Apr 30, Restless legs syndrome (RLS) is a disorder of the part of the nervous system that causes an urge to move the legs. Because it usually interferes. Nov 11, WebMD explains some of the common triggers of restless legs syndrome (RLS) symptoms. Jul 17, Overview. Restless legs syndrome (RLS) is a condition that causes an uncontrollable urge to move your legs, usually because of an.
Leg What causes Syndrome? Restless
Fortunately, most cases of RLS can be treated with non-drug therapies and if necessary, medications. People with RLS feel the irresistible urge to move, which is accompanied by uncomfortable sensations in their lower limbs that are unlike normal sensations experienced by people without the disorder. The sensations in their legs are often difficult to define but may be described as aching throbbing, pulling, itching, crawling, or creeping. These sensations less commonly affect the arms, and rarely the chest or head.
Although the sensations can occur on just one side of the body, they most often affect both sides. They can also alternate between sides. The sensations range in severity from uncomfortable to irritating to painful.
Because moving the legs or other affected parts of the body relieves the discomfort, people with RLS often keep their legs in motion to minimize or prevent the sensations.
They may pace the floor, constantly move their legs while sitting, and toss and turn in bed. A classic feature of RLS is that the symptoms are worse at night with a distinct symptom-free period in the early morning, allowing for more refreshing sleep at that time. Some people with RLS have difficulty falling asleep and staying asleep. They may also note a worsening of symptoms if their sleep is further reduced by events or activity.
RLS symptoms may vary from day to day, in severity and frequency, and from person to person. In moderately severe cases, symptoms occur only once or twice a week but often result in significant delay of sleep onset, with some disruption of daytime function.
In severe cases of RLS, the symptoms occur more than twice a week and result in burdensome interruption of sleep and impairment of daytime function.
People with RLS can sometimes experience remissions—spontaneous improvement over a period of weeks or months before symptoms reappear—usually during the early stages of the disorder. In general, however, symptoms become more severe over time. People who have both RLS and an associated medical condition tend to develop more severe symptoms rapidly. In contrast, those who have RLS that is not related to any other condition show a very slow progression of the disorder, particularly if they experience onset at an early age; many years may pass before symptoms occur regularly.
However, RLS has a genetic component and can be found in families where the onset of symptoms is before age Specific gene variants have been associated with RLS. Evidence indicates that low levels of iron in the brain also may be responsible for RLS.
Considerable evidence also suggests that RLS is related to a dysfunction in one of the sections of the brain that control movement called the basal ganglia that use the brain chemical dopamine.
Dopamine is needed to produce smooth, purposeful muscle activity and movement. Disruption of these pathways frequently results in involuntary movements. Sleep deprivation and other sleep conditions like sleep apnea also may aggravate or trigger symptoms in some people. Reducing or completely eliminating these factors may relieve symptoms.
The five basic criteria for clinically diagnosing the disorder are:. Individuals may be asked about frequency, duration, and intensity of symptoms; if movement helps to relieve symptoms; how much time it takes to fall asleep; any pain related to symptoms; and any tendency toward daytime sleep patterns and sleepiness, disturbance of sleep, or daytime function.
Laboratory tests may rule out other conditions such as kidney failure, iron deficiency anemia which is a separate condition related to iron deficiency , or pregnancy that may be causing symptoms of RLS. Blood tests can identify iron deficiencies as well as other medical disorders associated with RLS. Periodic limb movement of sleep during a sleep study can support the diagnosis of RLS but, again, is not exclusively seen in individuals with RLS. Diagnosing RLS in children may be especially difficult, since it may be hard for children to describe what they are experiencing, when and how often the symptoms occur, and how long symptoms last.
Pediatric RLS can sometimes be misdiagnosed as "growing pains" or attention deficit disorder. RLS can be treated, with care directed toward relieving symptoms.
Moving the affected limb s may provide temporary relief. Sometimes RLS symptoms can be controlled by finding and treating an associated medical condition, such as peripheral neuropathy, diabetes, or iron deficiency anemia. Iron supplementation or medications are usually helpful but no single medication effectively manages RLS for all individuals. Trials of different drugs may be necessary. In addition, medications taken regularly may lose their effect over time or even make the condition worse, making it necessary to change medications.
Certain lifestyle changes and activities may provide some relief in persons with mild to moderate symptoms of RLS. These steps include avoiding or decreasing the use of alcohol and tobacco, changing or maintaining a regular sleep pattern, a program of moderate exercise, and massaging the legs, taking a warm bath, or using a heating pad or ice pack.
