Restless Legs Syndrome (RLS)

Restless Legs Syndrome (RLS) is a neurological condition related to the movement of the extremities that is frequently linked with a sleep problem. Individuals with RLS may experience non-painful but annoying symptoms, such as a seemingly uncontrollable need to move their legs. RLS may leave you physically and emotionally handicapped.

It can also induce creeping, scratching, tugging, squeezing, straining, throbbing, scorching, or biting feelings. RLS is a disease that runs in families as well as it is sometimes associated with some medications or long-term illnesses.

It may appear at any age and get worse as you get older. It can result in poor quality of life by affecting daily tasks and disrupting sleep.

Basic self-care and behavioral adjustments may be beneficial in alleviating symptoms. Many people with RLS benefit from treatment.

Most episodes of RLS are unknown to doctors, although your DNA may play a significant role. Approximately half of those who suffer from RLS have a close relative who suffers from it.

Chronic illnesses might potentially be a factor. RLS symptoms can be caused by a number of long-term medical disorders, including iron deficiency, Parkinson's, renal failure, hepatic illness, peripheral neuropathy, and hyperglycemia.

Medications: Some medicines, such as anti-nausea medications, antihistamine-antipsychotics, and some antidepressants, may exacerbate symptoms.

Environmental Factors: Sleep deprivation or another sleep condition such as apnea can exacerbate or provoke symptoms. Beer, tobacco, and energy drink usage can all be harmful.

Pregnancy: While pregnant, RLS affects some women, specifically in the third trimester. Within a month of birth, the symptoms normally subside.

In general populations, the prevalence of RLS is believed to range between 3.9 percent and 14.3 percent, and it tends to rise with age. Restless legs syndrome is among the most frequent sleep and movement problems. For unknown reasons, the condition affects females more frequently than males.

Other than the family history, some of the medical conditions may increase your chances of having RLS;

• Having low levels of iron in your body
• Fibromyalgia
• Depression
• Disorders affecting kidneys
• Diabetes mellitus
• Parkinson’s disease
• Hypothyroidism 

The primary symptom is a strong desire to move one's legs which is accompanied by the following symptoms:

• After a period of relaxation, you will experience certain sensations. The sensation usually starts when you've been lying or seated for a long period, such as in a car, plane, or movie theatre.
• With activity, such as relaxing, jiggling your legs, cycling, or walking, the feeling of RLS reduces.
• Symptoms are worse at night.

All individuals with RLS complaints should have an iron deficiency checked. A ferritin level must be measured at least, while a comprehensive iron profile, which includes the following, is preferred because ferritin can be mistakenly raised in acute inflammatory responses:

• Levels of iron
• Ferritin levels
• Total iron-binding capacity.
• Transferrin Saturation

Other laboratory tests should be performed if a secondary source of RLS is suggested based on history, clinical findings on examination by a brain doctor, or unsatisfactory response to therapy.

The following are further tests your doctor would suggest to rule out some of the secondary causes of restless legs syndrome.

• Creatinine and (BUN)
• Blood glucose levels 
• Vitamin B-12
• Folate
• Magnesium
• Thyroid-stimulating hormone (TSH) 

Your doctor could also send you to a sleep professional. If another sleep condition, such as sleep apnea, is indicated, this may include accommodation at a sleep center, where specialists can examine your sleep pattern. A sleep study is typically not required for confirmation of RLS.

Many diseases may look like Restless Legs Syndrome, such as:

• Peripheral Vascular Disease
• Neuropathy
• Nocturnal leg cramps
• Osteoarthritis
• Vascular disease
• Radiculopathy

RLS manifestations can be considerably relieved by addressing an underlying problem, such as an iron deficit. Iron supplements can be taken either orally or intravenously to treat an iron deficit. On the other hand, iron supplements should only be used under a doctor's supervision and after the physician has evaluated your iron level.

General measures

You must start working to improve your sleep hygiene. Maintaining a good sleep cycle is the key.

• Caffeine, alcohol, and tobacco should not be consumed by people with mild RLS who are susceptible to these stimulants.
• Medications that induce or worsen RLS, such as SSRIs, SNRIs, cough suppressants, and dopamine blockers, should be stopped as soon as possible.
• Exercise regularly to have a good sleep at night. A hot bath and leg massage may help as well.

Medications

Because cure is only achievable in secondary RLS, drug treatment for primary restless legs is mostly supportive. The following medications are being used in the management of RLS:

• Dopamine agonists: These medications minimize involuntary leg jerks when sleeping and control the need to move legs and sensory abnormalities in the legs. Examples include ropinirole (Requip) and pramipexole (Mirapex).
• Anticonvulsant medications: These medications are especially useful for people who suffer from severe RLS as a result of neuropathy. Gabapentin (Neurontin) and pregabalin (Lyrica) are two examples. 
• Benzodiazepines: Due to their addictive tendency and adverse effects, including daytime sleepiness, benzodiazepines, particularly clonazepam (Klonopin), are sometimes recommended for RLS but are typically reserved for more extreme stages.
• Opioids, such as methadone or oxycodone, can be given to treat RLS symptoms. Still, they are rarely administered due to the danger of addiction until the condition worsens and other treatments have failed.

Restless legs syndrome is a chronic illness that can worsen as you get older. However, some people experience remission and go months or years without experiencing symptoms. Your doctor may recommend various lifestyle modifications or drugs if you begin to feel unwell. Engaging with people who understand what you're experiencing, whether it's a member of the family with RLS or a support network, can be beneficial.

By making some changes in your way of living, you can easily overcome your symptoms.

• Relax your legs by sitting in a hot bath and massaging your limbs.
• You may apply warmth or ice or alternate the two to help reduce leg symptoms.
• Because tiredness exacerbates the symptoms of RLS, it's critical to maintain excellent sleeping habits. 
• Ideally, you should sleep in a cold, peaceful, and pleasant setting. Go to bed, wake up around the same time every day, and obtain at least 7 hours of sleep every night.
• Caffeine reduction can sometimes help with restless legs. For a few weeks, eliminate caffeine-containing goods such as cocoa, espresso, tea, and fizzy drinks to see if it benefits you.
• Moderate, regular activity can help reduce RLS symptoms, but straining it or exercising late in the day might exacerbate symptoms.
• Keep note of the drugs and techniques that assist or hamper your RLS struggle, and talk to your healthcare provider about it.
• Yoga exercises or a gentle massage can be used to start and end your day.
• Relatives and people with RLS come together in support networks. Your ideas may not only benefit you but even someone else if you participate in a community.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 08, 2023.

References

https://www.ninds.nih.gov/health-information/disorders/restless-legs-syndrome#:~:text=What%20is%20restless%20legs%20syndrome,irresistible%20urge%20to%20move%20them.

https://www.indianjournals.com/ijor.aspx?target=ijor:ijanm&volume=10&issue=2&article=018