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Restless legs syndrome (impatience in the legs) Causes, Symptoms and Treatment

The restless legs syndrome, also called restless leg or nocturnal restlessness, is a neurological disorder that causes an uncontrollable urge to move the legs. This need arises from discomfort in the lower limbs – tingling, tingling, and burning – which varies greatly from person to person. These unpleasant sensations occur especially during periods of relaxation or inactivity. As a result, it can be very difficult to simply rest, or to sit down to attend a meeting or travel by plane, for example.

Since the symptoms occur mainly in the evening and at night, drowsiness is more difficult. The chronic insomnia that can result causes fatigue and drowsiness during the day, greatly affecting the quality of life. Some people even report having the sensation, on waking, of having walked all night. It should not be confused with night cramps, which are totally different.

Restless legs syndrome has been better known in medicine since the early 1980s. But, it was first described in the medical literature in 1945.

Who is affected?

In North America and France, about 1 in 10 people suffer from restless legs syndrome. According to epidemiological studies, it would be more frequent in certain populations: this is the case of Northern Italians and French Canadians. In Quebec, about 15% of people have this syndrome. This is attributable to a genetic anomaly passed down from one generation to the next.

The disease is clinically significant, moderate to severe, in about 3% of the adult population and 0.5% in children.

Causes of Restless legs syndrome

For the majority of cases, the cause remains unknown. Physiologically, it is known to be a neurological disorder that involves a lack of dopamine in the brain and spinal cord. Dopamine is an important chemical compound that allows nerves to communicate with each other and regulate movement.

We distinguish the primary (idiopathic) form and the secondary form. The primary form has no known cause. It is often family-based and often starts in early adulthood. Eight genetic loci were identified and these abnormalities are found in 70% of cases in the primary form. It gets progressively worse, and reaches its peak between 40 and 60. In Quebec, approximately 1 in 2 of restless legs syndrome occurs in people who have the primary form.

Secondary forms are associated with the following conditions:

  • An iron deficiency. The lack of iron could hinder the production of dopamine, even if the deficiency is not enough to talk about anemia. Iron is involved in the production of dopamine in the brain. It was found in a search in 88 children with ADHD a third also had a restless leg syndrome and that they were more likely to have iron deficiency.
  • A chronic illness: diabetes, renal failure (4 of 10 patients on dialysis suffer); fibromyalgia or rheumatoid arthritis may contribute to restless leg syndrome.
  • The pregnancy. It can trigger symptoms, especially during the last trimester, or aggravate them. In the first case, these tend to disappear within 2 weeks of delivery.
  • deficiency in folic acid (vitamin B9).
  • Taking certain medications, such as tricyclic antidepressants, lithium, antinauseants and antipsychotics.
  • The caffeine.
  • Obesity slightly increases risk.
  • Medications can exacerbate or unmask: antihistamines, antidopaminergics, antidepressants (especially mirtazapine), beta blockers, neuroleptics, lithium.
  • Patients with multiple sclerosis, amyotrophic lateral sclerosis or migraine are more often affected.

Evolution

The syndrome tends to get worse with age . Symptoms initially felt in the calves , for example, can extend to the thighs, and occur more often. In more severe forms of the disease, the arms can also be affected. Some people manage to control the syndrome very well by changing their lifestyle . Cases of spontaneous remission have been described.

Diagnostic of Restless legs syndrome

To make a diagnosis, the doctor is based on the description of the symptoms, the medical history and the family history. Some muscle or blood tests (ferritin, hemoglobin, folic acid, vitamin B12, glucose and creatinine , thyroid) are sometimes suggested. If necessary, the general practitioner proposes to consult a neurologist. He may, if necessary, observe the polysomnographer the quality of sleep during a night spent in a sleep study center.

Do not hesitate to consult!

Some people do not dare to consult a doctor because they trivialize their symptoms or believe that they will not be taken seriously. Nowadays, there are effective ways to relieve them. For your first appointment, have a journal describing your symptoms and the times when they occur.

Symptoms of restless legs syndrome (impatience in the legs)

The following 4 states must be united according to the criteria of the International Restless Legs Syndrome Study Group.

  • need to move the legs , usually accompanied and sometimes caused by unpleasant sensations in the legs (tingling, tingling, itching, pain, etc.).
  • This need to move appears (or worsens) during periods of rest or inactivity , usually sitting or lying down.
  • Symptoms increase in the evening and at night .
  • relief occurs when moving the legs (walking, stretch, bend the knees) or that the mass.
  • The symptoms come in periods, which last from minutes to hours.
  • The syndrome is often accompanied by chronic insomnia , therefore a great fatigue during the day.
  • During the night, the syndrome is accompanied, in about 80% of the cases, of involuntary movements of the legs , in 10 to 60 seconds. These make sleep light. These leg movements are often noticed by people with whom the subject shares the bed. Not to be confused with night cramps, which are painful?
    Note . The majority of people with periodic leg movements during sleep do not have restless legs syndrome. These periodic movements can manifest themselves in isolation.
  • The symptoms usually affect both legs, but sometimes only one is.
  • Sometimes the arms are also affected.

People at risk for Restless legs syndrome

  • People with a close family member with Restless Legs Syndrome. According to the results of a study conducted among 249 Quebeckers, among the siblings of the patients affected, the relative risk of suffering from the syndrome was multiplied by 3.6.
  • Women are more often affected than men.

Risk factors

No risk factor is known. See the possible causes listed above.

Prevention

Can we prevent?
As the causes of restless leg syndrome are poorly understood, there is no known way to prevent it.

