Restless Leg Syndrome (RLS)

Whenever we hear about RLS, it often comes to our mind that what actually is RLS?? Are you really suffering from RLS? Read on to know…

Restless leg syndrome is a condition, characterized by urge to move legs. Most commonly it’s the legs but not exclusively the legs. There are associated abnormal sensations, described as tingling, burning, and insects crawling under the skin.

Now, the classical feature of RLS is that these abnormal sensations are relieved partially the by movement, the symptoms worse in the evening.

So, there is an Urge to move the legs as the relief in sensations is there. It causes great distress and disturbance of sleep compromising the quality of life.

So, what causes RLS??

  • i. Idiopathic – No cause is found but symptoms classically fit into RLS.
  • ii. Iron deficiency
  • iii. Pregnancy
  • iv. Uraemia
  • v. Neurological problems.

What will your doctor ask you if he suspects RLS?

  • Pregnancy status – in case of females of reproductive age group.
  • History of anemia, or any other history precipitating anemia.
  • A careful history and examination to rule out the other RLS mimicking conditions like neuropathy, cramps, parkinsonism, arthritis, fibromyalgia and varicose veins.
  • Drug history to see for any offending drug that can aggravate these symptoms which are actually not due to RLS. Drugs which are blamed to exacerbate these conditions are antipsychotics, SSRI’s, Metoclopramide, Diphenhydramine.

What tests will your doctor order for you, if he suspects RLS?

  • i. Complete blood count
  • ii. Iron Profile
  • iii. Kidney Function tests
  • iv. Calcium and Vitamin D3 levels.
  • v. Fasting Blood sugar levels.

If any issues are found, they are treated and if nothing is found and symptoms are consistent with RLS, treatment for Idiopathic RLS is instituted.

Criteria for Diagnosis of RLS (British Medical Journal, BMJ 23 May, 2012).

Essential diagnostic criteria

  • 1. An urge to move the legs, usually accompanied or caused by uncomfortable or unpleasant sensations in the legs
  • 2. Unpleasant sensations or urge to move begin or worsen during periods of rest or inactivity, such as lying or sitting
  • 3. Unpleasant sensations or urge to move are partially or totally relieved by movement, at least for as long as the activity continues
  • 4. Unpleasant sensations or urge to move are worse during the evening or night than during the day, or they occur only during the evening or night

Supportive criteria

  • 1. Positive response to dopaminergic agents
  • 2. Periodic limb movements of sleep or during wakefulness
  • 3. Positive family history of restless legs syndrome

Associated features

  • 1. Onset can be at any age, but patients are usually middle aged or older at presentation
  • 2. Leg discomfort or the need to move results in insomnia
  • 3. Low serum ferritin (112 pmol/L; <50 μg/L)

How to treat RLS?

Treatment of the cause is the best treatment for RLS. If iron deficiency is found, your doctor will prescribe you Iron supplements.

Now, most difficult is to treat Idiopathic RLS. Not all patients need treatment, and only about 20% require drugs. Supportive measures include avoidance of alcohol, Caffeine, and smoking.

Education on good sleep hygiene and how to avoid stress is given.Unnecessary pill popping is strongly discouraged.

Drugs are considered in patients with symptoms that impair quality of life, sleep, in spite of correction of any cause if found like iron deficiency.

Your Doctor will prescribe medications if the above therapy does not work. Drugs used for the purpose are Dopamine agonists like Ropinirole, Pramipexole, and Rotigotine.

Gabapentin and Pregabalin are also approved by FDA in the treatment of RLS.