Restless Legs Syndrome

 

Ms. Sneha R. Dubey

Shridevi College of Nursing, Tumkur, Plot No.16, Araya Nagar, Koradi Road, Nagpur, 440030

 

ABSTRACT:

Restless legs syndrome is also associated with involuntary jerking of the legs and arms, known as periodic limb movements in sleep (PLMS).  It typically happens in the evening or night time hours when you're sitting or lying down. Moving eases, the unpleasant feeling temporarily. Restless legs syndrome, now known as restless legs syndrome/Willis-Ekbom disease (RLS/WED), can begin at any age and generally worsens as you age. It can disrupt sleep, which interferes with daily activities. It affects up to 1 in 10 people at some time during their life.

 

 

INTRODUCTION:

The vast majority of cases of RLS resolve on their own over time or once simple lifestyle changes have been made. Restless legs syndrome (RLS) is generally a long term disorder that causes a strong urge to move one's legs. There is often an unpleasant feeling in the legs that improves somewhat with moving them. This is often described as aching, tingling, or crawling in nature. Occasionally the arms may also be affected. The feelings generally happen when at rest and therefore can make it hard to sleep. Due to the disturbance in sleep, people with RLS may have daytime sleepiness, low energy, irritability, and a depressed mood. Additionally, many have limb twitching during sleep.

 

Some people have the symptoms of restless legs syndrome occasionally, while others have them every day. The symptoms can vary from mild to severe. In severe cases, restless legs syndrome can be very distressing and disrupt a person's daily activities.

 

Definition:

Restless legs syndrome (RLS) is a condition that causes an uncontrollable urge to move your legs, usually because of an uncomfortable sensation.

 

Symptoms:

The chief symptom is an urge to move the legs. Common accompanying characteristics of RLS/WED include:

 

Sensations that begin after rest. The sensation typically begins after you've been lying down or sitting for an extended time, such as in a car, airplane or movie theater.

 

Relief with movement. The sensation of RLS/WED lessens with movement, such as stretching, jiggling your legs, pacing or walking.

 

Worsening of symptoms in the evening. Symptoms occur mainly at night.

 

Night time leg twitching. RLS/WED may be associated with another, more common condition called periodic limb movement of sleep, which causes your legs to twitch and kick, possibly throughout the night, while you sleep.

 

People typically describe RLS/WED symptoms as abnormal, unpleasant sensations in their legs or feet. They usually happen on both sides of the body. Less commonly, the sensations affect the arms.

 

The sensations, which generally occur within the limb rather than on the skin, are described as:

Crawling

Creeping

Pulling

Throbbing

Aching

Itching

Electric

RLS is categorized as either primary or secondary.

 

Primary RLS is considered idiopathic or with no known cause. Primary RLS usually begins slowly, before approximately 40–45 years of age and may disappear for months or even years. It is often progressive and gets worse with age. RLS in children is often misdiagnosed as growing pains.

 

Secondary RLS often has a sudden onset after age 40, and may be daily from the beginning. It is most associated with specific medical conditions or the use of certain drugs

 

Causes:

In most cases, the cause of RLS is unknown (called primary RLS).  However, RLS has a genetic component and can be found in families where the onset of symptoms is before age 40.  Specific gene variants have been associated with RLS.  Evidence indicates that low levels of iron in the brain also may be responsible for RLS.

 

Considerable evidence also suggests that RLS is related to a dysfunction in one of the sections of the brain that control movement (called the basal ganglia) that use the brain chemical dopamine.  Dopamine is needed to produce smooth, purposeful muscle activity and movement RLS also appears to be related to or accompany the following factors or underlying

 

Conditions:

end-stage renal disease and hemodialysis

iron deficiency

 

certain medications that may aggravate RLS symptoms, such as antinausea drugs (e.g. prochlorperazine or metoclopramide), antipsychotic drugs (e.g., haloperidol or phenothiazine derivatives), antidepressants that increase serotonin (e.g., fluoxetine or sertraline), and some cold and allergy medications that contain older antihistamines (e.g., diphenhydramine) use of alcohol, nicotine, and caffeine

pregnancy, especially in the last trimester; in most cases, symptoms usually disappear within 4 weeks after delivery.

 

neuropathy (nerve damage).

Sleep deprivation and other sleep conditions like sleep apnea also may aggravate or trigger symptoms in some people.  Reducing or completely eliminating these factors may relieve symptoms.

 

Diagnosis:

There are no specific tests for RLS, but non-specific laboratory tests are used to rule out other causes such as vitamin deficiencies. Five symptoms are used to confirm the diagnosis:

·       A strong urge to move the limbs, usually associated with unpleasant or uncomfortable sensations.

·       It starts or worsens during inactivity or rest.

·       It improves or disappears (at least temporarily) with activity.

·       It worsens in the evening or night.

·       These symptoms are not caused by any medical or behavioral condition.

