RLS restless leg syndrome: symptoms, treatment, risk, tests

It affects 3-15% of the general population. RLS restless leg syndrome is a neurological disorder characterized by the appearance of an unpleasant sensation, difficult to describe, in the legs that appears when lying down or with rest, and that temporarily improves when moving them. Symptoms may appear or worsen with rest or at night when the patient is in bed and interfere with adequate rest.

Up to 80% of patients also associate involuntary leg movements during sleep and a smaller percentage also report this type of movement while awake, sitting, or lying down.

RLS usually affects the quality of sleep, causing drowsiness during the day, as well as anxiety and depression that have a significant impact on the quality of life of affected people.

In some cases, restless legs syndrome may be due to peripheral nerve injury, decreased iron accumulation, or increased uric acid in the blood. However, in most patients, the cause of restless legs syndrome is not evident, and it is defined as idiopathic. In the latter, there may be a genetic predisposition component, since at least a third of patients have a family history.

On the other hand, it is believed that the origin of this syndrome may be related to a decrease in dopamine, which is a brain neurotransmitter necessary for carrying out and coordinating movements.

• Nervous system specialties:
• Neurology
• Interventional neuro-radiology
• Neuropsychology
• Neuro-oncology
• Neuro-otology
• Epilepsy
• Neuro-ophthalmology
• Neuroimaging
• Neurosurgery
• Colunm surgery
• Pediatric Neurosurgery
• Neurophysiology
• Neuro-rehabilitation
• Neuro-pathology

Summary of rls

Restless legs syndrome (RLS) is a common sensorimotor disease that is generally associated with significant sleep disturbances and discomfort during wakefulness, which can potentially increase the risk of comorbidities. RLS is diagnosed when the following four criteria are met: the need for movement, usually in association with paresthesias; onset or exacerbation of symptoms during rest; relief of symptoms with movement, and symptoms that manifest with a circadian rhythm.

RLS can occur in adults and children and there is a genetic predisposition linked to an earlier presentation of the symptoms of the disease, generally before the age of 45. A variety of disorders can mimic RLS, making differential diagnosis important during patient evaluation.

Treatment of RLS includes iron supplementation, dopaminergic agents (DAs), opioids, benzodiazepines, and antiepileptic drugs. ADs are associated with a greater therapeutic effect and two drugs in this group are the only medications approved by the FDA for the treatment of RLS in the US. Iron supplementation in patients with RLS may be useful when it comes to patients with a deficiency of this mineral.

However, each of the therapeutic alternatives, including AD, must be considered in each particular case, depending on the severity of the symptoms and the profile of adverse effects. Greater identification and targeting of RLS, an often debilitating disorder, may be associated with improved quality of life and potential optimization of overall health for the many people who suffer from it.

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What is restless leg syndrome?

Restless legs syndrome, additionally referred to as Willis-Ekbom disease, motives disagreeable or uncomfortable sensations in the legs and an irresistible urge to go them. Symptoms usually occur in the late afternoon or early evening and are often more severe when the person is resting, such as when they are sitting or lying down.

They may also occur when you are inactive or sitting for long periods (for example, during a plane ride or at the movies). Because symptoms may worsen at night, it may be difficult to fall asleep or get back to sleep if you wake up. Walking or moving the legs usually relieves the discomfort, but the sensation often returns once the movement is stopped.

Restless legs syndrome is classified as a sleep disorder since symptoms are triggered by rest and when trying to sleep, and also as a movement disorder, since people are forced to move their legs to relieve the symptoms. However, it is best characterized as a neurological sensory disorder with symptoms that originate from the brain itself.

Restless legs syndrome is one of several disorders that cause exhaustion and daytime sleepiness. This can greatly affect mood, concentration, personal relationships, and work and school performance.

Many people with restless legs syndrome report that they are often unable to concentrate, have memory problems, or stop completing daily tasks. Untreated moderate to severe restless legs syndrome can cause an approximately 20 percent decrease in work productivity and may contribute to depression and anxiety. It can also make travel difficult.

It is estimated that in the United States, between 7 and 10 percent of the population may suffer from restless legs syndrome. It can begin at any age and occurs in both men and women, although women are more likely to suffer from it. Many severely affected people are middle-aged or older, and symptoms generally tend to be more frequent and last longer with age.

More than 80 percent of people with restless legs syndrome also have periodic movements of a limb while sleeping. This disorder, which occurs during sleep, is characterized by twitching or twitching of the leg (and sometimes the arm), usually lasting 15 to 40 seconds, but sometimes lasting all night. Although many people with restless legs syndrome also have periodic movements of a limb while sleeping, the majority who suffer from restless legs syndrome do not have restless legs syndrome.

Fortunately, many cases of restless legs syndrome can be treated with non-drug therapies and, if necessary, also with medications.

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At what age can restless legs syndrome start?

