Creepy-Crawly, Crazy Legs - Restless Leg Syndrome

• Restless leg syndrome (RLS) is a common neurological disorder that may affect 10 percent of the population, but has long been ignored or misdiagnosed. People with restless leg syndrome have an uncontrollable urge to move their legs, along with uncomfortable or painful feelings in the legs or calves (and sometimes the arms or other parts of the body). The troubling sensations are described as creepy-crawly, crazy legs, pins and needles, like soda bubbling in the veins, or like an electric current. Restless leg syndrome affects both men and women and can start at any age, but is more common and more severe among older people.
  
  For most people, the symptoms are worse at night and they find it difficult to fall or stay asleep, resulting in exhaustion and fatigue during the day. Sleep disturbances are often the reason that people suffering from restless leg syndrome seek a doctor's help. The problem also becomes obvious or worse during periods of rest or inactivity, for example while watching a movie, riding in a car, or sitting in an airplane. Walking, pacing, stretching or generally moving around provides some relief.
  
  Many people with restless leg syndrome also experience periodic limb movements in sleep (PLMS), which are involuntary jerking or bending leg movements that occur every 10 to 60 seconds, most often during periods of lighter sleep.
  
  DIAGNOSIS
  
  Diagnosis of restless leg syndrome is usually based on the patient's description of symptoms, in addition to the person's medical and family history and a thorough physical examination. There is no single laboratory diagnostic test for restless leg syndrome, but blood tests or nerve or muscle studies may be performed to rule out other conditions such as anemia, diabetes or kidney failure, or to support a diagnosis of restless leg syndrome. Overnight sleep studies may be recommended to measure leg activity (periodic limb movements) during sleep.
  
  In most cases, the exact cause of restless leg syndrome is unknown (idiopathic), but it is frequently associated with an underlying condition such as iron deficiency, diabetes, anemia, or peripheral neuropathy, or a side effect of certain over-the-counter and prescription medications. Some women develop restless leg syndrome during the last several months of pregnancy, but the syndrome usually disappears after delivery. There may be a genetic component to some forms of restless leg syndrome.
  
  TREATMENT
  
  Treating an underlying condition, such as iron deficiency, diabetes or peripheral neuropathy, can often relieve many symptoms associated with restless leg syndrome.
  
  For people with mild-to-moderate cases of restless leg syndrome, eliminating or reducing the use of caffeine, tobacco, and alcohol can help alleviate some symptoms. Other ways to find some relief include moderate exercise, stretching, hot baths, massaging the legs, hot or cold packs, developing a consistent sleep routine, or relaxation techniques such as yoga or meditation.
  
  In some cases of restless leg syndrome, a variety of medications are used to control symptoms. The most commonly used drugs fall into four categories:
  
  1.) Dopaminergic agents are considered the initial treatment of choice and have been shown to reduce restless leg syndrome symptoms and nighttime leg movements. Although these drugs are used to treat Parkinson's disease, restless leg syndrome is not a form of Parkinson's and people with restless leg syndrome are at no greater risk of developing the disease than those without it. Dopaminergic drugs that are used for restless leg syndrome include carbidopa-levodopa (Sinemet®/Restix®), pramipexole (Mirapex®) and ropinirole (Requip®). Side effects can include nausea, vomiting, dizziness, and drowsiness. Requip®, first approved in 1997 to treat Parkinson's, was recently approved by the US Food and Drug Administration to treat moderate-to-severe restless leg syndrome.
  
  2.) Benzodiazepines such as diazepam (Valium®) and clonazepam (Klonopin®) are sedatives that improve sleep quality, but do not completely alleviate symptoms. These drugs can cause daytime sleepiness and should not be used by people with sleep apnea.
  
  3.) Anticonvulsants such as gabapentin (Neurontin®) can help reduce pain and the creepy-crawly sensations of restless leg syndrome. These drugs may be useful when the patient also suffers from peripheral neuropathy. Dizziness, fatigue and sleepiness are among the possible side effects.
  
  4.) Opioids (narcotic medications) such as codeine are prescribed to treat more severe symptoms and are useful for relieving pain. Possible side effects include dizziness, nausea, vomiting and the risk of addiction.
  
  Unfortunately, no one medication is effective for everyone with restless leg syndrome. What may help one patient may actually worsen the symptoms for another. In addition, some medications taken on a regular basis may lose their effect, making it necessary to change medications periodically.