Restless Legs Syndrome

RLS (or Wittmaack-Ekbom´s syndrome) is poorly understood. It is a neurologic movement disorder that is often associated with a sleep complaint.
It may be described as uncontrollable urges to move the limbs in order to stop uncomfortable, painful or odd sensations in the body, most commonly in the legs. Moving the affected body part modulates the sensations, providing temporary relief.
The sensations and need to move may return immediately after ceasing movement, or at a later time. RLS may start at any age, including early childhood, and is a progressive disease for a certain portion of those afflicted, although the symptoms have disappeared permanently in some sufferers.
It is estimated that between 2 and 15% of the population may experience symptoms of RLS.
Direct adverse effects of RLS include discomfort, sleep disturbances and fatigue. These consequences have a secondary impact on functioning by affecting occupational activities, social activities and family life. Disrupted sleep and an inability to tolerate sedentary activies can lead to job loss, a compromised ability to enjoy life and problems with relationships.

Although the prevalence of RLS increases with age, it has a variable age of onset and can occur in children. In patients with severe RLS, 1/3 had their first symptom before 20 years of age, although the precise diagnosis of RLS was made much later.

In a 1945 publication titled „Restless Legs“, Swedish neurologist Karl-Axel Ekbom described the disease and presented eight cases used for his studies. Earlier studies were done by Thomas Willis (1685) and by Theodor Wittmaack in 17th century.

Types of RLS

• primary - idiopathic
• secondary

Causes
The cause of RLS, in most cases, is unknown. RLS is not caused by psychiatric factors or by stress but may contribute to or be exacerbated by these conditons.

• primary cause – 40% of cases are familial and inherited (the exact mode of inheritance is unknown)
• iron deficiency (below 50 ng per mL)
• neurologic lesions
• pregnancy
• uremia
• drugs – anti-nausea drugs, certain antihistamines (often in OTC cold medications), drugs used to treat depression, antipsychotic drugs
• after consumation of diet soda, alcohol, or caffeine
• hypoglycemia

Diagnosis
There is no single diagnostic test for RLS. Diagnosis is based primarily on the patient´s history. The primary care physician plays a central role in the diagnosis and management of RLS.
The most common symptoms of RLS are:

1. sleep profile – fatigue, sleepiness, confusion or difficulty concentrating
2. legs and arms – creeping, crawling or uncomfortable, difficult-to-describe feelings in the legs or arms; itching, burning, searing, tugging, aching, restless, painful

The physical examination is usually normal in patients with RLS and is performed to identify secondary causes and to rule out other disorders. The most important are neurologic and vascular examinations.
Also laboratory tests (serum ferritin level, serum chemistry to rule out uremia and diabetes) can identify possible causes of RLS.
Differential diagnosis may include nocturnal leg cramps, akathisia, peripheral neuropathy, or vascular disease.
Despite established standard criteria, the clinical diagnosis of RLS is often difficult to make.

Treatment
RLS is treatable condition. Treatment depends on severity, frequency, or regularity of symptoms; age of the patient; presence of pregnancy or comorbid illnesses; or renal failure.
It consists of:

• lifestyle changes (exercise, healthy diet, good sleep hygiene)
• medical approaches (dopamine agonists, opioids, benzodiazepines, anticonvulsants, iron, clonidine).