Most of the time it is impossible to identify the cause of this syndrome - then it is called 'idiopathic RLS'.
Frequently, several members of one family may be involved, which points to a genetic origin. However, the responsible gene has not yet been identified. It seems that a certain disturbance in the dopamine metabolism of the brain may play an important role. In other RLS patients, deficiencies of iron, magnesium, folic acid or Vitamin B12 have been identified. Chronic renal failure can be found in association with the typical RLS complaints. Diseases which can cause a so-called secondary RLS include diabetes mellitus, rheumatic joint disease or Parkinson disease. Certain medications can also, at times, be responsible for this painful restlessness of the legs.
 

Symptoms:
 
Symptoms such as a tingling sensation, itching or burning feeling in both legs appear typically after an extended period of rest. At this time, the urge to move around can become so strong that it cannot be controlled anymore. It is usually between midnight and 2 o'clock in the morning when the legs become 'hyperactive'. The patient tries to relieve the discomfort by walking around or walking up and down a staircase. Muscle twitching or other involuntary movements of the legs are often seen. Occasionally, the symptoms can even extend to the arms. The RLS patient experiences a restless night with no sleep
or not enough sleep leading to daily fatigue, disturbances in concentration and a decline in performance.
 
RLS symptoms are independent of age and thus can also occur in children; however, the full range of symptoms is usually only seen in patients of advanced age. The course of the disease can vary, the symptoms may increase over time and occasionally decrease, but they rarely ever disappear completely.
 

Diagnosis:
 
The patients' description of their symptoms can lead an experienced physician to the correct diagnosis.
But, although RLS occurs fairly frequently and has been identified more than 300 years ago, it is often misdiagnosed. Many patients run from one doctor to another until the correct diagnosis has been established. Since the involuntary movements occur predominantly during sleep, following are methods that help determine RLS.
 
Polysomnographic studies (brain wave studies during sleep), in which electrodes are attached to the head and legs, identify muscle activity that occurs during the lighter stages of sleep and is often associated with eye movements. In addition, changes of breathing patterns are registered concomitantly through a special belt around the chest and can differentiate RLS from other causes of sleeplessness (such as the sleep-apnea-syndrome).
 
The physician has to rule out any iron, magnesium or folic acid deficiency. Should a deficiency be responsible for the syndrome, replenishing the deficient blood components can often cause a complete recovery from this type of RLS. Unfortunately, a deficiency syndrome is not often the cause of RLS.
 
Of course, one has to establish whether the disease is primary or secondary due to other causes. In the latter case, it is often sufficient to treat the underlying disease and the RLS symptoms will disappear.
 

Therapy:
 
Before starting with a drug treatment, it is worthwhile trying to improve the symptoms by changing your lifestyle. Warm and cold showers to the legs can bring relief and massaging the afflicted extremities with a vibrator can be helpful. It is also recommended that one perform light bodily activity before going to bed or, if RLS causes sleep disturbances, to go to bed late and sleep well into the day.
 
If 'changing your lifestyle' does not lessen the discomfort, the physician can prescribe a series of drugs which all show rather good results. Among the first-line drugs are drugs that influence the dopamine metabolism, such as levodopa or carbidopa. This medication can decrease the frequency of involuntary leg movements and improve sleep. Another advantage of this drug is that it can be taken as needed, e.g. ahead of airline trips of long duration, a visit to the theater and the like. Some side effects of this drug such as dry mouth, nausea and headaches can, however, occur.
 
Pergolide is another drug that works on the dopamine metabolism. Recent trials showed that the typical RLS symptoms disappeared almost completely and that the duration of sleep increased considerably. In particular, patients with severe idiopathic RLS responded much better to pergolide than to levodopa. While side effects such as nausea, constipation and headaches can occur as well, they rarely forced the patient to stop taking the drug.
 
Strong painkillers like opioids containing codeine or central acting drugs such as tramadol hydrochloride can also improve leg symptoms and sleep pattern. However, drugs containing codeine or drugs like benzodiazepines (e.g. Clonazepam) may not be given to patients who show signs of the sleep-apnea-syndrome. The latter class of drugs should only be prescribed for a short period of time, since longer use can create dependency.
 
While the aforementioned drugs provide relief, none can yet lead to a complete response to the disease process and its complete disappearance. If the patient stops taking the drugs, the symptoms will reappear.
 

Prevention:
 
A way of life that could prevent the appearance of RLS is not known. However, a balanced diet with sufficient intake of minerals and vitamins can help to prevent at least the kind of RLS that is caused by those deficiencies.
 
Alcohol, nicotine and coffee can increase the RLS symptoms and sometimes even initiate the first bout of RLS, while on the other hand, a cup of coffee can help some patients and even decrease their pain. The fashionable drug 'Ecstasy' is known to cause painful restlessness of the legs in some users.

 

                                                                                        

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DISCLAIMER: The above article is only intended to provide general information regarding this topic. It is not intended and does NOT replace the need to consult a medical or other professional person, if you have or believe to have this disease/disorder. While the article was researched, written and reviewed by medical professionals, and Medicine for Africa, its staff and publisher made every effort to assure accuracy and correctness, it does not claim to be complete, correct or to reflect the very latest stand of medical/scientific knowledge in the disease’s/syndrome’s pathology, diagnostic and/or therapeutic development. Medicine for Africa, its founder, management, staff, writers, reviewers or publishers may NOT be made responsible or legally bound to any information provided above, and cannot be held liable to any conclusions or decisions the reader may draw after reading this article. The reader is explicitly advised to consult a licensed physician and to present his/her specific situation before making any health related decisions.