Restless legs syndrome: causes and treatments
Restless legs syndrome is an uncomfortable feeling in the lower extremities that occurs most often at night. Because of them, a person wakes up, and may even suffer from insomnia. The main manifestation of restless legs syndrome is the occurrence of involuntary movements of the lower extremities. Painful discomfort makes them move.
This syndrome was first described by the English physician Thomas Willis. It happened in 1672. After him, Karl Ekbom took up a thorough study of the problem in the 40s of the last century. It is therefore not surprising that restless legs syndrome is often referred to as Ekbom syndrome or Willis disease.
Statistics indicate that restless legs syndrome is diagnosed in 5-10% of adults. In childhood, the disorder is rare. Most often, elderly people suffer from it (about 20% of the entire population of the planet, who is in old age). In 1.5, RLS is detected less often in men, but this information is not accurate, since women more often seek medical help and complain of similar problems.
Chronic insomnia conceived is caused precisely by the syndrome of restless legs (about 15% of all cases), which must be taken into account when searching for the causes of disturbed night rest. Thus, RLS is an urgent problem that is quite acute in the practice of neurologists and somnologists.
Content:
- Causes of restless legs syndrome
- Symptoms of restless legs syndrome
- Diagnosing restless legs syndrome
- Restless legs syndrome treatment
- Prediction and prevention of restless legs syndrome
Causes of restless legs syndrome
There are two large groups of causes that can provoke RLS - primary and secondary.
Primary or idiopathic restless legs syndrome most often debuts in people over 35. It is not possible to trace the connection with any disease. Observations show that this disorder is most often hereditary. Family history of RLS is diagnosed, according to various sources, in 30-90% of cases. The severity of discomfort depends on the activity of the pathological gene. Scientists believe that some gene flaps are responsible for the development of restless legs syndrome, which are located on chromosome 12, 14 and 9. However, it was impossible to explain the development of this disorder solely by gene mutations, therefore modern science considers this pathology as polyetiological.
Secondary restless legs syndrome manifests itself in adults. Most often, people over 45 years old turn to doctors with complaints of discomfort in the lower extremities.
The following conditions of the body can provoke its development:
- Pregnancy. During gestation, SDF is diagnosed in an average of 20% of women in the second and third trimester. Most often, after childbirth, this discomfort goes away. Although sometimes it persists for the rest of your life.
- Iron-deficiency anemia.
- Uremia. With an increase in the level of urea in the blood, with complaints about restless legs syndrome, up to 80% of patients consult a doctor. Moreover, most of them are diagnosed with renal failure. People undergoing hemodialysis report RLS in 33% of cases.
- Diabetes.
- Amyloidosis.
- Alcohol abuse.
- Folic acid deficiency anemia.
- Lack of vitamin B12 and vitamin B6 in the body.
- Diseases of the thyroid gland.
- Rheumatoid arthritis.
- Porphyria.
- Obliterating endarteritis, atherosclerosis of the lower extremities, chronic venous insufficiency of the legs.
- Radiculitis.
- Spinal cord pathologies: discogenic myelopathy, tumors, trauma.
- Parkinson's disease.
- Overweight. If a person is obese, there is a 50% chance of developing restless legs syndrome. This is especially true for overweight young people.
-
Tourette's syndrome.
- Amyotrophic lateral sclerosis.
- Partial gastric resection.
- Taking certain medications: antipsychotics, tricyclic antidepressants, histamine, anticonvulsants.
Sometimes in people who have a hereditary predisposition to the development of restless legs syndrome, adverse environmental factors or bad habits can provoke its onset. In particular, drinking large amounts of coffee.
In people with neurological conditions, such as Parkinson's disease, restless legs syndrome may be medication-related. Sometimes these two pathologies are simply combined with each other and do not have a causal relationship.
Why exactly restless legs syndrome develops is not known for certain today. Most scientists dealing with this issue indicate that the dysfunction of the dopaminergic system is at the heart of the disorder. They indicate that RLS can be eliminated by taking drugs of the dopaminergic group. In addition, the symptoms of pathology intensify precisely at night, when the level of dopamine in the tissues increases. However, until now it is unclear which dopamine disorders underlie the pathology.
Symptoms of restless legs syndrome
The main symptoms of restless legs syndrome are sensory disturbances, which are expressed in paresthesias and movement disorders.
Violations affect both legs, and the movements of the limbs are often asymmetrical.
Sensory disorders occur when a person is sitting or lying down. Symptoms are most severe between 12 and 4 am. To a lesser extent, symptoms appear between 6 and 10 am.
Complaints that patients may have:
- Tingling sensation in the legs.