Restless legs syndrome (RLS) or Willis-Ekbom disease (WED) can begin at any age, although the average onset is 27.2 years. As age increases, the prevalence increases. Many patients can carry the disease from an early age. In fact, it can appear in babies, in the first months of life. In the case of children, the most common occurrence (63%) is between 5 and 7 years of age. The earlier it appears, the more related it usually is to hereditary burden. In pediatric ages, it affects men and women equally, unlike in adults, where it affects women twice as much.

Restless legs syndrome and insomnia

The desire to move your legs makes falling asleep and sleeping challenging for many people with RLS. According to one study, 88% of people 4 who suffer from it reported at least one sleep-related symptom. Symptoms usually appear shortly after going to bed at night, in which case patients kick, squirm, or massage their legs to decrease the sensation. In fact, some people are forced to get out of bed and walk or stretch.

As a result of the sleep disturbances associated with nervous legs syndrome, those affected often suffer from fatigue and daytime sleepiness. Lack of sleep is associated 5 with:

• Depression
• Anxiety
• Heart diseases
• Obesity

Concern about sleep is the main reason RLS patients seek medical care for their condition.

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Is there a higher risk of suffering from RLS during pregnancy?

Restless legs syndrome affects women twice as often as men and it has been proven that many develop this urgent need to move their extremities during pregnancy. Discomfort is usually more common in the third trimester and can affect more than 25% of pregnant women.

This adds to the other complications of pregnancy and can influence the quality of sleep and rest of pregnant women. In most cases, these RLS symptoms disappear once the woman has given birth or shortly after. Of course, in the event of a new pregnancy, the probability of suffering from restless legs again is higher.

Restless legs syndrome and periodic limb movement disorder

Most people 6 with RLS also have a disorder known as periodic limb movement disorder. This disorder involves repetitive bending or contraction of the limbs while we sleep at night.

It differs from RLS in that these movements are not accompanied by uncomfortable sensations and, since they occur while the patient sleeps, they are usually not aware of them. However, the movements associated with periodic limb movement disorder can wake the person up and, therefore, aggravate sleep problems in patients who also suffer from RLS.

Although most people with Willis-Ekbom disease have this disorder, many people do not have it.

• Depression
• Anxiety
• Heart diseases
• Obesity

Concern about sleep is the main reason RLS patients seek medical care for their condition.

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Can restless leg syndrome appear during pregnancy?

Restless legs disorder or syndrome appears with some severity in 2-3% of the population and affects both men and women. This can appear at any age, although it will be much more common after the fourth decade of life and yes, it can appear during pregnancy. In fact, in around 20% of cases, there are specific medical situations that could explain the appearance of the symptoms of this syndrome, such as anemia, kidney failure, some drugs, but also pregnancy.

In the latter case, it is best to go to a specialized center to be evaluated and treated appropriately. It will be the medical professional specialized in syndromes like this who determines the intensity of the symptoms you present and who also assess the diagnosis and treatment alternatives that best suit your illness. We know that this syndrome can affect all types of people from young children to older people.

However, pregnancy is one of the reasons that makes its appearance possible. And since pregnant women normally experience pain and a tingling sensation in their legs when they are sitting or sleeping, it can almost always be thought that they suffer from this symptom. It is best, therefore, to go to the doctor. In addition, it must also be taken into account that as the pregnancy progresses, the discomfort caused by restless legs syndrome will also increase.

It will be much worse in pregnant women who have iron anemia. To relieve this sensation during pregnancy, in addition to receiving treatment from the appropriate medical professional, the pregnant woman should:

*Lead an appropriate lifestyle that allows you to follow a healthy lifestyle

*Reduce your stress

*Follow healthy eating guidelines

*Exercise to improve your blood circulation

*Receive leg massages (if the doctor deems it appropriate)

*Practice yoga or shiatsu to promote relaxation.

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What vitamin deficiency causes restless leg syndrome?

Iron levels are closely related to the development of restless legs syndrome, so its control is indicated to prevent the pathology from worsening and to reduce its effects. Iron can be provided orally in tablets or liquid form for a variable period of time, on average three months. Also, in cases of especially low levels or chronic deficiency, it is possible to resort to the intravenous route.

Other deficiency states that may influence are low values ​​of Vitamin B12, folic acid, and vitamin D. The deficiency of the latter has been given special importance in recent times, due to its role in brain neurotransmission mechanisms involved in sleep regulation and, specifically, on restless legs.

If I have night cramps, can I have restless legs syndrome?

There are several imitators of restless legs syndrome that, however, have nothing to do with this disease despite the fact that their circumstantial effects are similar. Nocturnal leg cramps, which a high percentage of the population suffers from, can make someone who frequently suffers from them think that they are facing an RLS problem. It is not like this. Positional discomfort or peripheral polyneuropathies can also be confused. The same thing happens with lumbosacral radiculopathies. If you have questions, consult our specialists in neurophysiological pathologies.