There are new medical devices that have been cleared by the U. Aerobic and leg-stretching exercises of moderate intensity also may provide some relief from mild symptoms. For individuals with low or low-normal blood tests called ferritin and transferrin saturation, a trial of iron supplements is recommended as the first treatment.
Iron supplements are available over-the-counter. A common side effect is upset stomach, which may improve with use of a different type of iron supplement. Because iron is not well-absorbed into the body by the gut, it may cause constipation that can be treated with a stool softeners such as polyethylene glycol.
Others may require iron given through an IV line in order to boost the iron levels and relieve symptoms. Anti-seizure drugs are becoming the first-line prescription drugs for those with RLS. The FDA has approved gabapentin enacarbil for the treatment of moderate to severe RLS, This drug appears to be as effective as dopaminergic treatment discussed below and, at least to date, there have been no reports of problems with a progressive worsening of symptoms due to medication called augmentation.
Other anti-seizure drugs such as the standard form of gabapentin and pregabalin can decrease such sensory disturbances as creeping and crawling as well as nerve pain. Dizziness, fatigue, and sleepiness are among the possible side effects. Recent studies have shown that pregabalin is as effective for RLS treatment as the dopaminergic drug pramipexole, suggesting this class of drug offers equivalent benefits. These drugs, which increase dopamine effect, are largely used to treat Parkinson's disease.
They have been shown to reduce symptoms of RLS when they are taken at nighttime. Symptoms partially responded to tramadol although it soon lost its effectiveness. Amitriptyline and acetaminophen with codeine had no effect on his symptoms.
One year after the initial examination, the restlessness had progressed to involve his legs. He described a discomfort in his lower extremities, similar to the upper extremity symptoms, that compelled him to move them. He reported that his symptoms occurred in the evening and disrupted his sleep.
Ambulation reduced the symptoms. He was given clonazepam, which partially reduced his symptoms and improved his sleep but became less effective over time. Gabapentin gave partial relief. He was then prescribed ropinirole, which brought about major improvement in symptom relief and quality of sleep. His neurologic examination results have remained stable, with no evidence of neuropathy. Our patient's signs and symptoms and the previous report 6 suggest that the diagnosis of RLS should be considered in the differential diagnosis of patients with arm restlessness.
The previously described case occurred in a man who had spastic paraparesis and lower extremity paresthesias due to a back injury. Our patient had subclinical polysomnographic evidence of periodic leg movements on examination for arm restlessness, 1 year before he developed typical RLS. He had no other neurologic abnormalities. Arm restlessness occurs in up to It is rarely reported as an initial symptom.
A few points require further discussion. First, periodic limb movements occur with greater prevalence in older individuals. Although amiodarone may be associated with neurologic symptoms, restless legs are uncommon, 9 and restless arms have not been reported, to our knowledge. Our patient had been taking amiodarone at a stable dose without symptoms for many years.
The pathogenesis of RLS is not known. Compared with those with isolated leg restlessness, subjects with arm restlessness had more severe leg restlessness and worse sleep efficiency. No other differences between the groups with and without arm restlessness were found.
Periodic arm movements have also been demonstrated in patients with RLS. The triggering mechanism is hypothesized to occur in an ill-defined supraspinal level.
Deficiency or impaired processing of iron has also been demonstrated to be an important factor. Iron deficiency may be associated with a decrease in the synthesis of dopamine or D2 receptors, or impaired dopamine transport.
To our knowledge, this is the first published case of RLS with arm restlessness as the initial symptom in a neurologically normal person. The clinical presentation of this patient and the frequent involvement of the upper extremities suggest that RLS should be considered whenever patients have upper extremity symptoms meeting the diagnostic criteria for RLS.
Corresponding author and reprints: Study concept and design Dr Freedom ; acquisition of data Drs Freedom and Merchut ; analysis and interpretation of data Dr Freedom ; drafting of the manuscript Dr Freedom ; critical revision of the manuscript for important intellectual content Drs Freedom and Merchut ; administrative, technical, and material support Drs Freedom and Merchut.
Arm Restlessness as the Initial Symptom in Restless Legs Syndrome
Jul 17, Sometimes, treating an underlying condition, such as iron deficiency, greatly relieves symptoms of restless legs syndrome. Correcting an iron. However, RLS has a genetic component and can be found in families where the onset of symptoms is. Restless legs syndrome (RLS) is a sleep disorder that causes an intense, often irresistible urge to move your legs, often accompanied by other sensations in the .