RLS: Restless Leg Syndrome
RLS is a neurologic condition that affects sleep and daytime functioning. The underlying cause is believed to involve abnormalities of iron and dopamine metabolism. Patients with RLS may have a compelling urge to move their legs, which worsens at night. Patients with RLS may have difficulty describing their symptoms and may present with daytime fatigue and general sleep difficulties.
The prevalence of RLS is believed to occur in 5-10% of the U.S. population. The prevalence increases with age and women are more likely to report symptoms. RLS is likely an under reported cause of insomnia related symptoms, chronic fatigue and mood disturbance.
Diagnostic criteria include- unusual urge to move limbs, active movement of limbs relieves the urge, rest brings on the urge and nighttime symptoms are worse than daytime symptoms. Most people report that the urge to move the limb is a sensation deep in the leg, but not a cramp. The legs are the primary focus, but the arms, back, and head can be involved. The spouse is often the one that forces the patient to seek help for the nighttime jerky movements. The history is often all that is needed to make the diagnosis of RLS. Medication history is helpful since some medications can aggravate RLS. Some of the common medications that may worsen the condition are: Reglan, SSRI antidepressants, the TCA antidepressants, calcium channel blocker anti hypertensives and anti seizure medications. Alcohol and caffeine may worsen the condition. Moderate exercise before bed may decrease symptoms.
Treatment of RLS includes avoidance of medications, alcohol and caffeine. The four main groups of medications found to be useful in the treatment of RLS are: Dopamine agents (Mirapex and Requip), Benzodiazepines (Klonopin, which is clonazepam), Opioids (Codeine, Methadone), and anitepileptics (Neurontin, which is gabapentin, and Topomax). The dopamine agents are considered to be the first line treatment for RLS. They appear to be the most effective for mild, moderate or severe RLS. This class of medications is also used in the treatment of Parkinson’s disease. However, no link between RLS and Parkinson’s disease has been discovered.
Mark Smith, MD