combine levodopa with carbidopa, which improves the action and duration of levodopa and reduces some of its side effects, particularly nausea. Levodopa combinations are well tolerated and safe.
Levodopa acts fast, and the treatment is usually effective within the first few days of therapy.
A rebound effect causes increased leg movements at night or in the morning as the dose wears off, or as tolerance to the drug builds up.
Long-term use of dopaminergic drugs can lead to tolerance, in which the drugs become less effective.
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When Does Restless Leg Syndrome Happen
Symptoms occur when the person is at rest or inactive, such as:
- Lying down
- In bed
- In a restricted space, like on a plane or at the movies
As a person is more likely to be at rest in the afternoon and evening, those are the parts of day when RLS symptoms are usually at their worst. For some of those affected by RLS, the symptoms may only occur occasionally, while for others they are present every day.
Symptoms tend to improve in the mornings with getting up, and whenever the person starts to move or walk around. Moving around as a remedy can cause problems when the person is trying to go to sleep.
Symptoms can vary in severity, from mild discomfort to being so disruptive and painful they affect day-to-day life. Sleep can be so disturbed that people have difficulty functioning during the day, which can commonly lead to depression and anxiety.
Worried you may have RLS? Start a symptom assessment on the Ada app.
Nonpharmacological Therapy For Intermittent Rls
The majority of patients with intermittent RLS symptoms have mild ones that typically do not require drug therapy. Nonpharmacological remedies are often sufficient to quell these patients symptoms.
Symptoms characteristically occur when patients are at rest both physically and mentally. Although the preferred activity to relieve symptoms is physical movement , it is not always possible . Mentally engaging activities, such as playing a video game, solitaire, chess, doing a crossword puzzle, or even having a mentally stimulating conversation can markedly reduce or eliminate RLS symptoms when the patient is sedentary, which is based on hundreds of anecdotal reports to the author and other RLS experts. However, patients report that passive activities, such as watching the in-flight movie provide no relief.
Abstinence from Caffeine, Nicotine, and Alcohol
The literature is also not very supportive for the effect of nicotine/tobacco on RLS. An early case report described a 70-year-old patient with severe RLS who had a complete remission of symptoms 1;month after smoking cessation. No significant differences in the incidence of RLS was found in a 1997 epidemiological study between Canadian adult smokers and nonsmokers, whereas 2 other epidemiological studies both found an increased risk of RLS in smokers. However, in clinical practice, the effect of smoking on RLS has not been very noticeable.
Avoid Medication That May Enhance RLS
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Restless Legs Syndrome Diagnosis
Thereâs no medical test for RLS. Your doctor might want to talk to your sleep partner about what theyâve noticed.
The five basic criteria for a diagnosis of RLS are:
- An overwhelming urge to move your legs, especially along with uncomfortable or unusual feelings
- An urge that starts or gets worse while youâre at rest
- An urge that goes away, either partly or totally, when you move
- An urge that starts or gets worse in the evening
- Another condition, such as leg cramps, arthritis, or muscle pains, isnât causing it
Your doctor may use lab tests to rule out other conditions. A neurological exam can check for nerve damage or blood vessel problems. A sleep study called polysomnography can tell them if you have other sleep disorders that might cause RLS.
The First Step In Treating Restless Legs Syndrome
The first line of defense against restless legs syndrome is to avoid substances or foods that may aggrivate;or worsen the problem. Stay away from alcohol, caffeine, and nicotine. This may help relieve your symptoms. In addition, review all medications you are taking with your doctor to determine if any of these drugs could be causing the problem.
Any underlying medical conditions, such as anemia, diabetes, nutritional deficiencies, kidney disease, thyroid disease, varicose veins, or Parkinsons disease, should be treated. Dietary supplements to correct vitamin or mineral deficiency may be recommended. For some people, these treatments are all that is needed to relieve RLS symptoms.
You may also benefit from physical therapy and self-care treatments, such as stretching, taking hot or cold baths, whirlpool baths, applying hot or cold packs to the affected area, limb massage, or vibratory or electrical stimulation of the feet and toes before bedtime. Exercise and relaxation techniques also may be helpful.
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Compresses Can Be Soothing
Heated or cooled pads, often used to relieve swelling caused by injuries and other conditions, have a long history as a home remedy. Dr. Vensel-Rundo says they can be effective by creating a new sensation for the brain to process, reducing the uncomfortable sensation produced by restless legs syndrome.
You can buy an inexpensive cold or warm compress at a store, but the simplest way to make one is to soak fabric in cold or warm water and place it against your skin.
Add An Iron Supplement
An iron deficiency may be exacerbating the problem for you. Research indicates that a low level of iron in your brain may be partially responsible for RLS, according to the National Institute of Neurological Disorders and . However, dont up your iron intake on your ownconsult your doctor first. You may need to get a spinal fluid analysis or an to get more precise information about the iron levels in your brain. Your doctor may also want to investigate other nutritional deficiencies, such as vitamin B12, magnesium or folic acid, to see if you might benefit from a supplement.
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Quinine: Not To Be Used Routinely For Nocturnal Leg Cramps
Quinine should only be considered when cramps cause regular disruption of sleep.
