Restless leg syndrome

Restless leg syndromeRestless leg syndrome appears at rest and at night when people lie down to rest. During that time, they get an unpleasant feeling in the legs. It is compounded by kicking while sleeping which can be disturbing to the patient and his/her partner in bed alike. In Europe, restless leg syndrome affects around 10% of people; women are affected twice as commonly as men. The main cause of this syndrome has yet to be discovered. Some research indicates dopamine and iron deficiency in the brain.

Why should you have your DNA analysed for predisposition to the restless leg syndrome?

One half of all cases are characterized by a known family history. In the rest of the cases, genetic predisposition also plays a role. Three genes are known to cause an increased predisposition to the restless leg syndrome. These genes are included in our analysis. Knowing your genetic background reduces the need for, often unnecessary, additional check-ups.

How is restless leg syndrome prevented or treated?

Individuals suffering from this syndrome should avoid stimulants, tobacco and alcohol, and should undertake moderate physical activity which controls the symptoms. The drugs are used only for the most resistant cases with very frequent symptoms. The medications stimulate dopamine receptors in the brain.

More detailed description about restless legs syndrome

The unpleasant feelings or the need to move one's legs can partially or completely be alleviated by activities such as walking or leg stretching, at least for the duration of the activity. 80% of RLS-affected individuals are also affected by the periodic limb movement syndrome (PLMS) during sleep. The patients are woken up by it and their partners also suffer disturbed sleep. RLS-induced insomnia results in extreme daytime fatigue and sleepiness, negatively affecting the quality of life of the affected individuals. In most severe cases, the symptoms are already present during the day. In such cases, the affected individuals experience great problems while travelling, e.g. during long hours of sitting in a car or plane. Furthermore, they are also hindered in other social activities - for instance, they are unable to go to the cinema or theatre where they have to sit and rest.

In Caucasian population, the incidence of the restless leg syndrome is around 10%. Asians, on the other hand, are much more rarely afflicted by it. RLS can start already in childhood years; with advancing age, the number of sufferers increases and reaches its peak in the 7th decade. Women are affected twice as commonly as men. 50% of RLS sufferers have a positive family history.

Restless leg syndrome development

The cause of RLS is unknown in most cases. Research shows an association with dopaminergic and opiate systems, iron deficiency in the brain as well as the wake-sleep cycle. This is a case of idiopathic or primary restless leg syndrome. Rarer secondary forms also exist. The possible causes of the secondary form involve neurological diseases (polyneuropathy, radiculopathy); metabolic disorders (iron deficiency, diabetes mellitus, lack of B vitamins, thyroid dysfunction); rheumatologic diseases (rheumatoid arthritis, fibromyalgia); medications and stimulants (antidepressants, neuroleptic agents, coffee, alcohol). Restless leg syndrome often appears during pregnancy. It affects 30% of pregnant women in their last trimester, often disappearing after giving birth.

Prevention

Often times, a minor lifestyle change is sufficient to make the restless leg symptoms tolerable without medication. We recommend you to avoid using stimulants containing caffeine and alcohol. Moderate physical activity during the day is recommended but excessive activity can worsen the symptoms. Often what helps is to go to bed later than usual when the evening symptoms have already more or less subsided.

Therapy

If preventive measures do not suffice, we recommend the patient to consult a physician who shall rule out other possible causes that may exacerbate or lead to the symptoms of restless leg syndrome.

Research has shown that a lack of iron may be connected with an increased risk for the appearance of restless leg syndrome. These people may also be anaemic due to the lack of iron, but not necessarily. In any case, in all people who suffer from restless leg syndrome, it is necessary to determine the iron level in the body by measuring ferritin in the blood; ferritin is the body's storage protein for iron. Iron supplementation can in this case successfully treat restless leg syndrome.

Kidney failure patients may also experience restless leg syndrome. Although the syndrome typically appears only in the late phase of kidney disease, it is useful to check kidney function with simple lab tests in all patients with restless leg syndrome.

It is often wrongly believed that varicose veins are the cause of the patient's complaints when the real culprit is restless leg syndrome that can easily be treated. Common diseases that may produce similar symptoms or are connected with the appearance of the restless leg syndrome include diabetes mellitus, Parkinson's disease and polyneuropathy (i.e. malfunctioning of the nerves). Certain medications, especially certain antidepressants and anti-allergy drugs, may worsen restless leg syndrome.

Interestingly, one third of pregnant women also experience restless legs in their last trimester. The reason for this has not been completely elucidated yet. The symptoms tend to disappear after giving birth but may reappear later in life.

When all possible causes have been ruled out and diseases that might lead to the syndrome or exacerbate it, determined, treatment with dopamine agonist drugs is fairly successful. However, such treatment is only required in about one third of patients with very severe restless leg syndrome.