How to sleep with restless legs syndrome?

The following methods may reduce symptoms in patients with mild or moderate RLS and can be combined with medication in RLS patients with severe symptoms.

Sleep hygiene:

Good sleep hygiene means maintaining a bedroom environment and daily routine that supports high-quality sleep. Avoiding alcohol and caffeine is especially important for patients with this syndrome, as these substances can worsen symptoms.

Exercise:

Since physical inactivity often triggers symptoms, exercise can be helpful. One study 8 revealed that patients with restless legs syndrome showed a 39% reduction in symptom severity after participating in an exercise program for six weeks, compared to an 8% symptom reduction in patients who did not practice sports.

Pneumatic pressotherapy:

Pneumatic compression devices stimulate blood flow to the legs by filling them with air to compress them. The researchers found that the device improved 9 symptoms of restless legs, quality of life, and fatigue after a month of daily use, compared to a control group.

Massages and hot baths:

In the literature on Willis-Ekbom disease, massages, and hot baths are strongly recommended to stimulate the legs. However, there is not much evidence to support the effectiveness of these methods at present.

Is neurofeedback effective in restless legs syndrome?

Restless legs syndrome ( RLS) is a condition that causes an out-of-control urge to move the legs, usually due to a feeling of discomfort. It usually happens in the afternoon or evening when you are sitting or lying down. The movement temporarily relieves the unpleasant sensation.

Neurofeedback is a scientifically based treatment of Neuroscience, which is produced by training the electrical activity of the brain, achieving balance. Neurofeedback acts on the brain, teaching it to self-regulate, reinforcing healthy brain activity, to change dysfunctional brain activity. Neurofeedback is safe, non-invasive has no side effects, and produces lasting changes in brain activity. Neurofeedback is an effective treatment for restless legs syndrome.

Restless legs syndrome, also known as Willis-Ekbom disease, can begin at any age and usually worsens with age. It can disrupt sleep, interfering with daily activities.

It is a neurological disorder characterized by the appearance of an annoying, non-painful sensation in the legs that requires mobilization.

In many cases, restless legs syndrome may be due to peripheral nerve injury, reduced iron accumulation, or increased uric acid in the blood.

However in most patients, a cause of restless legs syndrome is not evident, and it is defined as idiopathic. There may also be a genetic predisposition component since at least a third of patients have a family history.

On the other hand, it is believed that the origin of this syndrome may be related to a decrease in dopamine, which is a brain neurotransmitter necessary for carrying out and coordinating movements.

Self-care steps and lifestyle changes can help relieve symptoms. Medications also help many people with restless legs syndrome.

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Characteristics of RLS restless leg syndrome

*Symptoms are partially or completely relieved or improved with movement.

*There is a defined circadian rhythm, with symptoms appearing or worsening in the afternoon and especially at dusk.

*Night awakenings.

*Fragmented dream.

*Significant discomfort or functional impairment.

*Symptoms are worse with caffeine, neuroleptic medications, and antidepressants.

*Poor sleep quality.

*Daytime sleepiness.

*Sleep-wake circadian rhythm disorder with delayed sleep phases.

*Anxiety.

*Normal neurological examination.

*Urgent need to move the legs with a feeling of pain or discomfort.

*Symptoms appear and worsen with inactivity, sitting or lying down.

Idiopathic RLS:

It usually has a family history and is associated with genetic causes. Its onset is usually at an earlier age than secondary RLS and with a slow and progressive evolution.

The secondary SPI:

Restless legs syndrome appears associated with the following diseases:

• Diabetic neuropathy
• Rheumatoid arthritis
• Fibromyalgia
• Venous insufficiency
• Neuropathic processes: multiple sclerosis, polyneuropathies, myelopathies.
• Hypothyroidism
• Pregnancy: due to iron and folic acid deficiency
• Iron deficiency anemia
• Folate deficiency
• Kidney failure
• Obesity
• Advanced Parkinson’s disease
• spinal diseases

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Types of RLS restless leg syndrome

Depending On Their Origin, They Can Be Differentiated:

*Idiopathic RLS: without other associated disease. These cases have a high genetic component.

*Secondary, or comorbid RLS: those cases that associate iron deficiency, or that occur in the context of chronic kidney disease. In the context of chronic kidney disease or other pathologies, such as Parkinson’s Disease or Multiple Sclerosis, for example.

According To Its Evolution, The SPI Can Be Defined As:

Chronic: when symptoms occur two or more times/week, for at least a year.

Intermittent: if symptoms appear less than twice/week in the last year, having presented at least five periods with symptoms throughout life.

This last type is very common, these are patients who alternate periods with RLS symptoms and other periods free of symptoms. Summer is very often a period in which symptoms are more frequent and intense.

However, the causes and underlying alterations are similar in all cases of RLS. There is no clinical, analytical, or polysomnographic marker that can differentiate idiopathic from secondary RLS, or chronic from intermittent RLS.

