Martha Jefferson HealthWise--August 13th

An estimated 12 million Americans are affected by restless leg syndrome, a condition that causes uncomfortable, irritating and even painful sensations in the legs. Left untreated, restless leg syndrome can cause exhaustion and a reduced quality of life. Joining us for Martha Jefferson Healthwise today is sleep specialist and neurologist Dr. Chris Winter to talk about restless leg syndrome.

RLS is a neurological disorder which causes uncomfortable and even painful sensations in the legs, especially when sitting or lying down, and is accompanied by an irresistible urge to move about. These sensations are usually felt deep inside the leg, between the knee and ankle, and most often affect both sides of the body.

RLS is caused by a reduction in brain dopamine, which is also seen in Parkinson’s disease. Brain dopamine is produced in the substantia nigra (Image 1). In Parkinson’s disease the cells that produce brain dopamine are lost causing a global reduction in brain dopamine. In RLS, the cells that produce dopamine are normal (Image 2), but the rhythm of dopamine release is upset and the typical dip that most individuals have in their dopamine cycle is exaggerated. This dip commonly occurs around 10pm which is when many individuals begin to feel their symptoms. This is primary RLS and it is the most common form.

Some cases of RLS have been linked to specific condition such as kidney failure, diabetes, low iron or Parkinson's disease. Some pregnant women experience RLS, especially in their last trimester. Certain medications such as antinausea, antipsychotic drugs and some cold and allergy medications-may aggravate symptoms. This group comprises what is referred to as secondary RLS or RLS with a known and/or treatable cause.

RLS can start at any age, even as early as infancy, although most patients who are severely affected are middle-aged or older. In addition, the severity of the disorder seems to increase with age. Older patients may experience symptoms more frequently and for longer periods of time. Women seem to be slightly more affected than men. In children, it is thought that growing pains may be an early manifestation of the condition. About 50 percent of people have a family history of the disorder.

One of the most difficult aspects of the condition is that lying down and trying to relax activates the symptoms. As a result, most people with RLS have difficulty falling asleep and staying asleep. Many patients will seek help for the condition because of insomnia or poor sleep and less often will describe difficulty with RLS. Left untreated, the condition causes exhaustion and daytime fatigue. Many people with RLS report that their job, personal relations, and activities of daily living are strongly affected as a result of their exhaustion. They are often unable to concentrate, have impaired memory, or fail to accomplish daily tasks.

RLS can often be controlled by finding possible underlying disorders, such as low iron, peripheral neuropathy or diabetes, and properly treating those conditions. For those with mild to moderate symptoms, many physicians suggest decreased use of caffeine, alcohol, and tobacco. Taking supplements to correct deficiencies in iron, folate, and magnesium, and maintaining a regular sleep pattern may also reduce symptoms. There are two FDA approved medications for the treatment of mild to moderate RLS that are very effective.

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