Restless Legs Syndrome

Restless legs syndrome (RLS) is a sensory-motor (movement) disorder characterized by uncomfortable sensations in one or both legs, which are worse during periods of inactivity or rest or while sitting or lying down. There is often a positive family history of the disorder. The symptoms of RLS may begin at any stage of life, including childhood, adolescence, or adulthood; however, the disease is more common with increasing age.

Fifty percent of patients report that discomfort in the legs prevents them from getting a good night’s sleep. Those with severe symptoms may sleep for only a few hours each night and, as a result, experience excessive daytime sleepiness. Increasing difficulty falling asleep and maintaining sleep is usually associated with a worsening of RLS symptoms.

It is a common condition that may affect up to 12 million people in the United States. Approximately 5 to 15 percent of the general population may be affected with varying degrees of RLS. While it has been proposed that RLS may be due to decreased dopaminergic activity in the central nervous system at the brainstem level or perhaps at the level of the spinal cord, the exact cause of restless legs syndrome is not known. A family history of RLS has reported in many patients, suggesting a genetic component to the disease.

In the absence of other secondary, treatable conditions, the major classes of drugs used to treat individuals with restless legs syndrome include dopaminergic agents, benzodiazepines, and in some cases, anticonvulsants. There have been some reports indicating that a transcutaneous electrical nerve stimulation or “TENS” unit may deliver significant improvement in some.

The diagnosis of RLS is based upon a thorough medical and neurologic evaluation as well as a detailed patient history. Diagnostic indicators include the following:

• Desire to move the limbs usually in association with paresthesias/dysesthesias
• Motor restlessness.
• Symptoms are worse or exclusively present at rest (i.e. lying, sitting) with at least partial and temporary relief by activity.
• Symptoms are worse in the evening/night.

In addition, almost all patients with RLS experience difficulty falling asleep as well as problems remaining asleep. Symptoms may gradually worsen with age.
RLS can occur as a result of an underlying medical condition, in association with the use of certain drugs, or due to environmental exposure to toxins such as heavy metals.

Symptomatic restless legs syndrome may occur secondary to iron deficiency anemia, folate deficiency, uremia associated with kidney problems, thyroid problems, diabetes, peripheral vascular disease or peripheral neuropathy. In such cases, appropriate treatment of the underlying condition may eliminate or alleviate RLS symptoms.

The use of certain prescription or over-the-counter medications may cause or aggravate restless legs syndrome. Prescription medications that may cause or aggravate RLS symptoms include many anti-nausea drugs (such as Compazine® or Reglan®), antiepileptics (such as phenytoin), and antipsychotics (such as haloperidol and phenothiazine derivatives).

Cases have been reported where depression medications (such as tricyclic antidepressants or selective serotonin reuptake inhibitors (SSRIs)) may aggravate the symptoms of RLS. In rare instances they may also result in some improvement in RLS symptoms.

When RLS occurs in association with other disorders, such as diabetes or peripheral neuropathy, etc., it is possible that abnormal neurologic findings may be discovered during the course of evaluation. These findings may include loss of tendon reflexes, an abnormal electrical impulse conduction study (electromyography or EMG), and an abnormal nerve conduction velocity test.

Positive heavy metal screens, red blood cell mineral studies and abnormal segmental vascular studies can also be revealing when combined with the associated pathology. The treatment of other chronic musculoskeletal conditions, such as ligamentous strains in the foot, ankle, or knee, may also reduce RLS symptoms. Regenerative medicine techniques such as PRP and Stem Cell have provided exciting results for restless legs patients. Other gratifying improvements for RLS occur in those patients with secondary sources, as the number of treatment options is so much greater.