Restless legs syndrome

Restless legs syndrome (RLS, or Wittmaack-Ekbom's syndrome, which is not to be confused with Ekbom's syndrome) is a poorly understood and often misdiagnosed neurological disorder characterized by unpleasant or painful sensations in the body's extremities and an overwhelming urge to move them. Moving the limbs provides temporary relief for this chronic condition. Symptoms are often discernable in early childhood, and may become disabling in later life, particularly due to sleep deprivation.

Symptoms

The key symptoms of RLS are:

• an urge to move the legs and sometimes arms, which can be irresistible when severe; this is usually associated with an abnormal sensation such as a "creepy" or "crawly" feeling, a tickle, an ache, or a discomfort that may be very difficult to put into words. These sensations generally occur inside the legs or arms (along the axis) in the calf or forearm area.
• involuntary muscle movements (spasms or 'twitching')
• excessive movement of the legs or arms when at rest,
• aggravation of the discomfort during rest and at least temporary relief by movement,
• a circadian rhythm of severity with symptoms being worse at the patient's usual bedtime.

Prevalence

Most sufferers think they are the only ones to be afflicted by this peculiar condition. Many people only have this problem when they try to sleep, but some people show symptoms during the day and pace or 'bounce' their legs. Some people get the symptoms on long car rides or during any long period of inactivity (like watching movies, attending dinners, etc.) The limbs may also start to twitch involuntarily, sometimes causing large limb excursions (flailing) especially during sleep. This is sometimes defined as a related syndrome, called Periodic limb movement disorder. It is not unknown for some people to be thrown out of bed by violent leg movements.

About 10 percent of adults in North America and Europe may experience RLS symptoms, according to the National Sleep Foundation, which reports that "lower prevalence has been found in India, Japan and Singapore," indicating that ethnic factors, including diet, may play a role in the prevalence of this syndrome.

Causes

There is a high incidence of familial cases, suggesting a genetic tendency. Secondary causes of RLS include antipsychotics, antidepressants, antihistamines (particularly those that cause drowsiness), serotonin reuptake inhibitors, and antinausea agents. As there seems to be a link between dopamine and RLS, drugs that interact with dopamine may also cause secondary RLS.

Treatment

Common medications include dopamine agonists (dopaminergic agents) such as levodopa, ropinirole, sinemet or pergolide, opioids such as propoxyphene or oxycodone, benzodiazepines (which improve quality of sleep), or anticonvulsants (patients who report pain may benefit most) such as gabapentin. In 2005, The Food and Drug Administration approved Requip (ropinirole) to treat moderate to severe Restless Legs Syndrome (RLS). The drug was first approved for Parkinson’s disease in 1997.

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