Ras: Literature Review On Existing Cases
Nine articles with a total of 10 RAS case studies were included in this literature review.
Analyses for adherence to IRLSSG diagnostic and supportive criteria
All of the 10 cases were fulfilling the IRLSSG criteria except for symptoms being localized in the arms. In the updated IRLSSG criteria,1 atypical cases of RLS including RAS are best classified as an RLS variant rather than being included in an expanded definition of RLS. The case study by Webb in 1979,20 previous to the publication of the IRLSSG diagnostic criteria,11 did not clearly state about the essential diagnostic criteria of worsening symptoms at rest. However, the author described that the urge to move was present only at night and returned a few minutes after moving one or both arms. He further wrote that the pattern continued until sleep intervened. Additionally, the author states having developed the interest in RLS because himself was that patient he reported of. Given this description the second essential criterium seems fulfilled.
Table 1 Reported cases restless arms syndrome and analyses for adherence to IRLSSG diagnostic and supportive criteria
A highly probable case of RLS was reported in the parental grandfather of patient number 4.23 No positive family history of RLS was present in four patients.21,2527 Family history was not reported in the other five patients.20,22,24,28
Characteristics of the reported cases
Table 2 Reported cases and characteristics of restless arms syndrome
Symptoms: What Does Restless Leg Syndrome Feel Like
The main symptom of RLS is an overwhelming urge to move the legs because of uncomfortable and unpleasant feelings in one or both legs.
The sensations in the legs and, in severe cases, the arms are variously described as:
- Having an electric current
Some people may experience the feelings as painful, but most people feel the sensations as an ache rather than sharp or sudden pain.
Primary Or Idiopathic Rls
Idiopathic means that the cause is unknown.
It is the most common type and has the following characteristics:
- It usually begins before the age of 40.
- It can start as early as childhood.
- It may have a genetic cause.
- Once primary RLS starts, it tends to be lifelong.
Symptoms may be sporadic, or gradually worsen and become more prevalent over time.
In mild cases, the person may have no symptoms for a long time.
What Are The Symptoms Of Rls
The common symptom of RLS is that you have a strong, overwhelming urge to move the affected part of your body, usually your leg. Symptoms can range from a mild feeling of restlessness in your legs on some evenings, to a more severe problem that occurs every evening and night which regularly disturbs sleep. Many people fall somewhere in between these extremes.
- You may also get an uncomfortable or tingling sensation such as ‘pins and needles’, prickling, pulling or crawling.
- These feelings begin about 15 minutes after you lie down to sleep or to relax or when you have not moved for long periods, such as when travelling in a car or airplane.
- Moving will usually make you feel better, at least for a short time.
Restless Legs Syndrome Symptoms
People with restless legs syndrome have unusual feelings in their legs and a powerful urge to move their legs to make the sensations go away. The condition can also happen in other areas like the arms, chest, or head. The feelings usually happen on both sides of the body. They can also happen on only one side, or they might start on one side and then move to the other.
RLS symptoms range from mild to unbearable. They might come and go, and the intensity can vary between episodes. Theyâre generally worse in the evening and at night.
Symptoms almost always go away in the early morning, so people who have RLS can often sleep well then.
The severity of RLS symptoms ranges from mild to intolerable. Symptoms can come and go and severity can also vary. The symptoms are generally worse in the evening and at night. For some people, symptoms may cause severe nightly sleep disruption that can significantly impair their quality of life.
Restless Legs Syndrome Triggers
Sitting or resting are common triggers for RLS symptoms. Additionally, some substances can make symptoms worse. These include:
- Medications, including certain drugs used to treat nausea, colds and allergies, and mental health conditions
Incidentally, most of these substances when taken in excess or too close to bedtime can also adversely affect our sleep architecture.
How To Manage Your Restless Arms
The goal of the treatment in cases of restless arm syndrome, as well as, restless legs syndrome aims to reduce the symptoms by reducing its frequency and intensity. If the symptoms are reduced than a person can have a better sleep. Treatment is individual and varies greatly from the factors that trigger restless arm. Possible treatment options include:
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What Are Restless Legs
Restless legs syndrome is a neurological disorder that causes you to feel extreme discomfort or an irresistible urge to move your body when youre at rest. The symptoms typically start in the evening and worsen at night, causing sleep problems.
They can occur without another known cause, but lifestyle factors such as lack of exercise and caffeine intake may make them worse.
