Restless Legs Syndrome
This is a neurological condition which is common and frequently undiagnosed. The criteria for restless legs syndrome (RLS) is:
An irresistible urge to move the limbs with or without sensations
An improvement in symptoms when moving the limbs
Onset or worsening of symptoms during inactivity or whilst relaxing
Worsening of symptoms in the evening or at night
It affects about 10% of the general population and affects women more commonly 10-20%.
The primary causes are a dysfunction of the dopamine producing system, dysfunction of iron metabolism and family history of RLS. It is thought that insufficient levels of iron produce spinal hyperexcitability and restlessness in the lower limbs through decreased activity of dopamine.
Secondary causes can include pregnancy, iron deficiency, peripheral neuropathy, diabetes mellitus, thyroid disorders, fibromyalgia, rheumatoid arthritis and kidney disease.
In children the symptoms can be confused with those for growing pains, attention deficit hyperactivity disorder(ADHD) or other sleep disorders.
Some aggravating factors can include iron deficiency, use of certain medications and high intake of alcohol, caffeine and/or nicotine. Making these changes may reduce the symptoms. Any changes to medication should be discussed with the patients’ doctor.
There have been some studies of intervention to try to reduce or eliminate symptoms. A pilot osteopathic study using specific points on the body found a reduction of symptoms although this was a small group and further work needs to be done.(CARL trial 2012)
Another small study by Dinkins and Stevens-Lapsley found that a traction straight-leg raising technique reduced symptoms. An 8 weeks yoga programme (Innes et al 2013) found improvement of symptoms including those of sleep, mood and perceived stress. Other interventions including wearing compression stockings have been found to improve symptoms (Lettieri and Eliasson 2009) as well as those applying pressure to the limbs.
Some patients’ find that standing on cold floors or immersing the feet in cold water reduces RLS. A study in which patients used a cold air chamber at -60C supported this although it was a small study.
Medication is also prescribed for patients 1-3 hours before going to bed. These include Levodopa, Ropinirole and Gabapentin.
Please see the National Institute of Clinical Guidelines (NICE) for further information. RLS UK is a charity which supports sufferers.