Paging Dr. Frischer - Restless Leg Syndrome

Do you get an overwhelming urge to move your legs - especially at night - accompanied by an uncomfortable sensation? Does moving your legs release that discomfort? Does the feeling only get worse when you try to relax or lie still? Does this (understandably!) keep you awake? You may be suffering from a condition known as Restless Leg Syndrome (RLS).Restless Leg Syndrome affects up to 10% of the population, including about a million children. Women are twice as likely to get it, and while symptoms can begin at any age, the more severe form of the disease occurs in middle-aged or older people. More than 80% of people with RLS also experience a condition known as periodic limb movement of sleep (PLMS). PLMS is characterized by involuntary leg twitching or jerking movements, occurring every 15 to 40 seconds, and leading to repeated awakenings. Symptoms vary from day to day in severity and frequency, and only by keeping in constant motion might the sensations be prevented. The arms, trunk and head are much less often involved. Classically, it's worse at night, and symptoms usually subside first thing in the morning. Common triggers include times of inactivity like a long car trip, sitting in a movie theater, a plane flight, immobilization in a cast, or relaxation exercises. In the long term, there may be periods of remission for days or months before a new relapse occurs. Symptoms tend to become more severe over time for most, and yet may disappear for some. The causes of Restless Leg Syndrome are puzzling. The medical literature first mentioned it in 1683. More than 60% of cases are felt to have a genetic component, as it is found clustered in families when the disease begins before age 40. RLS can also be related to iron-deficiency, which seems to account for 20% of all cases, but 75% percent of cases show elevated levels of iron in the blood! Other conditions that often occur in those suffering from RLS include varicose veins, folate deficiency, magnesium deficiency, fibromyalgia, sleep apnea, kidney failure, diabetes, thyroid disease, Parkinson's disease, certain autoimmune disorders, celiac disease, rheumatoid arthritis, and peripheral neuropathy. Finally, in a study just released by the Mayo Clinic, it appears that RLS could be a sign of hidden heart problems. The study showed that people with very frequent leg movements were more likely to have thick hearts, a condition that makes them more prone to cardiac problems, stroke and death. A cause-and-effect relationship has not been proven to date, but the association of the two has definitely been observed. Some medications aggravate RLS symptoms, including anti-nausea meds, anti-psychotic drugs, certain over-the-counter antihistamines, and some anti-depressants. Other factors that can make it worse are being in the last trimester of pregnancy, detoxing from opioids, alcohol use, sleep deprivation, and undergoing any surgery. Diagnosis of RLS is made clinically, not through a lab test. Your doctor will focus on your description of symptoms, triggers, what gives relief, and the pattern it follows throughout the day and night. While laboratory tests can be run to rule out other conditions such as vitamin deficiencies or other movement disorders, and sleep studies can rule out sleep apnea, there is as of yet no diagnostic test to establish a diagnosis of RLS. The goal of treatment is to reduce symptoms, including decreasing the number of nights with symptoms, the severity of symptoms, and the frequency of nighttime awakenings. •When RLS is a result of an underlying medical condition, it may be cured when the underlying condition is taken care of. •For the 20% of cases associated with iron deficiency, iron replacement may eliminate or reduce RLS symptoms. •Stretching exercises of the leg muscles can bring relief lasting from seconds to days. Walking may give some relief. •For some, dopamine agonist medications, such as Requip (Ropinirole) and Mirapex (Pramipexole), have helped. •Lifestyle changes may make a real difference, including reducing caffeine, alcohol and tobacco; taking iron, folate, and magnesium supplements; maintaining regular sleep patterns; and getting exercise, massages, and baths. Unfortunately, RLS is a chronic condition with no cure. There may be hope in the many research projects that are currently underway, which promise to give new insights into the causes and cures for this debilitating condition. I wish you good health and sound sleep! Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

********** Published: April 14, 2011 - Volume 9 - Issue 52