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November 28, 2012 at 10:07 AMComments: 0 Faves: 0

Leg Issues? It Could Be Restless Legs Syndrome

By Jeffrey VanWingen M.D. More Blogs by This Author

Sometimes, I see patients with vague complaints about their legs. They describe pain, cramping, burning, creepy-crawly sensation, and/or an uncontrollable need to move them about. This problem can affect sleep, which, in turn, affects productivity, energy, and overall happiness. Most are relieved when I diagnose their problem as restless leg syndrome (RLS).

The Picture of RLS

The following terms have been used to describe RLS:
 

  • Creeping-crawling
  • Pulling
  • Throbbing
  • Itching
  • Aching
  • Cramping
  • Gnawing
  • Burning

Sometimes patients sheepishly tell me that they cannot describe the sensation, as if they are wasting my time, and they have some unique affliction. Moving the legs about or rubbing the legs seems to temporarily satisfy the unpleasant sensation. Typically, the symptoms are more noticeable at night when still and in bed trying to get to sleep. The need to move the legs can make sleep difficult, not only for the person with the disorder, but also for anyone they share a bed with. An associated condition to RLS occurs when the limb movement occurs involuntarily during sleep and, less commonly, while awake. This is called Periodic Limb Movement Disorder (PMLD).  

Causes of RLS

RLS is believed to be linked to a deficiency in the neurohormone, dopamine. Among the many functions that dopamine modulates, it is instrumental in communications between the brain and muscles.Dopamine deficiency in a specific location deep in the brain is the basis of Parkinson's Disease which also causes problems with muscle control.

RLS may be acquired, seen more commonly with anemia due to iron deficiency and also pregnancy. Occasionally, it is manifested as a side effect of drugs, namely antidepressants and anti-nausea medications. RLS can be present at any age after late childhood, but is more common with increasing age. Familial tendencies imply a genetic component may be present. Most cases, however, have no definitive cause. 

Treatment

The first goal in treatment is to identify a potential cause. A test for anemia is simple and can be done with a finger poke in your doctor's office. With pregnancy, delivery is the inevitable cure. 

Pharmaceuticals are available for treatment. The most common and effective are agents that were first developed to treat Parkinson's. These give a boost in dopamine levels (the most common are Mirapex and Requip). A seizure drug called Neurontin has also been used less commonly.  These parmaceuticals should not be used during pregnancy. Narcotics, muscle relaxers, and sleep medications have also been used, but are not favored due to relative efficacy and potential for addiction. 

A home remedy for RLS can be found at your supermarket-- Indian tonic water (without the gin). While most don't, this tonic water still contains a small amount of quinine to give it that distinctive bitter taste.

Quinine

Quinine was the first effective treatment for malaria and had been used since the 17th century. But this was fraut with complications, namely because of a dangerous anemia that can occur when quinine is given to someone with a deficiency in a certain enzyme called G6PD. This deficiency is more common in certain ethnicities. As such, quinine is no longer used to treat malaria. 

The amount found in tonic water is very small, however, and it seems to offer benefit for RLS. I have some patients that swear by it. Homeopathic medications offer another effective alternative to pharmaceuticals. For instance, Hellolife offers the product Restulex, which I would recommend.

Restless Leg Syndrome often presents with a bewildering constellation of symptoms for those it affects. Patients are often relieved that I am able to put a name on their problem and offer treatment. If you suffer from the symptoms of RLS, I encourage you to see your doctor to explore a cause and trial one of the options in treatment.

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