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What are the most common signs and symptoms of restless legs syndrome?

People with this syndrome feel an irresistible urge to move, accompanied by uncomfortable sensations in the lower extremities that are totally different from what people who do not have this disorder experience. The sensations in the legs are often difficult to define. but they can be described as a stabbing pain, pulling, scratching, or as if something is walking or crawling up your legs. These sensations less frequently affect the arms and rarely the chest or head.

Although the sensations may occur on only one side of the body, they usually affect both sides. They can also alternate between one side and the other. The sensations vary in severity, from uncomfortable, to irritating, to painful.

Because moving the legs (or another affected part of the body) relieves discomfort, people with restless legs syndrome often keep their legs moving to minimize or avoid these sensations. They may pace from side to side, constantly move their legs while sitting, or toss and turn restlessly in bed.

A classic feature of restless legs syndrome is that symptoms worsen at night, with a defined symptom-free period in the early morning, allowing for more restful sleep at that time. Some people with this disorder have difficulty falling asleep and staying asleep. They may also notice worsening symptoms if their sleep is further reduced due to an event or activity.

The symptoms of restless legs syndrome can vary from day to day, both in severity and frequency and from person to person. In moderately severe cases, symptoms occur only once or twice a week, but often cause a significant delay in the onset of sleep, with some impairment in daily functioning. In severe cases, symptoms occur more than twice a week and cause bothersome interruption of sleep and disruption of daily functioning.

Sometimes people with restless legs syndrome can have remissions, that is, spontaneous improvements over a period of weeks or months before symptoms return, which usually occur in the early stages of the disorder. However, symptoms generally tend to become more severe over time.

People who have both restless legs syndrome and an associated medical problem tend to develop more severe symptoms quickly. On the other hand, those who have restless legs syndrome without any other related disease show a very slow evolution of the disorder, especially if its onset occurs at a young age. It may take many years before symptoms occur regularly.

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RLS restless leg syndrome symptoms

*The first symptom of the syndrome is that you suffer from sensations that are not pain but tingling, itching, or a feeling of deep tightness.

*The sensations worsen throughout the day, being greater at rest, whether sitting or in bed.

*The severity of the symptoms can vary depending on the day; it is also associated with lack of sleep, during pregnancy, alcohol or antidepressants, and caffeine consumption.

*There are frequent jerks in the legs, waking up the patient, which worsens the symptoms due to lack of sleep.

*You feel an uncontrollable need to move.

*You can partially or temporarily relieve symptoms by doing some activity such as walking or stretching.

*Symptoms worsen at night.

*The symptoms cannot be explained solely by another medical or behavioral condition.

Symptoms of RLS restless leg syndrome

Patients with RLS have an urgent need to move their legs, which appears when they are at rest (sitting or lying down), in the late afternoon, and at night, and improves with movement. This forces them to move their legs, walk, or continually change positions to alleviate these symptoms. In many cases, they also have discomfort in their legs, which may feel like tingling, pain, “restlessness,” or “discomfort,” although they are often difficult to verbalize.

At what time of day do symptoms appear?

RLS follows a circadian rhythm, so symptoms usually begin late in the afternoon, around 8-9 p.m., although as the disease progresses they may appear earlier and earlier, throughout the afternoon.

What impact do the symptoms have on the patient’s daily lives?

The symptoms frequently affect the daily life of the patients, since after 8-9 p.m. it is very difficult for them to remain seated, which has a negative impact on daily and social activities that are usually carried out at that time, such as going to the movies, theater, or dinner. If rest is prolonged, symptoms can also appear during the day, which is why RLS patients often have difficulty taking long trips.

Do RLS symptoms affect sleep?

Given the time of onset of symptoms, it is also very common that they prevent falling asleep, given the need to remain mobile, often requiring walking around the room, to relieve symptoms. Sleep maintenance is also frequently affected, since the symptoms generally persist until dawn, improving later, until they generally disappear when you wake up.

Is there any motor phenomenon associated with RLS?

Approximately 80% of patients with RLS have involuntary leg movements, called Periodic Leg Movements. These are present during wakefulness, during sleep, in the late afternoon, and during the night. They consist of flexion of the foot, knee, and hip, sequentially, as if it were a kick, which appears on both legs, alternately.

It is considered pathological when 15 or more of these movements occur per hour of sleep. Each one is accompanied by a brief awakening, which causes sleep to be very fragmented. The sleep of the bed partner can even be affected, as the kicks can become vigorous, reaching them, or causing them to wake up due to the frequent movements.

Diagnosis of RLS restless leg syndrome

The diagnosis of RLS is clinical, this means that it is made based on the symptoms that the patient reports during the consultation. The neurologist will ask the patient about the symptoms he perceives in his legs, during rest, and the maneuvers he performs to alleviate them. It is also of interest to collect information from the bed partner, who can report the involuntary movements that the patient presents during sleep, and which are usually described as kicking.

