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Restless legs syndrome is a discomfort 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. They are forced to move by painful unpleasant sensations.
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. Therefore, it is not surprising that restless leg syndrome is often referred to as Ekbom’s 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, the elderly suffer from it (about 20% of the total population of the planet, who are in old age). Men are 1,5 times less likely to have RLS, but this information is not accurate, as women are more likely to seek medical help and complain of such problems.
Chronic insomnia is conceived due to restless legs syndrome (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.
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 years of age. No association with any disease could be traced. As observations show, this disorder is most often hereditary. Family history of the development 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 certain flaps of genes, which are located on chromosomes 12, 14 and 9, are responsible for the development of restless legs syndrome. However, it turned out to be impossible to explain the development of this disorder solely by gene mutations, therefore modern science considers this pathology as a polyetiological one.
Secondary restless legs syndrome manifests in people of mature age. Most often, people over 45 years of age turn to doctors with complaints of discomfort in the lower extremities.
The following conditions of the body can provoke its development:
Pregnancy. During childbearing, SDN is diagnosed on average in 20% of women in the second and third trimesters. Most often, after childbirth, such discomfort disappears. 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 turn to the doctor. And most of them are diagnosed with kidney failure. People undergoing hemodialysis complain of RLS in 33% of cases.
Diabetes.
Amyloidosis.
Alcohol abuse.
Folate 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.
Pathologies of the spinal cord: discogenic myelopathy, tumors, trauma.
Parkinson’s disease.
Overweight. If a person suffers from obesity, then restless leg syndrome will develop in him with a probability of 50%. First of all, this is true for young people with overweight.
Tourette’s syndrome.
Lateral amyotrophic sclerosis.
Partial resection of the stomach.
Taking certain medications: neuroleptics, tricyclic antidepressants, histamine, anticonvulsants.
Sometimes in people who have a hereditary predisposition to develop restless legs syndrome, adverse environmental factors or bad habits can provoke its onset. In particular, the use of large volumes of coffee.
In people with neurological conditions, such as Parkinson’s disease, restless leg syndrome may be due to medications. Sometimes these two pathologies are simply combined with each other and have no causal relationship.
Why exactly restless legs syndrome develops is not known for certain today. Most scientists dealing with this issue point out that the dysfunction of the dopaminergic system lies at the heart of the disorder. They indicate that it is possible to eliminate RLS 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, to date, it is not clear which dopamine disorders underlie the pathology.
Restless legs syndrome symptoms
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 most often asymmetrical.
Sensory disturbances occur when a person is sitting or lying down. The maximum strength of the symptoms is gaining in the period from 12 to 4 o’clock in the morning. To a lesser extent, symptoms appear between 6 and 10 am.
Complaints that patients may present:
Feeling of tingling in the legs.
Feeling of numbness in the lower extremities.
Feeling of pressure on the legs.
Skin itching of the lower extremities.
Feeling of goosebumps running down the legs.
These symptoms are not accompanied by severe pain, but are very annoying to the person and cause him serious physical discomfort. Some patients report dull, aching pain or mild but sharp pain.
Unpleasant sensations are localized mainly in the lower leg, less often affect the feet. As the pathology progresses, the hips, arms, perineal region and even the torso are involved in the process.
In the initial stages of RLS development, a person begins to experience discomfort 15-30 minutes after he went to bed. In the future, discomfort begins to disturb almost immediately after the cessation of physical activity, and then during the daytime, when the legs are at rest. It is very difficult for such people to drive a car, travel by air, visit the theater and cinema, etc.
In general, a clear symptom of restless leg syndrome is that the person only feels uncomfortable when they are not moving. To eliminate discomfort, he is forced to move them: shake, wiggle, bend and unbend. Sometimes patients get up and stomp on the spot, 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. The movements are stereotyped and constantly repeated. A person bends either the big toe or all the toes, 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 30 second break. Such episodes are repeated for several minutes or several hours.
If the pathology has a mild course, then the person himself may not even be aware of such a violation. It can only be diagnosed during polysomnography. When RLS is severe, the patient wakes up several times a night and cannot fall asleep for a long time.
Such pathological behavior during sleep cannot go unnoticed. In the daytime, a person feels tired and weak. His mental functions worsen, attention suffers, which affects his working capacity. Therefore, restless legs syndrome can be attributed to 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. The disease begins to disturb a person more strongly during an emotional upheaval, after consuming drinks containing caffeine, after playing sports.
The vast majority of people indicate that the pathological symptoms, although slowly, still progress. Sometimes there are periods of calm, which are replaced by periods of exacerbation. Long-term remissions, which stretch 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. However, remissions are rare.
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.
Discomfort is aggravated at rest. During physical activity, it is either absent altogether, or weakly expressed.
When a person moves his legs, the discomfort goes away.
At night, unpleasant sensations gain maximum intensity.
If a person answers yes to all 4 questions, then with a high degree of probability he can suspect restless legs syndrome.
Be sure to direct efforts to find the cause that provoked RLS. If this syndrome is primary, then it will not be possible to detect it in the end.
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.
Reberg’s test and a biochemical blood test, which allow you to assess the performance of the kidneys.
Ultrasound examination of the vessels of the legs.
It is important to make a differential diagnosis with other diseases that have 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 the symptoms of neuropathy occur. Unpleasant sensations do not go away after the start of physical activity. |
ectasia | A person shows increased anxiety, he has a desire to move his legs. Unpleasant sensations are aggravated at rest. | There is no daily rhythm, there is no burning sensation in the legs, they do not “crawl”. Close relatives did not suffer from a similar problem. |
Vascular diseases | The patient complains of crawling in the legs | Unpleasant sensations intensify during movement, vessels are clearly visible under the skin. |
night cramps | Discomfort can be relieved by stretching the legs. Seizures have a daily rhythm. | Unpleasant sensations arise unexpectedly, they do not cause a desire to move your legs. When walking, the cramps do not stop. |
Restless legs syndrome treatment
If RLS is caused by any disease, then efforts should be made to eliminate it. It may also be necessary to replenish iron stores, 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. Take them 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. As a rule, such therapy is effective. It consists of pharmacological and non-pharmacological correction.
Non-drug treatment
If a person is taking any drugs that can provoke the development of RLS, then the treatment must be adjusted. If possible, they refuse to use them.
Be sure to activate physical activity, but the load should be moderate. It is good to walk before going to bed, take a shower, eat right. Patients should stop drinking coffee and strong tea, eating chocolate and other foods that may contain caffeine.
Alcoholic beverages should be, if not banned, then restricted. It is equally important to stop smoking, to observe the regime of the day.
If a person’s feet are in the cold, then the symptoms of RLS increase, 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 alleviate the course of the pathology.
As for physiotherapy, methods such as magnetotherapy, reflexology, darsonvalization, massage, electrical stimulation are effective.
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