You might find it helpful to take medication for RLS. Iron supplements also can help with mild cases.
Abnormalities Of Iron Metabolism
Iron deficiency, even at a level too mild to cause anemia, has been linked to RLS in some people. Some research suggests that RLS in some people may be due to a problem with getting iron into cells that regulate dopamine in the brain. Some studies have reported RLS in a quarter to a third of people with low iron levels.
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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.
Restless Legs Syndrome Causes
Doctors donât know what causes most cases of restless legs syndrome, but your genes might play a role. Nearly half of the people with RLS also have a family member with the condition.
It might also be tied to:
- Chronic diseases. Certain long-term medical conditions include RLS symptoms, including iron deficiency, Parkinsonâs disease, kidney failure or renal disease, diabetes, and peripheral neuropathy.
- Medications. Some drugs might make symptoms worse, including anti-nausea meds, antipsychotics, some antidepressants, and cold and allergy medications that have antihistamines.
- Pregnancy. Some women have RLS during pregnancy, especially in the last trimester. Symptoms usually go away within a month after delivery.
- Lifestyle. A lack of sleep or another sleep disorder like apnea can trigger symptoms or make them worse. So can alcohol, tobacco, and caffeine use.
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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.
Primary Restless Legs Syndrome
Primary restless legs syndrome tends to begin slowly, around the age of 40. This is earlier than most secondary RLS cases. RLS also runs in families, suggesting a genetic link.
There is research that suggests restless legs syndrome may be connected to problems with a part of the brain called the basal ganglia, which uses dopamine to control muscle movement. If transmission of dopamine signals in this part of the brain becomes impaired, it can result in muscle spasms and jerky movements.
What Are The Possible Causes Of Restless Arms
The real reason is not known, as well as, its pathophysiology. It is believed that irregular hyperexcitability at the entire spinal cord or at certain parts of the cervical and lumbar part of the spine lead to sporadic arm and leg movements.
Other findings support that dopaminergic activity and central involvement can lead to restless arm.
An iron deficiency or iron absorption problems can lead to the onset of restless arm. When it comes to iron deficiency it is believed that it impairs the synthesis of dopamine, the binding affinity of dopamine receptors or the transportation of dopamine. However, until now no neurological impairments have been identified in the development of restless arm.
Certain factors can trigger restless arms syndrome such as:
- Sleep deprivation, making the restless syndrome worse or triggering it
- Chronic alcoholic consumption
- Using certain medications such as antidepressants, antipsychotic medications, anti-allergic medications, anti-emetic medications, etc.
- Pregnancy, especially during the last trimester of pregnancy
What Is The Evidence For The Iron
Watch a video of Dr. Christopher Earley discussing: What Is the Evidence for the Iron-Dopamine Hypothesis?/p>
Role of Iron in RLS
The single most consistent finding and the strongest environmental risk factor associated with RLS is iron insufficiency. Professor Nordlander first recognized the association between iron deficiency and RLS, and reported that treatment of the iron deficiency markedly improved, if not eliminated, the RLS symptoms.
Despite this strong association between serum iron insufficiency and RLS, only about 15% of the RLS clinical population appears to have peripheral iron deficiency . To account for this, Professor Nordlander in proposing his iron deficiency hypothesis of RLS stated It is possiblethat there can exist an iron deficiency in the tissues in spite of normal serum iron.
This hypothesis has led investigators to examine whether the brain could be deficient in iron in the face of otherwise normal serum iron measures.
All studies to date support the concept of diminished brain iron in patients with RLS even when blood tests indicate that their iron stores are normal. Cerebrospinal fluid obtained by lumbar puncture has shown that the iron storage protein ferritin is low in RLS patients, despite these patients having normal serum levels of iron and ferritin.
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Symptoms Of Restless Arm Syndrome
Restless arm syndrome is a spectrum disease, meaning that the symptoms can vary greatly from person to person in both severity and frequency. Symptoms range from mild to unbearable and from occasionally to daily. Symptoms may include:
- Involuntary Arm Movements: People tend to experience sudden, jerky, uncontrollable movements in the arms, and in some case other body parts as well, most commonly the legs
- Odd Sensations: People with restless arm syndrome often report feeling strange sensations in their arms such as tingling, burning, numbness, tickly, buzzing or itching sensation or like a creepy crawly crawling over you. The strange sensations associated with restless limbs can also give you a strong urge to want to move
- Daily Pattern: Symptoms of restless limbs tend to be worse in the evenings and overnight or when resting or relaxing. As a result, sleep is often affected. Some people get symptoms throughout the day, but they tend to be least in the mornings
Restless Leg Syndrome And Pregnancy
Symptoms of RLS can spring up for the first time during pregnancy, usually in the last trimester. Data suggests that pregnant women may have two or three times higher risk of RLS.