Article date: June 2010
Quinine has been used in the UK for the treatment of nocturnal leg cramps for many years. Although patient response may vary, overall efficacy is modest. A meta-analysis of eight randomised placebo controlled trials reported that the mean number of cramps in a 4-week period while taking placebo was 17·08 and the absolute reduction in cramps while taking quinine was 3·6 . Hence patients had around 20% fewer cramps in this periodaround 1 episode a week differencewhen taking quinine compared with placebo.
Restless Legs Syndrome: Seeking Help
Studies estimate that one out of 10 people suffer from restless legs, yet its not always easy to find help and support. Many people with RLS never receive proper treatment. Part of the problem is that its hard to explain and sufferers are often dismissed as being nervous. Those who havent experienced the distressing symptoms may not understand how severely they can impact the quality of your life. Even doctors may not take restless legs seriously, recognize the symptoms, or realize that they point to a real medical condition.
The good news is that recent research has increased our understanding of restless legs syndrome, leading to more effective treatments. At the same time, RLS is becoming more widely recognized. If you or your partner suffers from restless legs, theres never been a better time to find relief.
A night in the life of RLS
If you have restless legs syndrome, a typical night might go like this: You lie down in bed, ready to go to sleep, and just as your body begins to relax, the crawling, tingling, or itching in your legs begin. You try to ignore the uncomfortable sensations, hoping they will go away, but eventually the urge to move is too much. You get out of bed to stretch and pace the floor and, for a moment, you find relief. But when you lie down again, the restless sensations in your legs start all over again.
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Treatment Of Restless Legs Syndrome
There is often no cure for primary restless legs syndrome, though its symptoms can be managed to make the condition easier to live with.
If restless legs syndrome is caused by a condition or medication, symptoms may go away and not return if the condition is cured or the causative medication is stopped. For example:
- RLS caused by pregnancy typically ends within four weeks after giving birth
- Treating iron deficiency with iron supplements may cause an associated RLS to go away
- RLS caused or made worse by a medication may be treated by stopping or changing medication, after consultation with a medical professional
Good to know: Stopping taking or changing any prescribed medication, without first seeking medical advice, can lead to serious health problems.
Diet Recommendations For People With Restless Leg Syndrome
There arent any specific dietary guidelines for people with RLS. But its a good idea to review your diet to make sure youre getting enough essential vitamins and nutrients. Try to cut high-calorie processed foods with little or no nutritional value.
Some people with symptoms of RLS are deficient in particular vitamins and minerals. If thats the case, you can make some changes to your diet or take dietary supplements. It all depends on what your test results show.
If youre deficient in iron, try adding more of these iron-rich foods to your diet:
- dark green leafy vegetables
Those strange sensations in your legs can be uncomfortable or painful. And those symptoms can make it almost impossible to fall asleep and stay asleep.
Sleep deprivation and fatigue are dangerous to your health and well-being.
In addition to working with your doctor to find relief, there are a few things you can do to improve your chances of restful sleep:
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How Is Restless Legs Syndrome Treated
RLS can be treated, with care directed toward relieving symptoms.; Moving the affected limb may provide temporary relief.; Sometimes RLS symptoms can be controlled by finding and treating an associated medical condition, such as peripheral neuropathy, diabetes, or iron deficiency anemia.
Iron supplementation or medications are usually helpful but no single medication effectively manages RLS for all individuals.; Trials of different drugs may be necessary.; In addition, medications taken regularly may lose their effect over time or even make the condition worse, making it necessary to change medications.
Treatment options for RLS include:
;Lifestyle changes.; Certain lifestyle changes and activities may provide some relief in persons with mild to moderate symptoms of RLS.; These steps include avoiding or decreasing the use of alcohol and tobacco, changing or maintaining a regular sleep pattern, a program of moderate exercise, and massaging the legs, taking a warm bath, or using a heating pad or ice pack.; There are new medical devices that have been cleared by the U.S. Food & Drug Administration , including a foot wrap that puts pressure underneath the foot and another that is a pad that delivers vibration to the back of the legs.; Aerobic and leg-stretching exercises of moderate intensity also may provide some relief from mild symptoms.
Adults Under Age 50 Had Threefold Greater Mortality Risk
Adults younger than age 50 treated with quinine for muscle cramps or restless leg syndrome had a threefold increased risk for death, according to results from a population-based study.
Treatment with quinine was associated with a less pronounced mortality increase in older adults, and there was a dose-response relationship, wrote Laurence Fardet, MD, PhD, of Frances University Paris-Est Cretei, and colleagues in JAMA.
Last year, the FDA once again warned against the off-label use of the malaria drug Qualaquin for the treatment of night-time leg cramps, noting that the treatment can cause life-threatening bleeding. FDA officialsa decade earlier in a report associating 93 deaths and 665 adverse outcomes with quinine use for these indications.
A Cochrane review in 2015 found low quality evidence that quinine treatment of 200 mg to 500 mg daily significantly reduces muscle cramp frequency, with moderate quality evidence that quinine reduces cramp intensity.
Fardets group noted that despite the safety warnings and questionable efficacy, quinine is still prescribed for the treatment of restless leg syndrome and other muscle cramp disorders.
The researchers also expressed concern that the widely consumed alcohol mixer beverages bitter lemon and tonic water, which contain quinine, could pose a risk to people who consume the drinks daily, although they cited no clinical evidence to back up the concern.
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