Restless Legs Syndrome: Causes, Symptoms And Therapy

A strange set of symptoms that makes us unable to stop moving our legs.

What is necessary to be able to fall asleep? A sine qua non condition is to maintain good sleep hygiene. Take care of routines in a way that favors drowsiness, avoid lights or physical exercise, a suitable temperature, all the silence that we can obtain, and so on. We also need to feel relaxed and free from physical discomfort, something that people with restless leg syndrome do not.

These people, as soon as the body rests, they begin to feel a series of sensations from the trunk down that prevents them from sleeping and forces them to move their legs to try to relieve the discomfort. The discomforts leave to return at the moment in which the person is at rest again.

Symptoms of restless legs syndrome

Patients with restless legs syndrome, when feeling discomfort or tingling in their legs, have the urgent need to move them to end the itching that interferes with rest. The type of sensations that someone with restless legs can feel is wide, from itching, very minor pain, vibrating tactile sensations, small pinches that are moving, and so on.

On rare occasions it also occurs on the arms, chest or even on the face. In addition, the sensations are usually bilateral, that is, they can occur on both sides of the body without any type of criteria. Some patients describe a certain alternation, as if when the sensations on one side disappear they move to the other side of the body.

These sensations are very uncomfortable, and the longer the individual waits for them to leave, the more irritated he becomes. This is why these people, whenever they are sitting or lying down, keep their legs moving. In this way the discomfort disappears during the time they are in motion. However, the symptoms return when one wants to rest completely, entering a circle that is difficult to break.

Course of the disorder

One of the characteristics of restless legs syndrome is that it fluctuates. The discomfort does not appear the same throughout the day, but often disappears in the morning to reappear in the afternoon and evening. Because of this, people without restless leg syndrome have many problems with both falling asleep and maintaining sleep.

They are also not present every day. In most cases, which are mild, they appear once or twice a week, which is enough to disturb sleep and seek professional help. In the most severe cases, there is talk of an occurrence of more than twice a week. Sometimes certain periods of remission occur in which the symptoms disappear completely over weeks or months. However this is a characteristic of the earliest stages of the disease; the tendency of symptoms is to get worse as time passes.

Causes

The first link in the causal chain is usually unknown. Most cases have an uncertain origin, although there are instances of genetically transmitted restless leg syndrome. The current hypothesis considers the possibility that the dopamine circuits  of the basal ganglia are not working properly. Apparently those people who already have a dopaminergic alteration in this place, as in the case  of Parkinson’s disease, have a significantly higher risk of suffering from restless legs.

There are some medical factors that have been linked to the appearance of restless legs, but they do not explain all the cases. These factors include:

  • Iron deficiency
  • Certain medications such as antiemetics
  • Use of alcohol, nicotine, or caffeine
  • Being in the third trimester of pregnancy
  • Neuropathy

Possible treatments

Management of the disease is symptomatic, there is no definitive cure. However, symptomatic treatment is already very successful on its own. For most of the cases changes in the daily routine can already be very beneficial. Having a regular sleep schedule, exercising continuously in the morning, or bathing your legs in hot or very cold water at night can be enough to prevent those annoying tickles from occurring.

There are also effective drugs such as anticonvulsants, which are almost the first line of pharmacological treatment due to their dopaminergic effects, or the dopaminergic agents themselves that are administered in diseases where these circuits are dysfunctional, such as Parkinson’s disease. However, long-term use of this medication seems to make symptoms worse. This phenomenon stops as soon as the dopaminergic drug is withdrawn.

Other drugs such as opioids or benzodiazepines may be helpful as they help you fall asleep, but they don’t really have any effect on the presence of discomfort and tingling in the legs. In addition, the use of benzodiazepines is not recommended beyond the first two or three weeks, as they have great addictive potential. So perhaps they would only serve as a rescue in those days when despite following all the advice and taking the proper medication, the discomfort remains.

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