Patient Education

Restless Legs

Description

Body parts sometimes seem to have a mind of their own. Like that time when you walked sixty miles through the snow to a chocolate shop without even thinking about it. Or that time your elbow jumped out of its own accord and jabbed your co-worker in the ribs during a disagreement at the office water cooler. For some people, these independent body movements or impulses don’t affect much. Unfortunately, those who have restless leg syndrome may find that they grow tired of this bodily autonomy thing.

Restless leg syndrome (or RLS) doesn’t really mean that your legs get up and carry you off without your brain’s direction. It does mean, however, that you’ll experience unpleasant sensations or simply an uncontrolled urge to move your legs. This usually happens when you’ve settled down for a rest and, naturally, often leads to sleep disruption, difficulty while traveling or sitting for other activities (like watching a movie in a theatre).

RLS tends to be a progressive disorder, and tends to affect older individuals more than the young (although people of any age can have the disorder). Women are also a little more likely than men to have restless leg syndrome, and there’s a strong genetic link for the syndrome: RLS tends to run in families. There is no known cure, although there are treatments available to ease symptoms.

Although it isn’t certain what causes RLS, it’s suspected that the disorder is related to lower than usual levels of dopamine in the brain. (Dopamine helps produce smooth muscle movement.) RLS may also be related to having certain other conditions, such as iron deficiency, neurological problems such as diabetes (particularly those with peripheral neuropathy) or Parkinson’s disease, kidney failure, and being pregnant (particularly during the last trimester). Some medications might also influence the development of RLS, including some antiseizure, antipsychotic and antinausea medications, as well as some cold and allergy medicines. Using or consuming tobacco, caffeine or alcohol may also make your symptoms worse.

Symptoms

Restless leg syndrome often goes unnoticed during the daytime, or when you’re active and up and doing things. However, when you stop all your activity and sit or lie down for prolonged periods of time (especially in the evening or at night), you may begin to notice crawling sensations, itchiness, burning, aching, cramping, electric sensations, or other feelings of tension and discomfort. Or you may just feel the urge to move or touch your limbs. (Sudden urges to dance an Irish jig may also occur, although they’re much less common.) These sensations often occur deep in the legs (usually somewhere on the lower half of the leg), although they can be felt in the feet, thighs, arms or hands as well. Because the symptoms are often relieved by movement, you might find temporary relief by jiggling your leg, walking around, stretching or exercising.

Many people with RLS also have a condition known as periodic limb movements of sleep (PLMS) or periodic limb movements disorder (PLMD). (Yes, namers of disorders are very fond of acronyms.) This other condition means that during sleep your limbs flex and twitch without your conscious control. Having PLMS often doesn’t affect sleep patterns if the limb movement isn’t rigorous. However, restless leg syndrome itself may significantly interrupt your sleep, making it difficult to perform normally the next day at work and other activities.

Symptoms may disappear for periods of time (weeks, months or even years), although they usually recur later.

Diagnosis

Restless leg syndrome is often misdiagnosed as stress, muscle cramps, or nervousness, and in the case of children, attention deficit disorder or growing pains. People may also refuse to see a doctor because they don’t feel they can describe their symptoms adequately, and they’re afraid their doctor won’t take them seriously. If you suspect you have RLS, be sure to speak about it with a doctor you trust.

Unfortunately, there’s no definitive test for RLS, so your podiatrist will likely make the diagnosis based on a history of your symptoms. He or she may ask about your sleep patterns, whether you feel drowsy during the day, as well as the sensations you experience in your legs or other limbs, and how often and how intensely they occur. Your doctor will also probably check with you to see if anyone else in your family has had restless leg syndrome or symptoms.

Some tests may be performed to rule out other potential causes of your symptoms. These may include tests for iron deficiency, nerve function, and muscle activity. Your doctor may also recommend an overnight sleep study to see if you have PLMS.

Treatment

When you find that your legs just simply want to get going on their own, there are a few things you can do to rein them in a little. Medications are one route, but there are also some home remedies that may prove effective. Talk with your doctor about the best options for you.

Some things you can do on your own include the following:

  • Take hot baths (as though this were a chore). Scented candles and scandalous novels are, of course, optional.
  • Get massages (again, not exactly torture, here). You can massage your legs yourself (possibly while in the hot bath), or pay (or bribe) someone to do it for you.
  • Alternate cold and heat on your legs, or simply try one or the other to see what works best for you.
  • Relax with yoga or meditation. While stress doesn’t necessarily cause RLS, it can make symptoms worse. Relaxing may help a bit.
  • Try exercising and stretching, although doing this too intensely or too late in the day may make your symptoms worse.
  • Reduce your intake or use of alcohol, caffeine and tobacco. Quitting is tough, but so is taking a five-hour flight when you can’t stop moving your legs.
  • Try to sleep or rest when your legs seem to be less troublesome. This might mean altering your sleep schedule if you can, such as going to bed and rising a bit later.
  • Take lots of breaks during long car trips, during movies, etc.
  • Try over the counter pain medications, such as ibuprofen, to relieve symptoms.
  • Join a support group. RLS sufferers may find advice, support, and understanding from others who have the syndrome.

Your doctor may also suggest some other medications to help you control your restless leg symptoms. These may include medications commonly used to treat either Parkinson’s disease (they affect dopamine levels in the brain)or epilepsy. Opioids can be very addictive, but taken in small amounts they may be effective at easing symptoms. Your doctor may also suggest medications to relax your muscles or help you sleep. You should be aware, however, that many medicinal treatments of RLS tend to become less effective over time, so you may need to switch medications at some point, or try combinations of medications to find a solution that will work for you.

It may be that your legs will always be a little independent. But, with the right care, you can find a nice balance both you and your wandering limbs can live with.