The reasons for this arent well-understood. Some possibilities are vitamin or mineral deficiencies, hormonal changes, or nerve compression.
Pregnancy can also cause leg cramps and difficulty sleeping. These symptoms can be hard to distinguish from RLS. If youre pregnant and have symptoms of RLS, talk to your doctor. You may need to be tested for iron or other deficiencies.
You can also try some of these home care techniques:
- Avoid sitting still for prolonged periods, especially in the evening.
- Try to get a little exercise every day, even if its just an afternoon walk.
- Massage your legs or perform leg stretching exercises before bed.
- Try using heat or cold on your legs when theyre bothering you.
- Stick to a regular sleep schedule.
- Avoid antihistamines, caffeine, smoking, and alcohol.
- Make sure youre getting all the nutrients you need from your diet or from prenatal vitamins.
Some of the medications used to treat RLS are not safe to use during pregnancy.
RLS in pregnancy usually goes away on its own within weeks after giving birth. If it doesnt, see your doctor about other remedies. Be sure to mention if you are breast-feeding.
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Alcohol And A Restless Leg
Disruptive, abnormal movement disorder:
Can someone have this disease that is just slightly restless while sober, and then it becomes unbearable when they drink? Or does that even make sense? Because we want to say no, but we are not entirely sure. This happens every time you drink, though. Its usually in your arms. But sometimes in your legs too. Eventually, the kicking gets bad enough that you cant sleep or sit still for very long.
Yes, alcohol withdrawal may cause symptoms similar to RLS. These include involuntary movements of the hands. Alcohol withdrawal seizures are also common.
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 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.
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The Basal Ganglia & Restless Leg Syndrome After Stroke
While the cause for restless leg syndrome is a mystery, many studies suggest that symptoms associated with RLS emerge within a few days following stroke.
Newer research is also looking at the relationship between RLS and stroke in which damage to the basal ganglia may be responsible for RLS-associated symptoms.
The basal ganglia is a cluster of neurons located deep in the cerebral cortex. It plays an essential role in helping the brain select which muscles to move.
It regulates abalance between the agonist muscles andantagonist muscles .
If a stroke damages part of the basal ganglia, its ability to keep this balance is disrupted and can cause conflicting muscle movement at the same time, resulting in twitching movements.
Q: Can Restless Legs Syndrome Affect Other Parts Of Your Body Like Your Arms
A: Typically, restless legs syndrome affects one leg or both legs. But sometimes it can affect other areas of the body, such as the arms and torso. When this happens, its usually a sign that the condition is worsening.
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With RLS, the areas of the brain and the pathways that connect to those areas are mainly responsible for sensations in the legs. So it usually starts off in the legs, but in severe cases it may spread to other parts of the body.
Restless legs syndrome can also be associated with involuntary jerking of the legs and arms, known as periodic limb movements in sleep . These movements can be seen in a sleep study with most patients with RLS, but PLMS can be seen in people who dont have RLS and usually doesnt affect sleep quality.
If youre experiencing RLS, try developing a relaxing bedtime routine like taking a warm bath and reading a book outside of your bed. Light stretching and walking can also help relieve symptoms. Or try a weighted blanket, light massage or a warm or cold compress. And remember, alcohol, caffeine and nicotine can all negatively affect RLS.
Sleep expert, Andy Berkowski, MD.
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Restless Leg Syndrome And Multiple Sclerosis Connection
Cases of restless leg syndrome in multiple sclerosis patients greatly vary from 13.3 percent to 65.1 percent. These numbers are still larger than rates of restless leg syndrome in the general population. Multiple sclerosis patients with RLS rate higher on the Expanded Disability Status Scale compared to MS patients without RLS. RLS can negatively impact a persons sleep and cause further complications such as worsened fatigue and greater inflammation, which can contribute to pain. Further research will be conducted to better understand the connection between RLS and MS and provide more effective treatment.