A diagnosis of RLS will be established if the five main diagnostic criteria are met, as defined in the RLS Diagnostic Criteria:

The presence of urgency to move the legs normally (although not always) is accompanied by unpleasant sensations and discomfort in the legs.

Symptoms appear or worsen during rest, such as lying down or sitting.

Symptoms relieved partially or completely by movement

Symptoms occur exclusively or worsen in the afternoon/night (or this was noted at the beginning of the disease).

The symptoms are not due to other diseases or habits, such as muscle pain, venous stasis, edema of the lower limbs, arthritis, cramps, postural discomfort, and habit of moving the feet when at rest (foot tapping or habitual tapping).

Diagnosis of restless rls restless leg syndrome in children:

Diagnosis in children is often difficult, since the youngest children may find it very difficult to verbalize their symptoms. The doctor will ask them to express them in their own words, adapted to their age. Thus, some children define it as “having ants running on their legs”, “feeling like kicking or kicking”… The use of drawings may be helpful, in which the child must color the area where they perceive the symptoms.

Differential Diagnosis of rls restless leg syndrome:

The Symptoms Of RLS Can Be Confused With Those Of Other Diseases, Mainly:

*Venous insufficiency: this also causes discomfort in the legs late in the day, but, unlike RLS, these symptoms improve with rest. Furthermore, these patients do not feel the need to move them, quite the contrary, they improve by keeping their legs at rest and elevated.

*Cramps: consist of a painful contraction of the muscles in the posterior compartment of the leg. They usually occur at night, and at rest, but do not associate the restlessness characteristic of RLS.

*Painful polyneuropathy and neuropathic pain: these are entities that cause intense, burning, burning pain that worsens at night. However, this pain does not worsen with rest and is not associated with the typical restlessness of RLS. On the other hand, patients with RLS do not usually present severe pain, as is the case with neuropathies. They generally describe the symptoms as discomfort in the legs, rather than pain.

*Postural discomfort: keeping your legs in the same position can cause discomfort, especially if you have osteoarthritis of the knees or hips. In this case, the discomfort will not only appear at night, and there will not be the restlessness characteristic of RLS.

These will be the symptoms of RLS, which will allow us to differentiate it from other diseases.

Complementary tests in rls restless leg syndrome

Nocturnal polysomnography:

Although it is not essential for the diagnosis, an overnight Polysomnogram (PSG) will frequently be requested. This consists of a sleep study, which is carried out in the hospital, and during which the patient’s brain, eye, respiratory, and muscle activity is recorded.

Performing the PSG will allow us to evaluate the impact of RLS symptoms on the conciliation and maintenance of sleep so that we will objectively quantify how long it takes the patient to fall asleep, due to RLS symptoms, and how many times they wake up or become alert. briefly during the night, due to the sleep fragmentation that accompanies RLS.

In PSG, the number of leg movements per hour of sleep is also measured. 80% of patients with RLS associate Periodic Leg Movements during sleep, and in this case they will present more than 15 movements/hour of sleep, sometimes these can be very numerous, even more than 100 movements/hour. With all this PSG data, we will have a clearer idea of ​​the impact of RLS on the patient’s sleep.

In addition, PSG can help us rule out the presence of other sleep disorders, such as Obstructive Sleep Apnea-Hypopnea Syndrome (OSAS), which consists of the presence of respiratory events during sleep, in which the respiratory tract collapses. air, which interrupts airflow. Many patients with RLS associate with OSAHS, and identifying it will allow us to treat it appropriately.

Blood analysis:

Once the diagnosis of RLS restless leg syndrome is established, a blood test will be performed, in which the blood count and the biochemical profile of iron-related parameters (iron, ferritin, transferrin, transferrin saturation index) will be analyzed. This way we will know if there is anemia, or iron deficiency, associated with RLS.

Brain neuroimaging:

Given that, as we have seen, brain iron content is altered in RLS, in recent years its study has been promoted through imaging tests. In this sense, the iron in the substantia nigra can be studied by performing a transcranial Doppler. This is a simple technique, but very dependent on the explorer, that is, it must be performed by an expert for its result to be reliable. Brain magnetic resonance imaging (MRI) can also be performed, preferably with a high field (3 Tesla).

The advantage of MRI is that it allows us to study iron in all brain structures, not just in the substantia nigra. In the coming years, when alterations in brain iron distribution become better known, the use of brain MRI will probably expand in the study of RLS.

How to stop restless leg syndrome immediately

First of all, we will begin by recommending non-pharmacological lifestyle modification measures that can improve RLS symptoms:

*Sleep hygiene: maintaining stable sleep schedules, every day of the week, both when going to bed and when getting up. Specifically, in patients with RLS, it is recommended that they go to bed a little later than usual, and reserve some tasks that require movement for those last hours of the day, thus, by not resting they will delay the onset of symptoms. They should, therefore, also get up a little later than usual.

