Restless Legs Syndrome (RLS) also known as Willis- Ekbom syndrome is described as a discomfort, creepy- crawly sensation, or an irresistible urge to move the legs arising from a profound feeling of ‘restlessness.’ These sensations only occur at rest and primarily at night. They are relieved by moving the legs and walking up and about. As the name implies they occur predominantly in the legs, however once treatment begins these abnormal sensations can spread to involve the arms due to augmentation. RLS occurs 2.5% to 15% in general population.
RLS can be familial (1/2 of the time, some have abnormality in chromosome 12) or secondary to another neurologic or medical illness such as PD or pregnancy. RLS can occur for the first time in pregnancy and more common in the second and third trimester. The symptoms undergo spontaneous remission after delivery. It can occur at any age and slightly more common in women than men.
As we know RLS is often seen in advance PD as a result of ‘wearing off’ and low dopamine doses (but who is too say is not due to low levels of Vitamin D in these patients?); however there is still much debate whether the two are linked or simply coexist. The debate comes down to the fact that RLS is a disorder of relative iron deficiency while iron levels are found to be high in the substancia nigra from oxidative stress. So even though they share similar treatment they do not appear to share a common brain defect.
Despite the fact that many neurologists and sleep specialists have believe that RLS is more common in PD, there is no data to support this claim to date. Three studies conducted outside of the US have shown controversial findings thus far; two studies stating increase RLS in PD compared to controls while a third one showed the opposite. Thus, uncertainty of risk of RLS in PD remains. Yet, if you suspect you have this go see an MDS because sleepless nights triggered by pacing the floor to relief symptoms is no life!
Chronic diseases – Parkinson’s disease, diabetes, kidney failure, iron deficiency, vitamin D deficiency, folate deficiency (which happens to be one of the risk factors for PD).
Medications: some types such as nausea pills, antipsychotics, some antidepressants, allergy medicines containing antihistamines can trigger these symptoms.
Pregnancy: In pregnancy the prevalence shoots up dramatically from 10% to 26%. This increase maybe due to an inherent iron and folate deficiency which are known risk factors for this condition.
Always TREAT UNDERLYING CONDITION FIRST!
- Reduce alcohol
- Exercise (especially yoga, tai-chi) 30- 60 minutes brisk walk or other type of exercise stretching and moving legs will improve symptoms and reduces night time fatigue, pain, restlessness, and help sleep better –this works best if followed by relaxation techniques like meditation.
- Massage your lower legs or ask someone to rub /massage for you on a daily basis ( some of my patients would put soap in their socks or underneath the sheets so each time they moved essentially getting a massage- I think there are better ways) you can also get some massage boots at Wal-mart or other retail stores.
- GET a Good night sleep – (sleep deprivation is a trigger)
- Avoid sitting in one position for too long (same thing that makes us stiff with PD)
- Medications- dopamine agonists – but I prefer as most movement disorder specialists a combined therapy plan to avoid augmentation and escalation of symptoms and increase drug dosage. Other medicines include klonopin, Neurontin, Lyrica, Sinemet ( this is preferred treatment in pregnancy if symptoms are severe and iron and folate normal). Elderly patients with RLS should be ware of dopamine agonists especially advanced PD patients who may already be predisposed or have beginning of dementia.