Nevertheless, since some  deficiencies in  essential nutrients (iron, folic acid, and vitamin B12) seem to contribute to the syndrome, we can put all the odds on his side by having a  varied diet  that meets our nutritional needs. If in doubt, consult a doctor to diagnose any deficiency. See also the Nutrition factsheet, as well as the Iron, Folic Acid and Vitamin B12 fact sheets for symptoms related to deficiencies and their dietary sources.

On the other hand, people with a  condition  such as diabetes or rheumatoid arthritis can reduce their risk by actively following their treatment.

 

Measures to prevent periods of symptoms and their worsening
Certain  lifestyle habits  tend to trigger and exacerbate the symptoms, for the majority of people affected. By modifying them, we can reduce the symptoms. This should be an integral part of the therapeutic approach.

  • Have a   healthy and diverse diet to meet the body’s nutrient needs. Consult our Nutrition file.
  • Reduce as much as possible the consumption of  caffeine , for example coffee, tea, cola and chocolate. Some people have reported that they have solved their problem this way. We can try the experiment for a few weeks and observe the difference 4 .
  • Reduce alcohol and tobacco consumption, which also appears to exacerbate symptoms.
  • Practice the exercise  regularly and moderately contributes to the quality of sleep and can also calm the symptoms. As part of a randomized clinical study, the decrease in symptoms was observed as early as the 6 Th week of the training program (3 sessions per week) and was maintained until the end of the study (3 months) 11 .
  • Learn to better fight  stress . Fatigue and stress sometimes contribute to the syndrome. See the Complementary Approaches section, and the Stress and Anxiety folder for an overview of possible solutions.
  • Create an  environment  conducive to  sleep . If you’re looking for something to sleep better, check out our file  Have you slept well?
  • Some  medications  can make the symptoms worse. This would be the case, for example, with antidepressants and  bronchodilators . Ask your doctor or pharmacist.

Medical treatment of restless legs syndrome

Some people do not dare to consult a doctor , believing their symptoms are minor and impossible to treat. However, sometimes the cause can be discovered and treated. In addition, there are several ways, medicated or not, to relieve the symptoms and thus find a more satisfactory life.

Treatment of the cause

The doctor first tries to discover the cause and treat it. For example, in cases of anemia, taking supplements of iron can solve the problem. Same thing in case of folic acid deficiency . If the symptoms are attributable to taking one medication , the doctor will suggest another. In people with chronic kidney disease who are on dialysis, symptoms often disappear after a kidney transplant.

Unfortunately, the treatment of the cause is not always possible. If the cause is genetic , it is nevertheless possible to eliminate the aggravating factors.

Life habits

In cases where symptoms are mild to moderate and do not interfere too much with everyday life, many people manage to reduce the intensity and frequency of their symptoms by modifying certain lifestyle habits . We must first be aware of the circumstances surrounding the moments of absence and exacerbation of symptoms, and then adjust our lives accordingly. See the Prevention section for some leads.

Aerobic exercise and lower limbs at the rate of 3 days per week have provided a significant reduction in symptoms in a search with 28 patients.

Pharmaceuticals

When insomnia significantly affects activities during the day (and this is usually the case if 2 or more nights a week are disrupted), doctors may prescribe various medications . None of them treat the syndrome specifically. However, they can help you sleep better, decrease the severity of symptoms, and minimize unwanted leg movements during the night. Their effectiveness varies from person to person.

  • First and foremost, we must try to reduce or eliminate drugs that are known to aggravate or unmask the disease.
  • Dopaminergic agents . These are, in general, the first drugs that we try. These drugs, sometimes called antiparkinsonian, act by mimicking the action of dopamine ( dopamine agonists), such as pramipexole (Mirapex), pergolide (Permax) and ropinirole (ReQuip). Dopaminergic agents are consumed at low doses compared to doses prescribed for Parkinson’s disease. They can cause side effects, such as nausea and vomiting, or in some cases increase the symptoms of the syndrome. Some research has shown a link with these agents and behaviors such as compulsive shopping.
    If you have side effects, talk to the doctor, who will correct the problem by adjusting the dosage or prescribing another medicine.
  • Anticonvulsants . In cases where sleep is regularly disturbed by involuntary leg movements, an anticonvulsant can inhibit the neurons that cause these movements. For example, gabapentin or pregabalin (Neurontin, Lyrica). Usually, they are used only in cases where dopaminergic agents are ineffective.
  • Sedatives . Sedatives such as benzodiazepines (Clonazepam, Diazepam, Valium, etc.) help to improve sleep and relieve symptoms during the night. They are often taken at bedtime. These drugs, however, create a physical addiction; their therapeutic effect thus diminishes with time. Physicians only use it in certain situations for a limited time.
  • Narcotic analgesics . If the symptoms are unbearable and accompanied by pain , narcotic pain medications (opioids) may be used. For example, codeine (only generic) and oxycodone (OxyContin). These drugs act in the brain and spinal cord and hinder the transmission of pain messages. Their effect is more powerful than that of non-narcotic analgesics, such as nonsteroidal anti-inflammatory drugs (NSAIDs), which act locally. They are prescribed very rarely, given their potential for abuse and side effects.
Tips for relieving symptoms

When symptoms are present, the following measures provide immediate but temporary relief.

  • When the need is felt, move your legs, stretch them or bend your knees. Do not try to suppress the urge to move.
  • Practice self-massage and light stretching, especially in the morning and evening before going to bed.
  • Take a hot bath.
  • Apply heat and cold to the muscles alternately.
  • Keep your mind busy with activities that require special attention when sitting for a long time (car ride, etc.).

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