*Physical exercise: it is advisable to do aerobic physical exercise at least 3 times/week.

*Avoid the consumption of stimulants and toxins: patients with RLS should not consume stimulant substances, such as caffeine, theine, or tobacco, as these will worsen the symptoms of RLS. Alcohol fragments sleep, so its consumption should also be avoided.

*Avoid drugs that can aggravate or cause RLS: all the patient’s medication should be reviewed, and all drugs that can worsen RLS symptoms should be removed, replacing them with others that do not have said side effects.

If, despite all these measures, RLS symptoms persist, and these negatively affect the patient’s sleep and quality of life, the start of pharmacological treatment is indicated. This happens in moderate or severe RLS cases, which make up 25% of RLS patients. There are various treatments available:

How to stop restless leg syndrome immediately with dopamine agonists

They were the first drugs approved for RLS, in 2006, and have been the most used until a few years ago. Among them, we find pramipexole, ropirinol, and rotigotine, which should be used at low doses (0.18mg-0.75mg pramipexole; 0.25mg-4mg ropirinol; 1-3mg rotigotine), in a single dose, at night. They are very effective in improving RLS symptoms and reducing periodic leg movements during sleep, but they do not improve sleep fragmentation.

Side effects of how to stop restless leg syndrome immediately with dopamine agonists

In general, they are well-tolerated drugs. Its most common side effects are nausea, headache, dizziness, edema in the legs, visual hallucinations, drowsiness, and impulse control disorder. When using low doses, these side effects are rare in patients with RLS.

Augmentation phenomenon caused by dopamine agonists

This is the great problem associated with treatment with these drugs, which favor the development of clinical worsening, known as “increase phenomenon”, or “augmentation” in English literature. It consists of the symptoms becoming more intense, and appearing earlier and earlier, throughout the afternoon, and even affecting the arms. Symptoms will improve by reducing doses of the drug.

This occurs in 8% of patients each year, so that, after 10 years, 80% of patients treated with dopamine agonists will worsen as a consequence of the treatment. For this reason, these drugs are no longer considered the first choice for the treatment of RLS, being reserved for the most serious cases, and trying to use the minimum doses and interrupt the treatment as soon as possible.

Treatment with antiepileptics for rls restless leg syndrome

Antiepileptics: especially those that reduce the release of glutamate, such as gabapentin and pregabalin. They are used at low doses (300-1200mg gabapentin; 25-300mg pregabalin), taken once at night. They are currently the treatment of choice since they are very effective in treating RLS symptoms, they also improve sleep fragmentation, and they do not cause long-term clinical worsening.

Side effects of antiepileptic drugs for rls

Its most frequent side effects are dizziness, drowsiness, and weight gain, although, when very low doses are used, they are infrequent, and they reverse quickly when the dose is reduced or treatment is suspended.

Opioid treatments for rls restless leg syndrome

They can be effective, and in recent years their use has been promoted in severe cases of RLS, to avoid using dopamine agonists. The most commonly used are tramadol, codeine, and methadone.

Risks associated with opioid use:

Its use is limited by the high risk of addiction and dependence. In addition, tramadol used chronically can also cause the appearance of the increase phenomenon, and worsen symptoms.

Iron for restless leg syndrome treatment

Iron treatment is recommended if ferritin levels are less than 50 µg/L.

*oral iron:

Classically, oral iron (oral ferrous sulfate) has been used, although this mode of administration has several limitations. Its absorption is very low, so the treatment must be very long, generally at least 2-3 months, and it is not possible to increase ferritin levels much.

*Side effects of oral iron:

Oral formulations frequently present digestive tolerance problems, causing both diarrhea and constipation, which makes treatment compliance difficult.

*intravenous iron for restless leg syndrome treatment

To promote therapeutic compliance and avoid the digestive problems of oral iron, intravenous iron formulations have begun to be used. In this way, ferritin levels can be quickly raised, and it is easier for iron to reach the brain in sufficient quantity to replace the deficit, which sometimes exists in some brain structures. We have several formulations of intravenous iron:

*Iron sucrose (200 mg × 5 doses or 500 mg × 2 doses)

*Low molecular weight iron dextran (975 mg in a single dose)

*Iron carboxymaltose (1 g in a single dose or 500 mg in two doses separated by 5 to 7 days): it is the most used

*Side effects of intravenous iron

The big problem with intravenous iron is that our body cannot dispose of free iron. By administering a large amount of iron, once the brain captures what it needs, a large part of the free iron will remain circulating in the blood and will end up being deposited, mainly in the liver and heart muscle, which can cause cirrhosis and heart failure. Furthermore, as we have seen, not all patients with RLS have cerebral iron deficiency, so perhaps intravenous iron will not be effective in all cases, and may even be harmful, in those cases described that show increased cerebral iron.

