If you would like to know more about restless leg syndrome, symptoms and diagnosis, and about restless leg syndrome treatment, read the following article for more information.
Ekbom's syndrome
Restless legs syndrome causes uncomfortable feelings in your legs. As a result you have an urge to move your legs which gives temporary relief. Symptoms come on when resting and are worse at the end of the day. No treatment may be needed if symptoms are mild. Medication can ease symptoms if the condition is distressing.
What is restless legs syndrome and what are the symptoms?
Restless legs syndrome (RLS) is sometimes called Ekbom's syndrome after the doctor who first described it in 1945. It is a condition where you have an urge to move your legs. This is usually caused by an uncomfortable or unpleasant feeling in the legs. Many people with RLS find it difficult to describe the feeling - it may be like a 'crawling' sensation, or like an electric feeling, or 'like toothache', or 'like water running down your leg', or just uncomfortable or painful. The unpleasant feeling and urge to move occurs every 10-60 seconds and so you become quite restless.
The symptoms:
- develop when you are resting - particularly when you are sitting down or lying in bed. They tend to be worse if you are in a confined space such as in a cinema seat.
- are usually worse in the evening. In many cases they only occur in the evening, especially when trying to get to sleep. The symptoms can make it difficult to get to sleep. This can have a knock-on effect of causing poor sleep, and tiredness the next day.
- are eased briefly by moving, massaging or stretching the legs. Walking around will also ease the symptoms. However, the symptoms tend to return shortly after resting again.
- usually affect both legs. Occasionally the arms are affected too.
Most people with RLS also have sudden jerks (involuntary movements) or legs when asleep. These can wake you up. The jerks may also occur when you are awake but resting.
Who gets restless legs syndrome?
A recent study suggested that up to 1 in 10 people develop some degree of RLS at some point in their life. It can affect anyone, and is slightly more common in women than men. The severity of symptoms can vary from a mild restlessness of the legs on some evenings, to a distressing problem on most evenings and nights which regularly disturbs sleep. This can lead to anxiety and depression on top of the RLS.
What causes restless legs syndrome?
The cause is not known in most cases
This is called primary or 'idiopathic' RLS. This typically first develops in younger adults (under 45 years old). Symptoms tend to become slowly worse over the years. It is thought that the cause may be a slight lack of, or imbalance of, some brain chemicals (neurotransmitters), especially one called dopamine. It is not known why this should occur. There may be some genetic factor as primary RLS runs in some families. Caffeine or alcohol may make symptoms worse.
Secondary causes
Symptoms of RLS develop as a 'complication' of certain other conditions. For example:
- Pregnancy. About 1 in 5 pregnant women develop RLS during pregnancy (especially in the later part of pregnancy). Symptoms often go after giving birth.
- Lack of iron (iron deficiency) - which can cause anaemia. If this is the cause, then the symptoms of RLS usually go if you take iron tablets.
- As a side-effect of some drugs. For example, it occurs in some people who take: antidepressants, antipsychotics, dopamine antagonists, antihistamines, calcium channel blockers, phenytoin, or steroids.
- As a symptom of some other conditions. For example, kidney failure, Parkinson's disease, diabetes, and underactive thyroid.
How is restless legs syndrome diagnosed? - do I need any tests?
A doctor makes the diagnosis from the typical symptoms. There is no test to prove the diagnosis. A doctor may do some tests to rule out a 'secondary cause'. For example, a blood test to check for a lack of iron, and to rule out kidney failure.
What is the treatment for restless legs syndrome?
Treatment for secondary RLS is to treat the underlying cause such as iron deficiency, etc. However, most people with RLS have primary RLS.
Many people are reassured that they have primary RLS and not something more serious. (Some people with RLS fear that they have a serious neurological disorder.) Simply understanding about the nature of this condition may help to reduce anxiety about the condition. If symptoms are mild then no particular treatment may be needed or wanted. One or more of the following may be advised if the symptoms are troublesome.
Self help measures
One or more of the following may help
- Simple distractions such as reading or watching TV may help if symptoms are mild.
- Sleep hygiene to help improve your sleep patterns. This means:
- Try to get in to a regular bedtime routine of going to bed and getting up at the same time each day.
- Do not nap - especially in the evenings.
- Take some exercise during the day (but not near bedtime).
- Avoid drinks that contain caffeine (a stimulant) before bedtime.
- Try to relax before going to bed. A relaxing warm bath may help.
- A trial without caffeine or alcohol altogether. Reduce or cut out any drinks that contain caffeine such as tea, coffee and cola. Also limit, or cut out alcohol. Try this for a couple of weeks or so to see if symptoms improve. If symptoms do improve, you could then experiment to see what level of caffeine or alcohol causes symptoms. For example, you may not need to cut these things out completely, but just take less than you were used to.
- Consider your medication. If you think that a drug that you take may be causing the RLS, then see your doctor. Do not stop any prescribed drugs without discussion with a doctor who may be able to advise on alternatives.
Medication
If symptoms are troublesome and are not helped much by the above then your doctor may suggest medication.
Dopamine agonists are the most commonly used drugs to treat RLS. There are various types and brands. These are the same drugs that are used to treat Parkinson's disease. (Note: people with RLS do not have an increased risk of developing Parkinson's disease.) Dopamine agonists in effect 'top up' a low level of dopamine which is thought to be lacking in people with RLS. The two most commonly used dopamine agonists to treat RLS are ropinirole and pramipexole. As with any medication, some people develop side-effects with these drugs. The benefit of treatment has to be weighed against the possible side-effects of treatment.
Other drugs that are sometimes used include: carbamazepine, gabapentin, strong painkillers, and benzondiazepines. Strictly speaking, these drugs do not have a license to treat RLS in the UK but some specialists advise one if other treatments have not helped much.
Further help and information
Ekbom Support Group
18 Rodbridge Drive, Thorpe Bay, Essex, SS1 3DF
Tel: 01702 582 002 Web: www.ekbom.org.uk
Tel: 01702 582 002 Web: www.ekbom.org.uk
©EMIS and PIP 2006 Updated: October 2006
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