- Feeling of numbness in the lower limbs.
- Feeling of pressure on the legs.
- Itching of the lower extremities.
- Feeling of goose bumps running down the legs.
These symptoms are not accompanied by severe pain, but they are very annoying to the person and cause him serious physical discomfort. Some patients indicate dull, cerebral pain or weak, but sharp pain.
Discomfort is localized mainly in the lower leg, less often affects the feet. As the pathology progresses, the hips, arms, perineal region and even the trunk are involved in the process.
In the initial stages of RLS, a person begins to experience discomfort 15-30 minutes after he goes to bed. In the future, discomfort begins to bother almost immediately after the cessation of physical activity, and then in the daytime, when the legs are at rest. Such people find it very difficult to ride in a car, travel by air, visit a theater and cinema, etc.
In general, a clear symptom of restless legs syndrome is that discomfort bothers a person only during the period when he is motionless. To eliminate discomfort, he is forced to move them: shake, wiggle, bend and unbend. Sometimes patients get up and tread on place, massage their feet, walk around the room at night. However, after they go to bed, the discomfort returns. When a person suffers from RLS for a long time, he determines for himself a specific ritual of movements that bring him maximum relief.
At night, people experience excessive motor activity of the legs. At the same time, the movements are stereotyped and constantly repeated. A person bends either the big toe or all of the toes and can move the foot. In severe cases of the syndrome, people bend their legs at the hip and knee joints. Each episode of physical activity does not take more than 5 seconds. This is followed by a break of 30 seconds. Such episodes are repeated for several minutes or several hours.
If the pathology has a mild course, then the person himself may not even know about such a violation. It can only be diagnosed during polysomnography. When RLS is severe, the patient wakes up several times during the night and cannot sleep for a long time.
This pathological behavior during sleep cannot go unnoticed. In the daytime, a person feels tired and weak. His mental functions deteriorate, attention suffers, which affects performance. Therefore, restless legs syndrome can be attributed to the risk factors for the development of depression, neurasthenia, increased irritability and mental instability.
As a rule, in primary restless legs syndrome, pathological symptoms persist throughout life, but their intensity varies. A person begins to worry more strongly about the disease during an emotional shock, after consuming drinks containing caffeine, after playing sports.
The overwhelming majority of people indicate that pathological symptoms, although slowly, still progress. Sometimes there are periods of calm, which are replaced by periods of exacerbation. Prolonged remissions that extend over several years occur in about 15% of patients.
If a person has secondary restless legs syndrome, then its course is determined by the underlying pathology. In this case, remissions are rare.
Video from Elena Malysheva's program "what to do if bad legs haunt my head":
Diagnosing restless legs syndrome
Diagnosis of SND is not difficult for a specialist. It begins with listening to the patient's complaints.
The survey is based on 4 criteria:
- The patient has a desire to move his legs at night in order to get rid of discomfort.
- The discomfort is worse at rest. During physical activity, it is either absent altogether or weakly expressed.
- When the person moves their legs, the discomfort goes away.
- At night, unpleasant sensations are gaining maximum intensity.
If a person answers in the affirmative to all 4 questions, then with a high degree of probability, restless legs syndrome can be suspected.
It is imperative to direct efforts to find the reason that provoked the RLS. If this syndrome is primary, then ultimately it will not be possible to detect it.
Methods that allow you to clarify the diagnosis:
- Polysomnography. This method allows you to identify involuntary movements during sleep.
- Electroneuromyography.
- A blood test to determine the level of iron, magnesium, B vitamins, rheumatoid factor in it.
- Rehberg's test and biochemical blood test, which allow assessing the performance of the kidneys.
- Ultrasound examination of the vessels of the legs.
It is important to make differential diagnosis with other diseases with similar symptoms.
| Disease | Symptoms that are similar to those of RLS | Symptoms that do not occur with RLS |
| Peripheral neuropathy | A person experiences discomfort in the lower extremities, complains of paresthesia | There is no rhythm with which neuropathy symptoms occur. Unpleasant sensations do not disappear after the start of physical activity. |
| Ectasia | The person shows increased anxiety, he has a desire to move his legs. The unpleasant sensations intensify at rest. | The daily rhythm is absent, there is no burning sensation in the legs, they do not "creep". Close relatives did not suffer from a similar problem. |
| Vascular disease | The patient complains of crawling feet | Unpleasant sensations intensify during movement, vessels are clearly visible under the skin. |
| Night crumpies | The discomfort can be relieved by stretching the legs. Convulsions have a circadian rhythm. | Unpleasant sensations arise unexpectedly, they do not make you want to move your legs. When walking, the cramps do not stop. |
Restless legs syndrome treatment
If RLS is caused by a disease, then efforts should be made to eliminate it. You may also need to replenish reserves of iron, B vitamins, or other trace elements.
