Restless legs syndrome: causes, symptoms and therapy

A strange set of symptoms that makes us unable to stop moving our legs.

What is necessary to be able to fall asleep? A sine qua non condition is to maintain good sleep hygiene. Taking care of routines in a way that favors sleepiness, avoiding lights or physical exercise, a suitable temperature, as much silence as we can get, and so on. We also need to feel relaxed and without physical discomfort, something that people with restless legs syndrome do not achieve.

These people, as soon as they rest their bodies, begin to feel a series of sensations from the trunk down that prevent them from sleeping and force them to move their legs to try to alleviate the discomfort. The discomfort goes away to return as soon as the person returns to rest.

Restless legs syndrome symptoms

Patients with restless legs syndrome, when they feel discomfort or tingling in their legs, have an urgent need to move them to stop the itching that interferes with rest, have an urgent need to move them in order to stop the itching that interferes with rest.. The type of sensations that someone with restless legs can feel is wide, from itching, very slight pains, vibrating tactile sensations, small pricks that move, etcetera.

On rare occasions it also occurs in the arms, chest or even the face. In addition, the sensations are usually indistinctly bilateral, i.e. they can occur on both sides of the body without any criteria. Some patients describe a certain alternation, as if when the sensations on one side disappear, they move to the other side of the body.

These sensations produce a lot of discomfort, and the longer the individual waits for them to go away the more irritated he or she becomes.. For this reason, these people, whenever they are at rest while sitting or lying down, keep their legs moving. In this way the discomfort disappears during the time they are in movement. However, the symptoms return when one wants to rest completely, entering a circle that is difficult to break.

Course of the disorder

One of the characteristics of restless legs syndrome is that it fluctuates. The discomfort does not occur the same throughout the day, but often disappears in the morning, only to return in the afternoon and evening. This is why people without restless legs syndrome have a lot of problems with both sleep reconciliation and sleep maintenance.

They are also not present every day. In most cases, which are mild, they appear once or twice a week, which is enough to disturb sleep and to seek professional help. In the most severe cases we speak of an occurrence of more than twice a week. Occasionally certain periods of remission occur in which the symptoms disappear completely for weeks or months. However, this is a characteristic of the earliest stages of the disease; the tendency of the symptoms is to worsen as time passes.

Causes

The first link in the causal chain is usually unknown.. Most cases are of uncertain origin, although there are instances of genetically transmitted restless legs syndrome. The current hypothesis is that the dopamine circuits of the basal ganglia may not be functioning properly. It appears that people who already have a dopaminergic disturbance in this location, as in the case of Parkinson's disease, have a significantly increased risk of developing restless legs.

There are some medical factors that have been linked to the onset of restless legs, but they do not explain all cases. These factors include:

• Iron deficiency
• Certain medications such as antiemetics
• Use of alcohol, nicotine, or caffeine.
• Being in the third trimester of pregnancy
• Neuropathy

Possible treatments

The management of the disease is symptomatic, there is no definitive cure.. However, symptomatic treatment alone is already very successful. For most cases, changes in the daily routine can already be very beneficial. Having a regular sleep schedule, exercising continuously in the mornings or bathing the legs in warm or very cold water in the evening may be enough to prevent the onset of those annoying tingling sensations.

There are also effective drugs such as anticonvulsants, which are almost the first line of pharmacological treatment due to their dopaminergic effects, or the dopaminergic agents themselves, which are administered in diseases where these circuits are dysfunctional, as in Parkinson's disease. However, prolonged use of this medication seems to worsen symptoms. This phenomenon stops as soon as the dopaminergic drug is withdrawn.

Other drugs such as opioids or benzodiazepines may be useful as they help to fall asleep, but they do not really have any effect on the presence of discomfort and tingling in the legs. In addition, the use of benzodiazepines is not recommended beyond the first two to three weeks, as they have great addictive potential. So perhaps they would only serve as a rescue on those days when, despite following all the advice and taking the appropriate medication, the discomfort remains.