Restless leg syndrome (RLS) is a common neurological sensorimotor disorder with an overall prevalence in adults of 5-10% in Europe and North America. RLS is manifested by strong feelings of restlessness and distressing paraesthesia-like sensations (crawling, burning itching and tingling) in the lower legs. it is a condition that causes an uncontrollable urge to move your legs, usually because of an uncomfortable sensation. It typically happens in the evening or nighttime hours when you’re sitting or lying down. As a result of that, patients usually have a difficult time to maintain a proper sleep pattern; the symptoms vary considerably in severity and frequency (Borreguero & Pumarega, 2017).
There’s no known cause for RLS. Restless leg syndrome is said to be a genetic disorder that is developed at the later stage of life; however symptoms starts slowly at a younger age. It has been reported that restless leg syndrome is associated with anxiety and depressive disorders including PTSD. Researchers also suspect the condition may be caused by an imbalance of the brain chemical dopamine, which sends messages to control muscle movement. Risk factors include peripheral neuropathy, iron deficiency, kidney failure and spinal cord conditions. Some differential diagnoses that may be associated with restless leg syndrome are peripheral neuropathy, ischemia and arthritis. The diagnosis of restless leg syndrome could be difficult to make because it is mainly based on the symptoms reported. Consequently, the condition is diagnosed by the clinical characteristics of restlessness in the legs associated often with abnormal sensations that start at rest and are improved by activity, occurring with a diurnal pattern of worsened symptoms at night and improvement in the morning. RLS is the cause of impaired quality of life in those more severely afflicted (Cormella, 2014).
According to Hallegraeff, Greef, Krijnen & van der Schans (2017) the chief symptom is an urge to move the legs. Common accompanying characteristics include sensations that begin after rest, typically begins after you’ve been lying down or sitting for an extended time, such as in a car, airplane or theater. The sensation lessens with movement, such as stretching, jiggling your legs, pacing or walking, worsening of symptoms in the evening and nighttime leg twitching. The sensations, which generally occur within the limb rather than on the skin, are described as crawling, creeping, pulling, throbbing, aching, itching and electric
RLS is often unrecognized or misdiagnosed. In order to make a diagnosis of RLS, patients should meet the criteria described above recently put forth by the International RLS Study Group and the National Institutes of Health (NIH) (Hallegraeff, Greef, Krijnen & van der Schans, 2017). There is no diagnostic test for RLS; the diagnosis is based on subjective symptoms. If concurrent PLMS is of concern, then a sleep study can be performed to evaluate the patient for leg movements during sleep.
Once the diagnosis is made, the clinician must be sure to provide a detailed education pertaining to the nature of the disease, its process and management. Patients should be thought to institute a healthy lifestyle capable of promoting sleep. Patients may be advised to exercise regularly during the day, to avoid ingesting alcohol or smoking later in the day. Also, education could be provided about healthy eating such as the need to eat light and small meal in the evening to avoid any discomfort during sleep time. One of the common drugs that may be prescribed for restless leg syndrome is Requip; Requip could be prescribed as immediate release: 0.25 mg per day by mouth 1to 3 hours before bedtime; after day 2, Requip may be increased to 0.5 mg per day; at end of week 1, the drug may be increased to 1 mg per day, then increased weekly by 0.5 mg per day up to 4 mg per day (Medscape, 2017).
According to Shubhakaran (2016) although pharmacologic treatment is helpful for many patients with RLS, those with mild symptoms may not need medications. Because no single medication or combination of medications will work predictably for all patients, treatment must be individualized. Dopaminergic agents are the first-line drugs for most RLS patients. It is important for primary care providers to educate patients about the nature and actions of the drugs that are prescribed, including side effects and the uncertainty of long-term effects. For example, when dopaminergic agents are prescribed, patients should be informed that although these medications are usually used to treat Parkinson’s disease, they also help to relieve RLS symptoms.
Most cases of RLS can be effectively managed by primary care providers. If the primary care clinician encounters difficulty managing RLS symptoms in a patient, referral to or consultation with a movement disorders specialist or a sleep specialist may be helpful.
References:
Borreguero, D. G. & Pumarega. I, C. (2017). New concepts in the management of restless legs syndrome.British Medical Journal, 10 (1). Retrieved from http://www.bmj.com
Chatterjee, S. S., Mitra, S., Guha, P., & Chakraborty, K. (2015). Prevalence of restless legs syndrome in somatoform pain disorder and its effect on quality of life. Journal of Neurosciences in Rural Practice, 6(2), 160-164. doi:10.4103/0976-3147.153219
Cormella, C. L. (2014). Treatment of restless legs syndrome. Neurotherapeutics Journal, 11 (1). Retrieved from https://www.ncbi.nlm.nih.gov
Hallegraeff, J., de Greef, M., Krijnen, W., & van der Schans, C. (2017). Criteria in diagnosing nocturnal leg cramps: a systematic review. BMC Family Practice, 181-9. doi:10.1186/s12875-017-0600-x
Medscape. (2017). Restless leg Syndrome. Retrieve from https://reference.medscape.com/dru
Shubhakaran, K. (2016). Restless leg syndrome and its treatment. Saudi Journal of Kidney Diseases and Transplantation: An Official Publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 27(3), 621. doi:10.4103/1319-2442.182445