Restless leg syndrome drugs

Treatment with new that may be useful in restless leg syndrome drugs

Some drugs have been tested in cases that have not responded to the usual treatments. There are no long-term studies supporting their general use, but their mechanism of action suggests they may be useful.

*Perampanel: is an antiepileptic that regulates the release of glutamate. In doses of 2-4mg, it has been shown to be effective in patients with RLS, being well tolerated.

*Dipyridamole: is an antiplatelet agent, that increases adenosine levels, and therefore can improve RLS symptoms. It is used at doses of 100-400mg, it has been effective in some small studies, although the most recommended regimen in RLS is not clear.

Summary: The treatment of secondary restless legs syndrome should be directed at the cause that produces it, such as administering iron when a decrease in iron accumulation in the blood is evident.

The first-line treatment for idiopathic restless legs syndrome is dopaminergic drugs (ropirinol, rotigotine, pramipexole, or levodopa).

Due to its great effectiveness in controlling the symptoms of this entity, it is suggested that dopamine is involved in the appearance of this clinical condition.

Other alternatives may be certain antiepileptic drugs such as gabapentin, pregabalin, topiramate or carbamazepine. In the third line, opiate drugs such as oxycodone are recommended.

Medical treatment:

Today there is an effective medical treatment for this disease. We have non-pharmacological measures and pharmacological measures.

Non-pharmacological measures:

Maintain a  regular sleep schedule, engage in moderate physical exercise  (late afternoon), and reduce coffee, tobacco, and alcohol consumption, as these are known to worsen RLS discomfort.

Avoid certain drugs that can worsen symptoms (antihistamines, some sedatives that block dopamine, and certain antidepressants).

In the case of secondary RLS, treatment must be directed to the cause that produces it, for example, administering iron when a decrease in iron accumulations in the blood is evident.

Pharmacological measures:

Dopamine agonists:  these are the first-line drugs. They are used to treat Parkinson’s disease, and at lower doses, also RLS.

Antiepileptics:  These drugs are used to treat epilepsy and neuropathic pain, and have also been found to be useful for the treatment of RLS.

Risk factors of rls restless leg syndrome

Restless legs syndrome can occur at any age, even during childhood. The condition is more common with advancing age and is more common in women than in men.

Restless legs syndrome is usually not related to a serious underlying illness. However, it is sometimes accompanied by other conditions, such as the following:

Peripheral neuropathy: Sometimes this damage to the nerves in the hands and feet is due to chronic diseases, such as diabetes and alcoholism.

Lack of iron. Even without anemia, iron deficiency can cause or worsen restless legs syndrome. If you have a history of stomach or intestinal bleeding, have heavy menstrual periods, or donate blood frequently, you may be iron deficient.

Renal insufficiency: If you have kidney failure, you may also have iron deficiency, often with anemia. When the kidneys do not function properly, iron stores in the blood can decrease. This, along with other changes in body chemistry, can cause or worsen restless legs syndrome.

Spinal cord conditions. Injuries to the spinal cord as a result of damage or injury have been linked to restless legs syndrome. If you received anesthesia in the spinal cord, such as a spinal block, your risk of developing restless legs syndrome also increases.

Parkinson’s disease. People who have Parkinson’s disease and take certain medications called dopamine agonists have a higher risk of developing restless legs syndrome.

Restless Legs Syndrome and Cardiovascular Risk

For years, some studies have suggested that patients with RLS may be at greater risk of developing cardiovascular diseases, such as coronary heart attack and stroke. It was proposed that numerous awakenings during sleep cause an increase in blood pressure levels, repeatedly throughout the night, which would end up damaging the cardiovascular system.

However, it has not been proven that there is actually a causal relationship between RLS and cardiovascular risk. It seems more likely that this association is explained because patients with RLS have more cardiovascular risk factors than the general population since they more frequently have Hypertension, Hypercholesterolemia, or obesity. Therefore, they are people with several factors that favor cardiovascular diseases, although it has not been proven that RLS itself directly increases cardiovascular risk.

Childhood Restless Legs Syndrome and ADHD

RLS can coexist with Attention Deficit Hyperactivity Disorder. But you have to be careful, and not misinterpret the symptoms of RLS as attention deficit.

In children, the circadian pattern is not as strict as in adults, so they not only have symptoms at night but at any time of the day. In addition, the time of day when they spend the most hours sitting is at school, so children with RLS often have to move their legs while sitting in class, or even get up and walk or run, to relieve their symptoms. Based on this behavior, they can be mistakenly diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).

If they are also started on stimulant treatment for ADHD, such as amphetamine derivatives (methylphenidate), which worsen RLS symptoms, treatment failure and poor school performance are more than likely.

