Restless Leg Syndrome

Definition and causes

Restless legs syndrome (RLS) is a neurological disorder characterized by the presence of strange and unpleasant sensations in the legs in the sitting or lying position. These sensations, which are described by the patient as pricking, itching, tingling or burning, imply the urgent need to move the legs to relieve them.

It is estimated that in Spain there are more than 4 million people affected by this syndrome.

Generally, the syndrome affects the elderly population, with a higher incidence in women (60% of all cases).

RLS can appear associated with another disease (generally chronic diseases), being called secondary RLS or in isolation, which is known as idiopathic RLS. The diseases with which it can be associated include diabetes, chronic kidney failure, iron deficiency or rheumatoid arthritis.

The cause of this disease is unknown but it has been related to a genetic predisposition, low iron levels, chronic diseases and also to a decrease in a neurotransmitter called dopamine that is responsible for the coordination of movements.

How to identify it?

There is no specific test to establish the diagnosis. This is established based on the description of the symptoms made by the patient and the absence of other data suggestive of another disease. Other tests can be performed to establish the cause or associated disease, for example, a blood test.

The diagnosis is clinical, that is, based on symptoms. The presence of at least the following four criteria * is required:

• Need for movement of the legs, accompanied by annoying sensations.
• Motor restlessness in the lower extremities.
• Worsening of symptoms with rest and improvement with movement.
• Appearance or exacerbation of symptoms in the evening / night.

Other minor criteria that support the diagnosis include:

• Normal neurological examination (that is, other possible diseases are excluded).
• Difficulty initiating or maintaining sleep.
• In a sleep study: presence of periodic leg movements.
• Family history of the disease.

* Source: Allen et al, Sleep Medicine 2003, 4 (2): 101-119)

A very characteristic aspect of the disease is that the symptoms always appear in the evening, especially when the patient is at rest. One of the diagnostic tests that is always indicated is a Sleep Study (or polysomnography) that reveals the symptoms.

In addition, they are usually performed routinely, especially to rule out other diseases that may cause similar symptoms, a blood test and an electromyogram.

Where to go?

This type of disorder is evaluated and treated by the specialist in Neurology or in the Units-Centers for Sleep Disorders.

How can it be treated?

There is no curative treatment for the disease. The main objective of it is the relief of symptoms to improve the quality of life of the patient. On the other hand, the treatment must be adapted to the intensity of the symptoms since they can be highly variable.

Treatment options include supportive measures and daily habits along with drug treatment. Pharmacological treatments include benzodiazepines, opioids such as codeine, anticonvulsants such as carbamazepine, and gabapentin or rotigotine, a drug used to treat Parkinson's.

• It is advisable to follow a series of tips in daily routines to alleviate symptoms, which, although they do not cure, can help reduce their intensity.
• Try to follow a healthy and orderly life, with adequate sleep hygiene (respect and maintain the times for getting up and going to bed).
• Physical and rehabilitation therapies (such as yoga) can be useful to keep the body in shape and also improve the psychological and emotional component that the disease brings.
• Other simple remedies such as stretching, walking, exercising daily, keeping busy, and taking hot baths can also be helpful.
• It is recommended to avoid caffeine and avoid alcohol.
• Avoid drugs that can aggravate symptoms (such as some flu, calcium blockers or antidepressants, among others).