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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House Call - answers to questions about exercise-induced asthma, restless legs syndrome, and sexual dysfunction in women - Brief Article
From Ebony, 11/1/01

Expert Advice on Health and Fitness

`Since my son has asthma, should he be allowed to play basketball?'

EXERCISE-INDUCED ASTHMA

Q My 14-year-old son has had asthma for most of his life, and I have spent some scary moments trying to help him get through an attack. He is an active child who now has hopes of playing basketball in high school. I'm afraid for him to participate because some people say exercise and asthma don't mix. Since my son has asthma, should he be allowed to play basketball? M.T., New York City

A Following the tragic death of Northwestern University football player Rashidi Wheeler, who the Cook County (Ill.) medical examiner said died as a result of exercise-induced asthma, more attention has been focused on asthma and how physical activity affects it.

Asthma is a very serious, potentially fatal condition that requires proper treatment. Exercise-induced asthma affects more than 80 percent of asthmatics, but with preventive care and proper treatment, doctors say athletes (like Olympic gold medalist Jackie Joyner-Kersee) can compete safely at the highest levels of competition.

For people whose symptoms are almost exclusively related to exercise, inhaled medication shortly before exercise can help prevent symptoms, which include chest tightness or pain, shortness of breath, wheezing and coughing.

Many medical experts say exercise is healthy for asthmatics and should only be restricted in severe, uncontrolled cases. Take your son to your physician and, together, determine if your son's condition will be seriously affected by the increased physical activity.

SEXUAL DYSFUNCTION IN WOMEN

Q There has been so much talk about erectile dysfunction and other sexual problems in men since Viagra came on the market, but what about the problems that women have? We all know that women experience sexual problems, but they aren't highlighted like those of the men. What's being done to help women? H.G., Los Angeles

A Traditionally, men's sexual problems have gotten most of the attention of medical experts, leading to treatments that include the very popular Viagra. But studies indicate that a large percentage of American women also experience sexual dysfunction, including diminished sexual sensation, a decrease in overall sexual satisfaction and low sexual desire.

A Doctors say sexual dsyfunction in many women (as it is in men) could be the result of underlying physical problems such as vascular disease, diabetes or other problems related to insufficient blood flow.

Several drugs are under development that may help women, and other drugs are awaiting Federal Drug Administration approval. Currently, one of the already-established approaches to boost some women's libido is the ingestion of the male hormone testosterone, taken in pill form. Medical researchers say testosterone can heighten a woman's sex drive, sexual appetite, sexual fantasies and the intensity of her orgasms.

Doctors say women with sexual problems should also consider getting a complete physical examination to determine if poor health, urinary-tract problems, sexually transmitted diseases, or stress might be contributing to their difficulties.

RESTLESS LEGS SYNDROME

Q I have always been a pretty heavy sleeper and now my husband has begun to complain that I kick him throughout the night. I've never done this before. What could be causing this? C.B., Nashville

A You could be the victim of Restless Legs Syndrome (RLS), a condition that affects about one out of every seven Americans and is characterized by involuntary leg movement during sleep. The cause is unknown; it often runs in families; and doctors say there is no cure. RLS appears to be triggered by a number of conditions, including rheumatoid arthritis, varicose veins, smoking, diabetes and iron deficiency. Various drugs to treat the condition have yielded varying results.

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