Restless Legs Syndrome (also called RLS from Restless Legs Syndrome ) is a neurological disorder characterized by an irrepressible urge to move the legs, often associated with a feeling of discomfort, pain and / or tingling in the lower limbs.
Symptoms are generally worsened by rest and sedentary lifestyle and increase in the evening hours compared to the daytime hours.
The sensation of discomfort experienced by those who suffer from it improves by moving the legs. This excess movement, made to seek relief when getting ready to sleep, often causes initial insomnia and difficulty falling asleep.
Restless legs syndrome is one of the most frequent causes of secondary insomnia in adulthood.
The daytime consequences of the disorder are: excessive sleepiness, increased tiredness and fatigue, irritability, distraction problems and so on.
How common is the syndrome?
Literature reports a prevalence of this disorder in adulthood between 5 and 15%, while in pediatric age restless legs syndrome affects between 5-10% of children. In fact, not being easily diagnosed, this prevalence could be even higher.
A recent study found that in a group of subjects who presented with symptoms of restless legs syndrome, 45% had not received a correct diagnosis.
What are the causes?
The genetic component is very high: in cases of onset of the disorder in pediatric age, between 70 and 80% of children have at least one close relative (parents / grandparents) who meets the criteria for the diagnosis of restless legs syndrome .
Even in cases where the disease occurs in adulthood, there is a very high familiarity, between 40-50%.
Compared to the general population, in any case, the most affected by this disorder seem to be women of childbearing age and the elderly.
Several researches (also carried out post mortem with techniques that exploit neuroimaging) have highlighted the central role of the dopaminergic system in the pathogenesis of this disorder.
Iron deficiency also seems to favor the onset of restless legs syndrome: in fact, low levels of ferritin in the blood are associated with an increase in the severity of the disorder.
What are the risk factors?
- The pregnancy. A large number of women during pregnancy experience more or less severe symptoms of this disorder. The reason for this is not well known, although it is hypothesized that it is due to a hormonal issue, and / or to the iron deficiency that many women experience during pregnancy.
- Low iron levels
- Poor health. The percentage of those with restless legs syndrome is higher among people with poor health, both physically and mentally
- The age. The percentage of people with this disorder increases by 1% between the ages of 20-29 and by 4% after the age of 70
- Parkinson’s Disorder. Although the relationship between these two disorders is unclear, people with Parkinson’s suffer more from restless legs syndrome than the general population.
Finally, there is an uncertain relationship with socio-economic status. In some countries it has been reported that restless legs syndrome is more present in people with a lower socio-economic status, but the hypothesis is that this relationship is mediated by greater alcohol consumption in the weaker groups.
How does it occur in children?
One of the main problems in developmental age is that children cannot actually explain symptoms clearly. Children, more often than not, say they feel like “undines” on their legs, or as if “there were little ants” walking on their legs.
What parents observe, however, is the child’s inability to sit still even when sitting.
In childhood, this disorder also determines a series of diurnal consequences, mainly at the behavioral level, such as inattention and hyperactivity.
Parents therefore ask for psychological counseling both because the child has problems falling asleep and because he is inattentive at school or hyperactive.
Recent literature has linked inattention deficit / hyperactivity syndrome (ADHD) with restless legs syndrome.
Several hypotheses have been advanced about the nature of this relationship, including the presence of a common dopaminergic deficiency. On a clinical level, the treatment of restless legs syndrome brings numerous benefits also on a behavioral level.
How is the diagnosis made?
Diagnosis requires a clinical evaluation based on the patient’s history and aimed at investigating any familiarity with the disorder.
The diagnostic criteria are as follows:
- Irrepressible need to move the legs, accompanied by sensations of discomfort, tingling, and / or pain.
- Symptoms improve with moving the lower limbs
- Symptoms get worse with rest
- Symptoms worsen in the evening hours
Instrumental examination (polysomnography) is indicated in cases where there is no certainty of the diagnosis.
What does the treatment consist of?
First, the patient must be instructed about the rules for adequate sleep hygiene. Above all, it is necessary to avoid the consumption of alcohol, caffeine, nicotine and substantial foods just before bedtime and to schedule regular bedtime times. Aerobic activity is also an element that favors an improvement in symptoms, therefore, regular physical activity is strongly recommended, as long as it does not take place in the evening.
Pharmacological treatment can consist in the intake of: Dopamine agonists (pramipexole), Benzodiazepines (used as adjuvant therapy to support sleep maintenance), Iron (in the event that a deficiency of this element is demonstrated in the patient).
In children it is always preferable to start behavioral treatment first and to resort to drugs only after an effective therapeutic failure.
