Restless legs syndrome (RLS) is a chronic, progressive movement disorder characterized by abnormal sensations caused by the urge or need to move the legs.
Patients with restless legs syndrome characteristically have difficulty describing their symptoms. They often express the desire to move the legs, which they cannot prevent, in the form of pain-burning-tingling, which is not very painful, but quite uncomfortable. This discomfort occurs during rest, intensifies at night, and is usually awakening from sleep, so chronic sleep disorder causes mental stress. Patients state that they cannot sleep at night, get up and walk around and sometimes try to relax by pouring water on their legs. It can also manifest itself on long journeys, in situations where long sitting is required, such as in the cinema/theatre. It impairs the quality of life by causing conditions such as fatigue, weakness and difficulty in concentration due to the sleep disorder it creates.
It is more common in women and is more common with age. It affects 5-7 people out of every 100 people.
Cause of Restless Legs Syndrome
Restless legs syndrome is a clinical condition that is among the “central sensitivity syndromes” characterized by a disorder in pain perception. Similar to Parkinson’s, it is reported to be caused by a disorder in the dopamine system.
Restless legs syndrome occurs in 2 ways:
Primary type Restless Legs Syndrome with no cause: No problem is found in all examination, laboratory and imaging methods. It may be genetically inherited, and some patients do not have a genetic origin.
Restless Legs Syndrome secondary to another disease: Iron deficiency, pregnancy, kidney failure, inflammatory rheumatic diseases, diabetes, multiple sclerosis. When the causative agent of Secondary Restless Legs Syndrome is found and treated (such as iron deficiency), it may be possible to completely eliminate the disease.
Diagnosis of Restless Legs Syndrome
The diagnosis of restless legs syndrome is made by the patient’s description and the absence of any other reason to explain the complaints in his legs. A neurological examination should be made to determine whether there is one of the other movement disorders, whether there is neuropathy, whether there is a problem in the waist, hip, knee and ankle, whether there are symptoms of both veins and arteries, and whether there is a problem related to the lymphatic system. It is also restless with some metabolic (such as diabetes, obesity, B12 deficiency, iron deficiency) and endocrine (thyroid-goiter dysfunctions, hypothalamus, pituitary, adrenal axis problems) and organ failures (kidney failure, dialysis, liver cirrhosis). Since leg syndrome is common, evaluation should be made in these aspects as well. Pregnancy should also be evaluated in this aspect due to the increased frequency of restless legs syndrome in multiple sclerosis and some inflammatory rheumatic diseases (such as rheumatoid arthritis). The drugs used by the patient should also be evaluated, because similar problems can be seen in neuroleptic users.
Differential diagnosis of some clinical pictures very similar to restless legs syndrome should also be made. One of them is night cramps. It usually involves the muscles of the back of the lower leg and is relieved by stretching. The other is “painful leg moving finger syndrome”. It is characterized by severe pain and burning in one or both feet, accompanied by repetitive movements of the big toes. Unlike restless legs syndrome, it does not worsen at night and does not improve with movement.
Diagnostic Criteria for Restless Legs Syndrome:
Basic diagnostic criteria
1. The need to move the legs due to or with uncomfortable or unpleasant sensations in the legs
2. The need for movement or uncomfortable sensations begin or worsen at rest
3. The need for movement or uncomfortable sensations are partially or totally relieved by movements such as walking or stretching.
4. The need for movement or uncomfortable sensations worsen during the day, in the evening or at night, or occur only in the evening or at night
5. The above-mentioned features cannot be considered solely in relation to primary symptoms or other medical or behavioral conditions (eg, myalgia, venous stasis, leg edema, leg cramps, habitual foot shaking).
Supporting clinical features
1. Family history
2. Response to dopaminergic therapy
3. Periodic limb movements (while awake or asleep)
4. Absence of expected daytime sleepiness
Markers associated with clinical course
a Chronic/persistent Restless Legs Syndrome: Symptoms appearing on average at least twice a week in the last year if no treatment is given
b. Intermittent Restless Legs Syndrome: If untreated, symptoms occur at least 2 times a week on average and at least five episodes in a lifetime
Markers associated with clinical significance
The symptoms of Restless Legs Syndrome cause severe distress and disability in social, education, work, and other important functional areas, with effects on sleep, energy/vitality, daily activities, behavior, cognitive status, and mood.
Treatment for Restless Legs Syndrome
Medication : The most preferred drug group is dopaminergic (drugs used in Parkinson’s) drugs. Apart from this, anticonvulsants (drugs used in epilepsy), opioids, benzodiazepines can also be used.
Complementary medicine methods:
Acupuncture:Acupuncture, which acts by regulating the energy systems in the body, is a method that can be used both in the control of pain, in sleep control and in regulating the psychological state.
neural therapy : Neural therapy, which regulates the nervous system by using local anesthetics and enables the patient’s own healing mechanisms to be activated, is successfully used in Restless Leg Syndrome patients. In our clinic, a combined treatment is usually performed with acupuncture.
ozone therapy: It activates the antioxidant mechanism in patients with Restless Legs Syndrome.
Relaxation Methods: Patients can be treated with relaxation training and biofeedback.
Exercise:Exercise ensures stability of the legs by maintaining joint movement, lengthening and strengthening shortened muscles.
With aerobic exercises (such as swimming, walking, running, cycling, dancing), respiratory and cardiac functions should be improved and resistance should be increased. In addition, it is possible to increase the release of pain relievers and happy substances (endorphin, serotonin) with regular aerobic exercises. In order to achieve this effect, the patient must exercise regularly for at least 8 weeks. It is very important to do all the exercises continuously and make it a way of life.
Yoga:Yoga is one of the most used methods, providing both stretching, strengthening and relaxation with its unique postures, breathing work, relaxation methods.
Massage:It can be recommended in terms of providing muscle relaxation.
Diet:It is recommended that patients stay away from alcohol, cigarettes, caffeine and chocolate as they increase their complaints.
Providing Sleep Hygiene: Since Restless Legs Syndrome occurs at night, getting into bed and waiting for sleep makes it difficult for patients. For this reason, it is recommended to take a warm shower before sleeping, to go to bed at the same time, not to have electronic items such as television, telephone, tablet computer in the bedroom, not to drink beverages such as tea and coffee that may disturb sleep after 19 pm, instead to drink calming teas such as lemon balm and chamomile tea.