Can’t sit still? Leg discomfort keeping you awake? Read on to find out if Restless Leg Syndrome (RLS) might be your problem…
What is Restless Legs Syndrome?
People with RLS have a strong compelling urge to move the legs, described as uncomfortable or painful, that:
Occurs when inactive
Increases in the evening and at night
Is relieved by movement of the affected arm or leg
Often causes difficulty falling or staying asleep
May cause involuntary jerking of limbs when asleep or awake
You may have difficulty describing the sensation, using words such as creepy-crawley, tingling, pulling, tightening or uncomfortable. Children can also have the syndrome and are sometimes misdiagnosed as being hyperactive or having “growing pains”.
As many as 15% of the population may have RLS, but because it is so difficult to describe and people affected with it often don’t realize there are effective treatments, symptoms may never be mentioned to their doctor. It is also sometimes misdiagnosed as another condition.
How is it diagnosed?
RLS can mimic other conditions such as: diabetic neuropathy, nighttime leg cramps, arthritis pains, back pain, depression or insomnia of other causes. There is no specific test for RLS and it is diagnosed by its symptoms, once other conditions have been ruled out. It will sometimes run in families (“Familial or Primary RLS”) and is often diagnosed sooner in these cases, as the family is familiar with the symptoms.
What are the causes?
RLS-like symptoms can also be caused by other conditions:
Low iron, magnesium, folic acid or vitamin B12
Problems with the spinal cord (spinal stenosis or a damaged disk) or nerves
By-products of kidney disease
This is called “Secondary RLS” and treating the underlying cause will result in improvements of the RLS symptoms in these cases.
There is also a third type of RLS, called “Idiopathic RLS”, where the cause cannot be identified. “Idiopathic” simply means “unknown cause”.
Research suggests a cause of RLS may be decreased function in a specific part of the brain called the “substantia nigra”, the same part that malfunctions in Parkinson’s Disease. However, in Parkinson’s the cells are gradually destroyed whereas in RLS function is simply reduced, either because of a lack of the iron they need to function or because the iron cannot be transported into that part of the brain properly.
What medications are helpful or harmful?
Because RLS is caused by the same part of the brain involved in Parkinson’s Disease, some Parkinson’s medications can be helpful, increasing the dopamine that the affected part of the brain is supposed to produce.
Eliminating any drugs that block production or action of dopamine can also be helpful. This means your symptoms may improve if you avoid drugs such as certain stomach medications (ranitidine, cimetidine, famotidine, omeprazole, lansoprazole and others in these groups), antihistamines, phenytoin, lithium, calcium channel blockers (used for heart disease and blood pressure), and others that decrease the effect of dopamine. Ask your pharmacist to review your file for any of these medications.
Because of the tie to decreased dopamine action, drugs that increase dopamine or act like dopamine can be helpful for RLS. These include levodopa/carbidopa (Sinemet), ropinirole (Requip), pramipexole and others. Be sure to tell your pharmacist why you are taking these medications, if they are prescribed for you, so they will explain their use correctly. For example, taking short-acting levodopa/carbidopa in the morning would be helpful for Parkinson’s but wouldn’t help nighttime RLS symptoms.
Narcotics can help some people with daytime symptoms. Some seizure medications, such as carbamazepine and gabapentin, may be tried when dopamine therapy fails.
Sleeping medications are sometimes used to help sleep, but they do not have any effect on the actual symptoms of RLS. Also, as these medications and the narcotics mentioned above can be habit-forming, it is better to improve sleep problems and other symptoms by treating the cause if possible.
Clonidine can be particularly helpful when symptoms are associated with substances that are increased in patients with kidney failure.
Caffeine, alcohol, and smoking can make symptoms worse and, if so, should be avoided.
In summary…
RLS is often untreated or under-treated because patients have difficulty describing the sensations that they are experiencing and are often unaware the syndrome exists. There is no cure, other than correcting underlying causes in secondary RLS, and the symptoms tend to worsen with time. As well, the effect of medications may diminish over time requiring the patient to change therapy periodically.
It is easy to become confused about your new medication, as the various medications for RLS are also used for other conditions such as Parkinson’s disease, blood pressure, seizures, etc. Be sure to tell your pharmacist why you were prescribed this medication so you can have an effective discussion.
Remember that there are additional things you can do, like exercise, hot or cold therapy, or distracting activities than can help to reduce the severity of symptoms, improving your sleep and your ability to sit still when travelling or doing other sedentary activities.