Treatment of iron deficiency should be started only if the level of ferritin in the blood is reduced to 45 mg or less. Iron preparations are prescribed in combination with ascorbic acid. They are taken 3 times a day, between approaches to the table.
If restless legs syndrome does not depend on any diseases, then the patient is prescribed symptomatic treatment that allows you to cope with the problem. Typically, this therapy is effective. It consists of medication and non-medication correction.
Non-drug treatment
If a person is taking any drugs that can trigger the development of RLS, then the treatment must be adjusted. If possible, they refuse to use them.
It is imperative to intensify physical activity, but the load should be moderate. It's good to go for walks before bed, take a shower, and eat right. Patients should stop drinking coffee and strong tea, from drinking chocolate and other foods that may contain caffeine.
Alcoholic drinks should be, if not banned, then restricted. It is equally important to quit smoking, observe the daily routine.
If a person's feet are in the cold, then the symptoms of RLS intensify, and if they are warm, they decrease. Therefore, it is recommended to take foot baths or do a warming massage before going to bed. This will facilitate the course of pathology.
As for physiotherapeutic treatment, methods such as magnetotherapy, reflexology, darsonvalization, massage, and electrical stimulation are effective.
Taking medicines
Medicines are prescribed to patients when restless legs syndrome worsens a person's quality of life, provokes insomnia, and other methods of therapy are ineffective.
The patient may be shown taking medications based on herbal ingredients. If they do not cope with the task, then you will need to choose from the following groups of medicines:
- Benzodiazepines. These drugs can help you sleep more deeply, but they have little effect on RLS symptoms. It is possible to take Clonazepam or Alprazolam. It should be borne in mind that these drugs can increase daytime sleepiness, worsen potency, increase apnea, and cause addiction. Therefore, they are used only if dopaminergic drugs do not have the desired effect, and the pathology has a severe course.
- Dopaminergic drugs. The main drug in this group is Levodopa. This drug can eliminate the symptoms of RLS and significantly improve the patient's condition. Also Levodopa can be combined with Madopar or Sinemet. Before bedtime, 50 mg of Levodopa is prescribed one hour before night rest. If the effect is not achieved, then the dosage is increased to 200 mg. As a rule, positive dynamics is observed in 85% of patients. Side effects are usually mild, and patients are well aware of this treatment. The negative side of therapy is that long-term use of levodopa drugs can lead to increased symptoms in the future. If such a situation is observed, then treatment is supplemented with dopamine receptor agonists (Bromocriptine, Cabergoline, Pramipexole, Piribedil).
- Anticonvulsants and opioids. These drugs are prescribed very rarely, in the case when the pathology has a severe course, and the above drugs do not bring the desired effect.
Treatment for restless legs syndrome is long-term and sometimes lifelong. Although in some cases, drugs are taken only during periods of exacerbation. If monotherapy with one drug does not allow achieving the desired effect, then it is supplemented with drugs from another group.
During pregnancy, most drugs are contraindicated for taking, therefore, women are prescribed Folic acid, iron-containing drugs. If RLS has a severe course, then Clonazepam or Levodopa can be taken in minimal dosages.
Video: Recommendations of a neurologist for the treatment of restless legs syndrome:
Prediction and prevention of restless legs syndrome
Idiopathic RLS develops and progresses slowly but unevenly. The periods of remission are followed by periods of exacerbation. Most often, they are provoked by external factors, although in 15% of patients, remission can stretch over several years.
Secondary RLS is determined by the course of the underlying pathology. If her treatment was chosen correctly, then all violations can be completely stopped, or significantly reduced.
As for the measures to prevent RLS, they boil down to the following recommendations:
- Timely treatment of kidney pathologies, vascular and spinal cord diseases.
- Compliance with a diet designed to prevent the development of a deficiency of iron, vitamins and trace elements in the body.
- Correction of metabolic disorders.
- Compliance with the regime moments.
- Minimizing stress.
- Refusal from excessive loads.
- Rejection of bad habits.
- Refusal to consume drinks and products containing coffee.
Restless legs syndrome is a common neurological disorder that requires a doctor to be able to diagnose it correctly. Therefore, such a diagnosis should not be overlooked if patients complain of insomnia and discomfort in the legs.
Author of the article: Sokov Andrey Vladimirovich | Neurologist
Education: In 2005 completed an internship at the IM Sechenov First Moscow State Medical University and received a diploma in Neurology. In 2009, completed postgraduate studies in the specialty "Nervous diseases".
