Written by Kelly A. Goff
If I wasn’t married to someone who has constantly twitching legs, then I might have scoffed when I first saw a television commercial advertising a drug for restless legs syndrome (RLS). Instead I practically pounced on my husband as he was just about to change the channel — his trigger finger is as twitchy as his legs are. “Wait! That’s you! You need that drug!” I screeched.
I don’t know what it’s like to have an uncontrollable urge to move my legs. I imagine it’s uncomfortable. But I do know what it’s like to try to relax next to someone who can’t sit still; it is beyond annoying. After researching the condition, I found out some people have RLS so bad their legs even jerk when they’re asleep. Sometimes they kick the covers off or, even worse, kick their partner. Ouch!
HOW IS RLS DEFINED?
Restless legs syndrome is a neurological disorder characterized by unpleasant sensations in the legs and an uncontrollable urge to move when at rest in an effort to relieve these feelings.
In 1995, the International Restless Legs Syndrome Study Group identified four basic criteria for diagnosing RLS:
(1) You have a strong urge to move your legs, which you may not be able to resist. The need to move is often accompanied by uncomfortable sensations. Some words used to describe these sensations include creeping, itching, pulling, creepy-crawly, tugging or gnawing.
(2) Symptoms start or become worse when you are resting. The longer you are resting, the greater the chance the symptoms will occur and the more severe they are likely to be.
(3) Your RLS symptoms get better when you move your legs. The relief can be complete or only partial, but it generally starts very soon after beginning an activity. Relief persists as long as the motor activity continues.
(4) Your RLS symptoms are worse in the evening, especially when you are lying down. Activities that bother you at night do not bother you during the day. RLS can make falling asleep or staying asleep difficult, which can be one of the chief complaints of the syndrome.
A substantial number of people who have RLS also have periodic limb movements of sleep (PLMS). These are jerks that occur every 10 to 60 seconds on and off throughout the night. This can cause partial awakenings that disrupt sleep. Sleep deprivation can seriously impact your work, relationships and health.
NOT AN EASY DIAGNOSIS
Despite efforts to establish standard criteria, the clinical diagnosis of RLS is difficult to make. Doctors must rely largely on patients' descriptions of symptoms and information from their medical history, including past medical problems, family history and current medications. Patients may be asked about frequency, duration and intensity of symptoms as well as their tendency toward daytime sleep patterns and sleepiness, disturbance of sleep or daytime function.
WHAT CAUSES RLS?
In most cases, the cause of RLS is unknown, according to the National Institute of Neurological Disorders and Stroke (NINDS). A family history of the condition is seen in approximately 50 percent of such cases, suggesting a genetic form of the disorder.
In other cases, RLS appears to be related to the following factors or conditions, although researchers do not yet know if these factors actually cause RLS.
Iron deficiency — People with low iron levels or anemia may be prone to developing RLS. Once iron levels are corrected, patients may see a reduction in symptoms.
Chronic diseases — Kidney failure, diabetes and Parkinson's disease are associated with RLS. Treating the underlying condition often provides relief from RLS symptoms.
Pregnancy — Some pregnant women experience RLS, especially in their last trimester. For most of these women, symptoms usually disappear within four weeks after delivery.
Certain medications — Anti-nausea drugs, anti-seizure drugs, anti-psychotic drugs and some cold and allergy medications may aggravate symptoms. Patients can talk with their physicians about the possibility of changing medications.
Researchers also have found that caffeine, alcohol and tobacco may aggravate or trigger symptoms in patients who are predisposed to develop RLS. Some studies have shown that a reduction or complete elimination of such substances may relieve symptoms, although it remains unclear whether elimination of such substances can prevent RLS symptoms from occurring at all.
HOW COMMON IS RLS?
The jury is still out on this point. Estimates range from 3 to 15 percent of Americans. RLS occurs in both genders; however, the incidence may be slightly higher in women. Although the syndrome may begin at any age, even as early as infancy, most patients who are severely affected are middle-aged or older. In addition, the severity of the disorder appears to increase with age. Older patients experience symptoms more frequently and for longer periods of time.
TREATING RLS
Although movement brings relief to those with RLS, it’s generally only temporary. However, finding and treating an associated medical condition, such as peripheral neuropathy or diabetes, can control RLS. When an associated cause cannot be identified, treatment is directed toward relieving symptoms.
LIFESTYLE CHANGES
Prevention is key, and many physicians suggest certain lifestyle changes and activities to reduce or eliminate symptoms before prescribing medication. Some of these initial approaches include:
• Checking to see if there is an underlying iron or vitamin deficiency and then possibly supplementing your diet with iron, vitamin B12 or folate.
• Looking at prescribed medications, herbal supplements or over-the-counter medications you may be taking that make RLS worse. These may include drugs used to treat high blood pressure, heart conditions, nausea, colds, allergies and depression.
• Identifying habits and activities that worsen RLS symptoms.
• Decreasing or eliminating caffeine, alcohol and tobacco.
• Suggesting various activities that may help you personally deal with RLS. These could include walking, stretching, taking a hot or cold bath, massages, acupressure or relaxation techniques.
• Implementing a program of good sleep habits.
MEDICATION
Depending on the severity or type of symptoms, physicians also may suggest a variety of medications to treat RLS. These medications fall into four major classes: dopaminergic agents (mainly used to treat Parkinson’s disease), sleeping aids, anti-convulsants and pain relievers.
Warning: You should never adjust your medications without speaking to your doctor first.
Unfortunately, no one drug is effective for everyone with RLS. What may be helpful to one individual may actually worsen symptoms for another. In addition, medications taken regularly may lose their effect, making it necessary to change medications periodically.
CLIFFHANGER RESOLVED
So you may be wondering if my husband was as sold on the magic pill solution as I was. After looking into the drugs approved by the FDA for RLS, he lost his enthusiasm. He felt the possible side effects sounded much worse than dealing with restless legs.
Since then he has dedicated himself to a serious yoga practice and cut back on his caffeine intake. I am happy to report that I can now stand to sit on the couch with him again, although yoga has not yet cured his uncontrollable urge to flip the TV channels.