Therefore, in all children with hyperactive behaviors, we must always carefully question their sleeping habits and possible pathologies associated with sleep, since any child deprived of sleep, that is, who sleeps less than usual, and what needs, will show a tendency toward hyperactive behavior.

RLS restless leg syndrome natural treatment

As a rule, restless legs syndrome is usually treated with natural treatment:

Iron treatment. Especially if ferritin is below 50mcg/l.

*Avoid exciting substances as much as possible since there is a correlation with the nervous system. Among them, avoid coffee, tea, alcohol, tobacco, and energy drinks as they are highly exciting.

*There are also drugs that increase symptoms such as antihistamines, antipsychotics, or antidepressants. Better to avoid them if possible.

*Try to increase mental concentration through games, puzzles, video games, etc.

*Exercises designed to stretch the muscles and relax them.

*Improve blood circulation with baths alternating hot and cold water.

*Leg massages, the use of pressotherapy is also recommended to relax the muscles, increase venous return, and have a neurosedative effect.

Home remedies for rls restless leg syndrome

To relieve the symptoms of restless legs syndrome, we recommend a series of home remedies:

*Try baths and massages.  To relax the muscles.

*Apply cold or warm compresses. Alternatively, it reduces sensations in the extremities.

*Establish good sleep hygiene.  Lack of sleep is linked to the syndrome, so measures must be taken to try to sleep at least 7 hours in a relaxed manner.

*Do exercise.  This directly affects the muscles, relaxing them, but it is not advisable to do it too late or too intensely so as not to further activate the problem.

*Avoid exciting things. It may be advisable to avoid caffeine, chocolate, coffee, tea, and soft drinks containing caffeine for a while to see if it improves.

*You can also try using a vibrating pad on the back of your legs.

FAQs for rls restless leg syndrome

How is restless legs syndrome treated?

The goals of treatment (pharmacological or non-pharmacological) of Willis-Ekbom disease are to stabilize symptoms and improve sleep quality.

If you think you suffer from restless legs syndrome, you should see a sleep doctor for diagnosis and treatment. Although there is no specific test for restless legs syndrome, you will generally be asked to describe how you perceive your symptoms, when they tend to occur, how long they last, how severe they are, and what makes them worse or better (for example, moving your legs).

Your doctor may also ask if these symptoms cause pain or interfere with sleep. Polysomnography is often prescribed to rule out other underlying sleep disorders and explore the presence of RLS. In addition, other values ​​are usually analyzed to rule out any exacerbation of symptoms, such as iron deficiency anemia, kidney failure, or pregnancy.

How is restless legs syndrome diagnosed?

To diagnose restless legs syndrome, a series of tests are required, such as:

*A physical and neurological examination

*Blood tests to check for iron deficiency

*Any sleep study to rule out apneas

They are also taken into account

*The existence of periodic jerky movements of the legs during the night.

*The existence of a history of suffering from this syndrome in the family.

*A favorable response to dopamine.

Who does it affect the most?

It affects both men and women, appearing at any age. In 20% of cases, there are diseases that explain the appearance of symptoms, such as anemia, kidney failure, polyneuropathy, pregnancy, medication, etc.

Very important! Take into account whether there is a family predisposition, resistance to some drugs used to treat the disease, and the presence of periodic leg movements during sleep and sometimes while awake (they appear in more than 80% of patients).

The evolution is usually chronic and slowly progressive, altering sleep in the majority of subjects.

When should we consult the doctor?

Some people with restless legs syndrome never seek medical care because they believe they will not be taken seriously. But restless legs syndrome can interfere with sleep, cause daytime sleepiness, and affect our quality of life. Talk to your doctor or psychologist if you think you may have restless legs syndrome.

What are the signs and symptoms of restless legs syndrome?

The symptoms can vary from simple discomfort to total disability, characterized by an abnormal and unpleasant sensation in both legs, particularly at night, which produces spasms. Other symptoms are:

Intense desire to move your legs, especially after sitting or lying down for a long time.

The feeling of relief when walking, stretching, or shaking your legs.

• Sleeping problems.
• Electric shocks.
• Itch.
• Pain.
• Tingle.

Sometimes the symptoms disappear for a while and then appear again, sometimes with greater intensity.

Conclusions:

It consists of an unpleasant sensation in the legs, which appears when lying down or while resting, and which temporarily improves when moving them.

These symptoms, since they occur mainly at night when in bed, interfere with adequate rest.

Up to 80% of patients also associate involuntary leg movements during sleep and a smaller percentage also report this type of movement during bedtime, while sitting or lying down.

There are patients for whom restless legs syndrome is somewhat tolerable; For others, however, it means not being able to sleep well at night, not being able to sit down when the afternoon comes, and also feeling increasingly irritated.

It is therefore not anything. We are facing a problem that affects more than 10% of the population. A chronic disease has no cure, but there are different types of treatments.

If it interferes with your quality of life and your sleep, it is advisable to see a doctor or mental health professional for possible treatment.

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