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RESTLESS LEG SYNDROME (RLS)

Restless Leg Syndrome (RLS) is a disorder that produces abnormal sensations in the legs and an uncontrollable urge to move them when at rest. Sufferers describe the sensations as burning, creeping, tugging, or like insects crawling deep inside the legs. Aside from the discomfort, the most maddening aspect of RLS is that it occurs only at rest, when a person is lying down on a bed or reclining on a couch. As a result, sufferers of RLS have difficulty relaxing, falling asleep, and staying asleep. Left untreated, RLS causes sleep disorders, sleep deprivation, exhaustion, and daytime fatigue and can lead to severe depression.

RLS affects at least 12 million men and women in America, although it is more prevalent in women. People over age 60 are more likely to suffer from RLS, although teens and those in their twenties can suffer from it as well. The severity of the disorder appears to increase with age.

Most patients also experience a related sleep disorder called periodic limb movement disorder (PLMD), an involuntary jerking or bending of the legs during sleep. In one sleep disorder study, RLS or PLMD was the cause of waking in 11 percent of people between 40 and 60 and 23 percent in people over 60 years of age.

The cause of RLS is unknown in most cases, however a strong family history observed in many patients suggests a genetic basis for this disorder. Iron deficiency, uremia, imbalances of electrolytes and vitamins, diabetes mellitus and pregnancy may also be causes. Symptoms of RLS may be exacerbated by medications such as antidepressants, antihistamines, antinausea medications, caffeine, and antipsychotics.

Pramipexole and Ropinirole (non-ergoline dipamine agonist) have been approved by the U.S. Food and Drug Administration to treat moderate to severe RLS. Unfortunately, medications taken regularly may lose their effect, making it necessary to change medications periodically. Combination therapy may be helpful in severe and refractory cases.

TREATING RLS SYMPTOMS

Since the precise cause of Restless Leg Syndrome isn’t known it cannot be prevented.

For those with mild to moderate symptoms, most physicians prescribe lifestyle changes to reduce or eliminate symptoms. Avoiding caffeine, alcohol, and tobacco products may help as well as the following tips.

• Sleep in a cool, quiet, com- fortable, dark room without a TV, computer or phone.
• Go to bed and wake up at the same time daily.
• Avoid vigorous exercise within two hours of bedtime.

Hot baths, leg massages, heating pads or ice packs have also proven effective. A daily supplement of iron, magnesium, the B vitamins, especially B12, and folic acid have proven effective for RLS sufferers. Vegetarians with RLS should take vitamin supplements to obtain sufficient vitamin B12.

Haiwen Ma, M.D., is an internist and Director of the Hospitalist Program at South Nassau Communities Hospital.

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