 

The most common conditions that should be differentiated with RLS include leg cramps, positional discomfort, local leg injury, arthritis, leg edema, venous stasis, peripheral neuropathy, radiculopathy, habitual foot tapping/leg rocking, anxiety, myalgia, and drug-induced akathisia.

 

Peripheral artery disease and arthritis can also cause leg pain but this usually gets worse with movement.

 

There are less common differential diagnostic conditions included myelopathy, myopathy, vascular or neurogenic claudication, hypotensive akathisia, orthostatic tremor, painful legs, and moving toes.

 

Treatment:

The medication will depend on the individual but might include:

 

Iron:

Supplementation with iron may help people who have low iron levels. This, in turn, may help improve symptoms. Iron supplements are available for purchase online.

 

Alpha 2 agonists:

These may help in cases of primary RLS, but they will not effect on periodic limb movement during sleep.

 

Painkillers:

Ibuprofen, a non-steroidal anti-inflammatory drug (NSAID), may help with mild symptoms. Ibuprofen is available for purchase online.

 

Anticonvulsants:

These treat pain, muscle spasms, neuropathy, and daytime symptoms. Neurontin, or gabapentin, is a popular anticonvulsant.

 

Benzodiazepines:

These are sedative medications that help people with persistent and mild symptoms to sleep through the effects of RLS. Restoril, or temazepam, Xanax, or alprazolam, and Klonopin, or clonazepam, are examples.

Dopaminergic agents: These medications raise the levels of dopamine, a neurotransmitter, in the brain. They can treat the unpleasant leg sensations associated with RLS. Levodopa and carbidopa are common dopaminergic agents.

 

Dopamine agonists:

These also raise brain dopamine levels and treat unpleasant leg sensations. They may cause adverse effects in older patients, although some report more side effects with levodopa

 

Opiates:

Treat pain and can relieve RLS symptoms. Doctors may prescribe these when other medications have failed. Codeine and propoxyphene are low dose opiates, while oxycodone hydrochloride, methadone hydrochloride, and levorphanol tartrate are common high-dose opiates.

 

Parkinson's disease and epilepsy drugs are sometimes used for RLS as they can reduce involuntary movements.

 

CONCLUSION:

There is often an unpleasant feeling in the legs that improves somewhat with moving them. This is often described as aching, tingling, or crawling in nature. Occasionally the arms may also be affected. The feelings generally happen when at rest and therefore can make it hard to sleep. Due to the disturbance in sleep, people with RLS may have daytime sleepiness, low energy, irritability, and a depressed mood. Additionally, many have limb twitching during sleep.

 

ACKNOWLEDGEMENT:

I would like to thanks to my parents and DR. Neeraj Bausker (Residential Medical Officer) Suretech Hospital.

 

REFERENCES:

1.      "Restless Legs Syndrome Fact Sheet | National Institute of Neurological Disorders and Stroke". www.ninds.nih.gov. Retrieved 7 July 2019.

2.      "What Is Restless Legs Syndrome?". NHLBI. November 1, 2010. Archived from the original on 21 August 2016. Retrieved 19 August 2016.

3.      "Who Is at Risk for Restless Legs Syndrome?". NHLBI. November 1, 2010. Archived from the original on 26 August 2016. Retrieved 19 August 2016.

4.      Ramar, K; Olson, EJ (Aug 15, 2013). "Management of common sleep disorders". American Family Physician. 88 (4): 231–8. PMID 23944726.

5.      "What Causes Restless Legs Syndrome?". NHLBI. November 1, 2010. Archived from the original on 20 August 2016. Retrieved 19 August 2016.

6.      "How Is Restless Legs Syndrome Diagnosed?". NHLBI. November 1, 2010. Archived from the original on 27 August 2016. Retrieved 19 August 2016.

7.      "Restless Legs Syndrome Information Page | National Institute of Neurological Disorders and Stroke". www.ninds.nih.gov. Retrieved 7 July 2019.

8.      "What Are the Signs and Symptoms of Restless Legs Syndrome?". NHLBI. November 1, 2010. Archived from the original on 27 August 2016. Retrieved 19 August 2016.

9.      "How Is Restless Legs Syndrome Treated?". NHLBI. November 1, 2010. Archived from the original on 27 August 2016. Retrieved 19 August 2016.

10.   Allen, R; Picchietti, D; Hening, WA; Trenkwalder, C; Walters, AS; Montplaisi, J; Restless Legs Syndrome Diagnosis Epidemiology workshop at the National Institutes of Health; International Restless Legs Syndrome Study Group (2003). "Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health". Sleep Medicine. 4 (2): 101–19. doi:10.1016/S1389-9457(03)00010-8. PMID 14592341.

 

 

Received on 02.01.2020          Modified on 24.01.2020

Accepted on 18.02.2020     © A&V Publications all right reserved