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    Dr. Rajesh Shah's advice on Restless Legs Syndrome

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Restless Leg Syndrome

Restless leg syndrome is a disorder characterized by a powerful, irresistible urge to move ones legs. It is also known as the Wittmaack-Ekbom's syndrome.

Many unpleasant sensations like those of burning, aching, or bugs creeping, crawling, tugging, etc. in the legs, make the person want to move them constantly. These sensations are strongest when the person relaxes his legs, lies down or while sitting. They can be intense enough to make the person unusually irritable and disturbs many a good night’s sleep.

Who can have Restless Leg Syndrome?

RLS can affect men, women and children. It is less common in persons below 20 years. Pregnancy is also known to cause RLS though how, is unclear. Usually it appears in the last trimester of pregnancy and disappears after delivery. Persons of North European descent are more likely to develop RLS. The French-Canadian populations are also more prone to RLS. RLS before 20 years is usually of a genetic origin. There is a strong history of close relatives (parents or siblings) suffering from the same.

Causes of Restless Leg Syndrome:

Many diseases and conditions can trigger RLS in vulnerable persons, while some conditions worsen the severity of RLS in sufferers:

  • Diabetes
  • Kidney failure
  • Peripheral neuropathy (injuries to nerves)
  • Pregnancy
  • Anemia à from iron deficiency or folic acid deficiency.
  • Rheumatoid arthritis
  • Sjogren’s syndrome
  • Celiac disease
  • Sleep apnea syndrome
  • Uremia
  • Thyroid problems
  • Any injury that causes lasting damage of the nerves.
  • Surgeries performed on the back
  • Parkinson’s disease
  • Low blood sugars (hypoglycemia)
  • Drugs used for various conditions like à nausea, allergies, seizures, depression.
  • Substances like tobacco, coffee, alcohol can either trigger or worsen an already existing RLS.

Whenever the cause of RLS can be ascertained, it is called secondary RLS. The condition id termed as secondary RLS when there is no appreciable cause. These persons usually have a genetic tendency to RLS. Scientists today believe that RLS can occur within families as an autosomal dominant trait. These persons develop the symptoms at an earlier age (less than 20 years).

Symptoms of Restless Leg Syndrome:

Primarily, RLS is thought of as a sensory disorder. Persons use many descriptive terms to explain the vague, indistinct sensations they feel. Often the same person may suffer from multiple types of sensations.

However, one common line running through all types of sensations is, the irresistible, overwhelming impulse to keep moving ones legs.

  • An uncomfortable sensation
  • A hard to describe feeling
  • Aching
  • Paining
  • Burning
  • Crawling
  • Creeping
  • Tugging
  • Itching
  • Pulling
  • Tingling

Are some words expressing the feelings of persons suffering from RLS. These sensations usually occur deep within the muscles. More common in the legs and thighs, occasionally, even the arms can present with unpleasant sensations. They generally occur when the person has long periods of inactivity:

  • watches television
  • while sitting down
  • Reads books, knits etc.
  • long car drives
  • performs relaxation exercises
  • sitting in a movie theatre
  • Immobilization like bed rests, or casts for fractures etc.

RLS can contribute to insomnia and increased day time drowsiness, and fatigue not only in the sufferer but also in persons sharing their beds! Many people find their symptoms reduce by early morning and are hardly noticeable by the day. Symptoms commonly are more severe at the onset of sleep in the night.

RLS may start in any stage of life and is more common with increasing age. Intensities and frequencies vary for different persons. Very mild symptoms are initially missed by the person. Symptoms tend to worsen faster when onset is delayed.

Initially, the symptoms may occur once or twice a week. Later, it may become more frequent and disrupt routine activities of the person. Thus, while some experience RLS only in the night time, others suffer from it all day.

Diagnosis of Restless Leg Syndrome:

The National Institute of Health (NIH) has provided the diagnostic criteria. Persons are diagnosed as suffering from RLS when the following are present:

  • An urge to move the legs with or without other sensations
  • Worsening at rest
  • Relieved partly or completely with activity
  • Worsening in the evening or night.

Additional information that your doctor may want to know:

  • Do you snore in sleep?
  • Does anyone else in the family have similar problems?
  • Do you have difficulty staying awake during the day?
  • Do your symptoms disrupt your sleep?
  • Which self-medications do you use?
  • Do you have trouble concentrating?
  • Do you consume alcohols, coffee, or tobacco in excess? Does having any of these trigger your symptoms?

Currently, no tests are available to diagnose RLS.

A diagnosis of primary RLS cannot be made until every possibility of secondary RLS has been ruled out.

Both physical exams as well as laboratory investigations are needed.

  • Complete blood count to rule out anemia and its causes.
  • Blood sugar levels
  • Tests to rule out renal (kidney) disorders
  • Tests for other mineral and vitamin deficiencies.

Treatment of Restless Leg Syndrome:

Conservative treatment

Mild to moderate forms of RLS are improved by changes in diet and lifestyles.

  • Avoiding use of tobacco, alcohol or coffee can positively relieve symptoms many a times.
  • In secondary RLS, the treatment of the underlying conditions often effectively improves the condition.
  • Your doctor may advise iron and vitamin supplements if required.
  • Anticonvulsants like gabapentine are prescribed when the symptoms cause pain.
  • Sedatives (benzodiazepines and opioid derivatives) can help one sleep better.
  • Magnesium supplements (magnesium oxide and magnesium gluconate) provide relief in many cases.
  • Dopamine agonists are also used wide to control RLS.

TIPS ON LIVING WITH RLS

  • Try avoiding all foods and substances that aggravate or trigger your symptoms.
    • Be cautious when using over-the-counter drugs. Check with your local physician before opting for them.
    • Indulge in activities that relieve your symptoms.
      • Walking and stretching
      • Warm water baths just before retiring to bed.
      • Soak your feet in hot water just before going to sleep.
      • Eat foods rich in magnesium content e.g. almonds, bananas etc.
      • Keep your mind preoccupied in a mind game before going to sleep.
      • Avoid being in situations with potential to worsen your symptoms, e.g. the theater in the evenings.

Homeopathic Treatment for Restless Leg Syndrome:

There is an effective treatment for Restless Leg Syndrome in homeopathy. Homeopathy is strongly suggested for Restless Leg Syndrome.

Case studies of Restless Leg Syndrome: Case 1, Case 2

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