With this term, in English Restless Legs Syndrome (RLS), we mean a disorder characterized by the urgent and unmanageable need to move the legs . Unpleasant and difficult to define sensations are associated (sensations similar to a cramp, tingling, electric shock or discomfort). With movement the discomfort diminishes or disappears.
In some situations, the upper limbs may also be affected. The unpleasant sensations of restless legs , and consequently the difficulty in staying still, occur in the state of rest and inactivity. It follows that the disorder is manifested mainly in the evening or at night with impairment of sleep in all its phases. L ‘ insomnia protracted may in turn compromise the psychic sphere, in attentional and emotional component, and the state of health in general.
Fashion diagnosis?
Although it is a picture that has only recently been receiving attention in the medical world and not, the first descriptions of the disorder date back to the second half of the 1600s by the English doctor Sir Thomas Willis. The formulation of more detailed diagnostic criteria took place in 1945 and is due to the Swedish neurologist Karl Axel Ekbom, who gave the syndrome the name we use today. The diagnostic criteria were validated in 1995 by the International Restless Legs Study Group and revised in 2002.
How common is restless legs syndrome?
In the literature we find a prevalence in adulthood ranging between 5 and 15%. In pediatric age, the estimates concern 5-10% of children. These data are very vague and unreliable since this diagnosis is not easily identified. The prevalences are likely to be higher.
Recent studies have found that, of a group of subjects who presented with symptoms of restless legs , 45% had not received an initial correct diagnosis.
Two forms of the disorder have been observed. One with onset before age 45, which tends to be hereditary, can present as early as childhood and usually persists throughout life. Over time, symptoms gradually worsen and tend to occur more and more frequently. In the milder forms, you can also have long periods free from symptoms. Another form has a later onset, usually after age 45, and does not appear to have large hereditary components. In the latter case, restless legs syndrome tends to appear suddenly and the symptoms tend to remain stable, showing no pejorative tendencies.
Restless Leg Symptoms
The syndrome is characterized by several symptoms including the following four characteristic ones:
- Overwhelming need to move the legs often, but not always, associated with unpleasant sensations in the lower limbs. In severe cases, the upper limbs are also involved.
- Symptoms are accentuated in moments of inactivity (eg when sitting or lying in bed).
- These are relieved by movement, especially walking, which helps reduce unpleasant sensations.
- Symptoms often appear or are more intense in the evening or at night.
It is essential to fully manifest this symptomatic constellation in order to formulate the diagnosis. The name of the syndrome derives from the urgent need to move the legs in order to find relief. The actions that usually relieve the symptoms are: walking, shaking the legs, stretching them, flexing them or rubbing them.
The unpleasant sensation is felt in the deep area of the legs; discomfort rarely starts from the superficial site. Both limbs are affected even if sometimes the prevalent involvement of a single leg is observed.
Differential diagnosis
The symptoms reported by people with restless legs syndrome are qualitatively distinguishable from generic cramps. The latter often involve limited muscle groups which tend to tense during contracture; moreover, the cramp pain is much more intense and is relieved only by stretching the affected muscle.
Other pathologies that can simulate the symptoms of restless legs syndrome are discomfort associated with arthritic pictures or peripheral arterial disease. However, in these last two situations, movement worsens the symptoms rather than improves them.
Another disorder that can be differentially diagnosed is Periodic Leg Movement Disorder (PLMS). It is characterized by repeated contractions or spasms of the lower or upper limbs during sleep, with a frequency every 20-40 seconds. These patients usually complain of sleep fragmentation with excessive daytime sleepiness and are usually unaware of the movements and brief awakenings that follow. They also do not have abnormal sensations in the limbs.
How does it occur in children?
Symptoms of restless legs syndrome in children may manifest themselves differently from what is seen in adults. There is a component of hyperactivity that sometimes poses problems of differential diagnosis with other disorders appearing in childhood. 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 “waves” on their legs, or as if they have little animals 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.
Possible causes of restless legs
Numerous studies focus on the genetic component which appears to be high. In fact, in cases with onset in childhood it is observed that between 70 and 80% of children affected by the disorder have at least one close family member (parent or grandparent) who meets the criteria for making the same diagnosis. Even in cases where the pathology becomes evident in adulthood, there is an estimated familiarity between 40 and 50%.
The syndrome can be triggered by numerous disorders, pathologies and drug therapies. The presence of defects in the use of iron by the body or an iron deficiency has been hypothesized . The link between iron and restless legs syndrome is explained by the fact that the brain uses iron in the processes of synthesis of dopamine, a neurotransmitter involved in multiple mechanisms including the control of movements.
There are several pathologies that can modify the levels of iron present including renal failure, Parkinson’s disease, diabetes mellitus, rheumatoid arthritis.
Even pregnancy can certain iron deficiency. Symptoms usually occur in the third trimester of gestation and disappear after childbirth, although in some women the disorder may persist even after, albeit in a lessened form. There are pictures that can increase the risk of suffering from this syndrome through a mechanism that sees a compromise of the nerves, eg diabetes.
Among the drugs and other substances we find alcohol and tobacco, some therapies used in the treatment of nausea, some antidepressants and antipsychotics , antihistamines, calcium channel blockers used in the treatment of arterial hypertension. In drug-induced pictures, the symptoms improve until they disappear after the suspension of the substance taken.
Prognosis of the syndrome
The prognosis is variable: over time, the symptoms of restless legs syndrome may improve until they disappear completely for up to a few months. In other situations, they can get worse over time. In forms secondary to other pathologies or pharmacological therapies, the picture improves by treating the underlying disorder or by suspending the responsible therapies.
The outcome of the disorder also depends on the patient’s willingness to change their lifestyle, such as avoiding alcohol and tobacco or being able to keep blood sugar levels within limits.
Restless leg care
While not currently having specific pharmacological therapies, there are several molecules capable of attenuating the symptoms until they are completely reduced. It is often necessary to change several molecules and adjust the doses in order to obtain the most effective result. These drugs usually work by optimizing the functioning of the nerve pathways that see dopamine as a neurotransmitter.
As we have already said above, in the forms of restless legs syndrome due to other organic diseases, the primary disorder must be treated first. Typically these drug therapies in addition to lifestyle modifications lead to appreciable improvements.
Among the activities to be recommended for relieving symptoms are:
- to walk
- do stretching
- take a hot or cold bath
- rub the affected limb
- use hot water or ice bottle on the affected limb
- engaging in activities that engage the mind.
In situations that require a stay in a sitting position, such as a cinema or means of transport, it is preferable to choose a place that allows you to easily change the position of the lower limbs. Practicing regular physical activity can be a helping factor, in addition to the above. In fact, patients report that as daytime activity increases, symptoms decrease.
Living with restless game syndrome can be stressful . For this reason, it is important for the patient and family to be able to ask for the right emotional support and to keep the motivation for treatment high, since this picture is often chronic. The behavioral psychotherapy can be a great help to motivate yourself to follow drug therapies over time, to build and maintain a more suitable way of life, to learn relaxation techniques to be employed in sleep disruption and to prevent the disturbance will become the fulcrum of one’s attention.
