June 13, 2006 12:00 am
A sleep disorder characterized by unpleasant creeping, crawling, tingling, or painful sensations in the legs during rest. It is believed to affect as many as 12 million Americans, and many more may be affected since the condition is underdiagnosed.
No one knows exactly what causes restless legs syndrome (RLS), but it is thought to involve abnormalities in the brain chemical dopamine’s action in the central nervous system. It is known to run in families and to occur fairly frequently in women during pregnancy. It has also been associated with anemia or low iron levels, spinal cord and peripheral nerve lesions, kidney failure, diabetes, and peripheral neuropathy (nerve damage in the feet, legs, hands, and arms).
The unpleasant sensations of RLS most often occur in one or both of the lower legs but may occur in the thighs, feet, or even arms and hands. The symptoms may occur at night or during any period of relaxation or inactivity. People with RLS often have an urge to move their legs whenever they experience these symptoms, which can be disruptive to bed partners. RLS sufferers are often sleepy and have trouble concentrating during the day because of not getting enough sleep at night.
Some people with RLS also have another sleep disorder called periodic limb movements of sleep (PLMS), characterized by involuntary jerking or bending of the knees, ankles, or hips during sleep. Like RLS, PLMS can rob people of sleep and make them drowsy during the day.
There is no specific diagnostic test for RLS, so doctors must rely on the person’s description of symptoms and medical history to make the diagnosis. The doctor may ask about the use of certain antinausea, antiseizure, antipsychotic, antidepressant, or cold and allergy drugs that may trigger or aggravate RLS; he may also perform blood tests and specialized examinations to identify underlying disorders associated with RLS, such as anemia or nerve damage.
For mild to moderate RLS, the following lifestyle changes may help alleviate symptoms:
• Decreasing the use of caffeine, alcohol, or tobacco may ease symptoms.
• Taking certain dietary supplements may correct underlying deficiencies in iron, vitamin E, folate, and magnesium.
• Maintaining regular sleep patterns may improve RLS.
• Regular exercise may help people sleep better (although excessive exercise can aggravate symptoms).
• Hot or cool baths or compresses, leg massages, and stretching of the leg muscles before bed may also provide some relief.
There are also several types of drugs doctors sometimes prescribe to treat RLS:
• Dopaminergic agents and dopamine agonists, two classes of drugs usually used to treat Parkinson disease, have been shown to reduce RLS symptoms. One such drug, ropinirole (brand name Requip) was approved to treat RLS symptoms in 2005.
• Benzodiazepines (such as clonazepam or diazepam), which are central nervous system depressants, may help people sleep better.
• Opioids (such as codeine or oxycodone) may help induce relaxation and reduce pain.
• Anticonvulsants (such as carbamazepine and gabapentin) may reduce unpleasant creeping and crawling sensations in some people.
• Alpha2 agonists (such as clonidine) may help control involuntary movements and sensations.
For more information about restless legs syndrome, visit the Restless Legs Syndrome Foundation Web site at www.rls.org.
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