Restless Legs

Restless legs: description

The name “Restless Legs“Translated means” restless legs “. Those affected have an enormous urge to move. In addition, most patients feel a tormenting pull or tingling in the legs, sometimes in the arms. The symptoms occur only in rest situations, typically in the evening or at night. But even with quiet activities such as long periods at work or in the car, complaints can occur.

The Restless Legs are among the most common nerve disorders in Germany. Women are more affected than men. The exact cause of the disease is not yet clear. However, there is evidence that the disease can be inherited. In this case, the disease usually begins early, before the age of 30. When children or adolescents are affected, Restless Legs symptoms are often misjudged as hyperactivity disorder or growing pains.

Restless Legs: Symptoms

The guiding symptom of Restless Legs is the urge to move that patients feel. There are also sensations in the legs, sometimes in the arms. These can be expressed differently: some patients complain of pulling or tearing, others of tingling or pressure pain. Common to all is that they usually come from the bottom of the leg. By moving, getting up or walking around the complaints can be alleviated for a short time.

Typically, the symptoms develop or aggravate but in peace, especially in the evening or at night. As a result, the sleep of the patients is restless and disturbed. For this reason, many sufferers during the day suffer from fatigue, lack of concentration or performance. Not infrequently, these are the symptoms that move the patient to the doctor’s office.

Even leisure activities in peace such as reading a book, a visit to the cinema, driving a car or even sitting for a long time during work can trigger the discomfort and force the person concerned to move. As a result, the quality of life of people with restless legs is severely limited.

The periodic leg movements involuntarily causing patients to sleep or awake are termed Periodic Limb Movements (PLM). In up to 80 percent of cases, they are signs of Restless Legs Syndrome, but they also occur in other diseases in old age.

The symptoms are individually very different in their strength and the frequency of their occurrence. There are also some sufferers, who indeed feel a urge to move, but do not specify any abnormal sensations in the legs. The disease is chronically progressive. This means that it progresses creepingly and the symptoms increase. At the beginning of the disease, the Restless Legs can occur in spurts, in between, those affected are symptom-free.

Restless Legs: Causes and Risk Factors

To this day, it is not completely clear what the reason for Restless Legs is. Because therapy with the neurotransmitter dopamine or substances that produce the same effect as dopamine (dopamine agonists) suggests that dopamine plays an essential role in the development of restless legs.

More than half of the patients have a positive family history, meaning that at least one case of Restless Legs is already known in their family. This and some research suggests that the disease can be inherited. Six genes have already been found that play a role. How exactly these genes affect the disease process, is not finally clarified at the present time.

You also have to differentiate between the primary and secondary Restless Legs syndrome. The primary RLS arises without any other cause known. Secondary RLS is the result of various underlying diseases or health conditions. Secondarily, the following factors may lead to restless legs:

• pregnancy
• other nerve disorders such as polyneuropathies (especially in diabetes mellitus) or radiculopathies (irritation or damage to a nerve root on the spinal cord)
• iron deficiency
• Kidney diseases that lead to the appearance of urinary substances in the blood (uremia)
• Hyperthyroidism or hypofunction
• Coordination disorder of movement due to progressive loss of nerve cells in cerebellum and spinal cord (spinocerebellar ataxia)
• rheumatic diseases
• Medicines (like some antidepressants, neuroleptics, thyroid or seizure medications)

Restless legs: examinations and diagnosis

To be able to diagnose Restless Legs, the doctor first asks for the medical history (anamnesis). He asks, for example, how the symptoms express themselves and when they occur and whether there is someone in the family who is affected by Restless Legs. Since it is often difficult for patients to accurately describe the sensations in their legs, a lot of time has to be devoted to the conversation. In addition, it may be that for the person concerned the consequences of the sleep disorder such as the lack of focus in the foreground and not the urge to move or the sensations.

Following the conversation, the doctor performs a physical and neurological examination, but both are unremarkable in the Restless Legs. They serve to exclude other possible causes of the complaints.

If the following criteria are met, restless legs are diagnosed:

• Urge to move the legs, often accompanied by abnormal sensations in the legs. Sometimes the arms or other parts of the body are affected.
• The symptoms start or worsen at rest (eg while sitting or lying down).
• The symptoms improve with exercise (eg getting up or running).
• The symptoms are worse in the evening or at night than during the day or occur only in the evening or at night.

With the so-called L-Dopa test, the suspected diagnosis Restless Legs can be confirmed relatively reliably. The patient is given a test dose of the drug L-Dopa. If the symptoms improve, Restless Legs Syndrome is likely. If the effect does not work, the restless legs are still not excluded.

Other points confirming the suspected diagnosis “Restless Legs” are:

• Another family member has already contracted RLS.
• There is an involuntary movement of the legs during sleep or waking (PLM).

Since not only the Restless Legs syndrome triggers symptoms such as urge to move and abnormal sensations in the legs, but can also put other illnesses behind it, the following investigations are sometimes useful for clarification:

• Blood tests (determination of iron, kidney and thyroid levels, vitamin B12 and folic acid)
• electrical examinations of nerves and muscles (electroneurography, electromyography)
• Examination of sleep (polysomnography, actigraphy)

Restless legs: treatment

The primary RLS, that is, that occurs without any other underlying disease, can not be treated causally. One can only try to relieve the symptoms and thus improve the quality of life of the patients. In secondary RLS, it is sometimes possible to completely cure restless legs by treating the underlying trigger (other illness, medication, etc.).

Restless legs therapy is medicated. Initially, L-dopa and a so-called decarboxylase inhibitor (for example, benserazide) are administered. The preparations are taken about an hour before going to bed because at the beginning of the disease the symptoms are worst at night. If L-dopa is no longer helpful, dopamine agonists can be given against the restless legs syndrome.

The most common side effects of Restless Legs Syndrome Therapy with dopamine-like substances (dopaminergic therapy) include dizziness, nausea, and circulatory problems. Therefore, it is important to find the right dose individually and to start with the lowest possible amount of active ingredient.

In addition, a dopaminergic treatment can lead to a so-called augmentation. This means that the symptoms are aggravated by the therapy itself. If the augmentation under L-dopa therapy, is switched to a dopamine agonist. If an augmentation occurs, then opiates are used. These are also used if dopaminergic therapy does not work or for some reason patients are not allowed to take these substances. Alternatively, carbamazepine or gabapentin may be prescribed. They are among the drugs that are used for example in seizure disorders (anticonvulsants).

In addition to conventional medical treatment, some patients with Restless Legs use homeopathy or other natural remedies to alleviate the symptoms.

Restless Legs: Disease course and prognosis

The prognosis of restless legs is individually very different. At the onset of the disease, many sufferers have little discomfort or are symptom free for weeks to months. In most cases, the Restless Legs syndrome is chronic progressive, so the condition of patients increasingly deteriorates. However, as restless legs progress slowly, many patients need treatment until later in life.

There is no therapy to treat the cause of restless legs. However, therapeutic measures can relieve the symptoms and their consequences such as sleep disorders and lack of concentration. This gives those affected a great gain in quality of life.

If restless legs are caused by another disease, the prognosis is good. By treating the underlying disease can usually be the complaints of Restless Legs improve or even disappear altogether.