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Restless Leg Syndrome (RLS)










































Restless Leg Syndrome (RLS)

Restless legs syndrome (RLS) is a common neurological movement disorder characterized by an irrepressible urge to move legs.

Experts classify RLS as primary (idiopathic) or secondary.

We can manage mild RLS with reassurance and lifestyle modifications. However, moderate to severe cases require pharmacological treatment.

If not treated thoroughly, RLS may cause many complications. For instance, over time, it can lead to insomnia and complications like depression.


Definition

Restless Legs Syndrome (RLS), also known as Willis-Ekbom Disease (WED), is a condition in which the legs feel very uncomfortable while sitting back or lying down. With RLS, the individual feels the urge to move the legs irrepressibly, creating abnormal sensations, such as burning, tingling, aching, or "insects crawling under the skin". Typically, any small movement can transiently or partially relieve these sensations, and RLS has a strong circadian influence. Symptoms are usually worse in the evening.



Classification

RLS is classified into two common types: Primary and Secondary RLS. The Primary RLS is also known as idiopathic condition, as it is caused without any medical issues. However, the secondary RLS is caused by some triggering medical problems, such as pregnancy, alcoholic addiction, iron deficiency, etc.



Epidemiology

The prevalence rate of RLS is about 5-15% in the general population. Some 2.5% of adults with RLS have severe symptoms requiring medical intervention. Some risk factors related to RLS include female gender, pregnancy, low iron levels, lower socioeconomic status, poor health, and elderly age. Moreover, common comorbidities with RLS include Parkinson's disease, positive family history of RLS, and psychiatric disorders. Furthermore, RLS can make sleeping and traveling difficult and uncomfortable.



Causes

Here are some common causes of RLS:



RLS may be hereditary, implying it can run in individual's family.

RLS can be categorized as primary (idiopathic) or secondary. Secondary RLS occurs due to certain conditions, such as iron deficiency, pregnancy, end-stage renal disease, diabetes, rheumatoid arthritis, and, occasionally, peripheral neuropathies.

Some types of medications can worsen RLS symptoms, including antidepressants, antinausea, antipsychotic drugs, and cold and allergy medicines containing antihistamines.


Symptoms

With RLS, the legs become uncomfortable as people lie or sit down. Some individuals describe it as a creeping, crawling, tingling, or burning sensation. Continuously moving makes the legs feel better, but not for long. RLS can make it challenging for the individual to fall asleep and stay asleep.



Diagnosis

The RLS diagnosis is based primarily on the individual's history and a neurological evaluation to exclude differential diagnoses. The International RLS Study Group (IRLSSG) diagnostic criteria includes the following five criteria for a proper diagnosis:



Some uncomfortable and unpleasant sensations cause urges to move in the legs.

Symptoms are exclusively present or worsen during times of inactivity/rest.

Partial or complete relief of symptoms occurs after movement, such as walking or stretching. Or at least, this relief remains as long as the activity continues.

Symptoms are generally worse or exclusively occur in the evening or night.

The occurrence of the first four essential criteria is not solely essential, especially if RLS might occur due to primary or other medical or behavioral conditions.


Treatment

The majority of RLS cases are mild. They are typically managed by lifestyle modifications or non-pharmacological treatment. Furthermore, sleep hygiene is vital and may improve people with RLS.


Lifestyle Changes

For mild symptoms, use an over-the-counter pain reliever to reduce twitching and restless sensations. Here are some suggestions:



Reduce the consumption of alcohol, caffeine and tobacco.

Taking a hot bath and massaging the legs before sleep can help the individual relax.

Applying warm or cool packs to the legs can relieve uncomfortable sensations.

Doing moderate exercise may help, but do not overdo it. Exercising vigorously or late in the day may make symptoms worse.

Medication

An anticonvulsant medicine (usually prescribed to stop seizures) is helpful in other more severe cases. Generally, doctors prescribe various medicines like sleep aids, muscle relaxants (called benzodiazepines), and pain medicines (called opioids) to relieve symptoms.


Sleep Hygiene

Sleep hygiene is also helpful in improving RLS. Here are some recommendations:



Create a quiet, comfortable, and cool sleeping atmosphere in the bedroom.

Wear appropriate nightwear (e.g., silk pajamas or dressing gowns).

Always associate the bed with sleeping activity only (for instance, avoid watching TV on the bed).

Keep a regular sleep pattern by going to bed at the same time every night and waking up at the same time every morning. Moreover, it would help if people strive to get sufficient sleep each night and avoid daytime naps.


Intervention

Bheavior Management

The intervention includes behavioral changes as follows:



Relaxation techniques like meditation and yoga can help the individual relax before sleeping.

Trying to distract the mind by reading a book or solving a crossword puzzle while waiting for sleep is helpful.

Doctors advise people with RLS to alter their sleep patterns by going to bed late and waking up late.

Monitoring Diary

During the treatment of RLS, the efficacy assessment is usually carried out once a month to check whether the symptoms of RLS have improved or disappeared and whether daily life has returned to normal.


Prevention

Experts advise to prevent RLS by performing the following tasks:



Treatment of primary diseases, such as diabetes, Parkinson's, renal failure, etc.

Avoid smoking and drinking too much alcohol and coffee.

Keeping nutrition balanced and adequate is essential. Eat more high-protein foods like eggs, milk, soy products, and high-vitamin foods like fresh fruits and vegetables.

Pregnant women or puerpera should take suitable iron supplements to minimize the likelihood of RLS.

Keep a regular sleep schedule by avoiding late staying up and stress.

Get moderate physical exercise.

Complications

The following complications are associated with RLS:



Early morning rebound is the reappearance of RLS symptoms early as the medication effects wear off.

RLS has been identified as the fourth leading cause of insomnia. Moreover, sleep disturbance is often the primary reason for RLS people seeking medical attention.

Augmentation is a treatment-related side effect characterized by increased RLS symptom severity. It is the worst long-term complication of dopaminergic treatment of RLS and leads to worse symptoms than pre-treatment conditions.

Mood swings, depression, and anxiety are common comorbid conditions associated with RLS.

RLS may be associated with vascular risk factors, such as hypertension, diabetes, and obesity.



Sources:- shuteye

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