Restless Leg Syndrome Part 2
I hope you managed to read part 1 yesterday and you are ready for part 2. I am going to cover the causes and treatment of Restless Leg Syndrome.
Causes of Restless Leg Syndrome (RLS)
In many cases , the exact case of this syndrome is not known. Research has shown that it runs in families and in these cases , symptoms usually occur before the age of 40.
There is evidence to suggest that RLS is related to a problem with part of the brain called basal ganglia which uses a chemical (neurotransmitter ) called dopamine to help control muscle activity and movement.
DOPAMINE acts as a messenger between the brain and nervous system to help the brain regulate and co-ordinate movement. If nerve cells become damaged, the amount of dopamine in the brain is reduced, which causes muscle spasms and involuntary movements.
Dopamine levels naturally fall towards the end of the day, which may explain why the symptoms of RLS are often worse in the evening and during the night.
Underlying health condition causing RLS
RLS can sometimes occur as a complication of another health condition, or it can be the result of another health-related factor. This is known as secondary restless legs syndrome.
One can develop secondary RLS if:
1- One has iron deficiency because low levels of iron in blood can lead to a fall in dopamine resulting in RLS.
2- One has long-term condition such as chronic kidney disease , Diabetes, Parkinson’s disease, Rheumatoid arthritis , underactive thyroid gland or fibromyalgia.
3- One is pregnant ( like my patient ) , particularly from 27 weeks until birth and in most cases symptoms disappear within 4 weeks of giving birth.
Triggers of RLS
There are certain lifestyle habits or medications that make the symptoms of RLS worse. Medications include:
Some antidepressants, antipsychotics, lithium, high blood pressure medication called calcium channel blockers, some antihistamines, metoclopramide .
Other possible triggers are : excessive smoking , caffeine intake , alcohol misuse, being overweight or obese, being under a lot of stress and lack of exercise.
So how is this syndrome treated?
Firstly it’s good to try and found out the possible cause of the RLS and treat that cause , for example if it is caused by iron deficiency , then taking iron supplements should sort out the problem. If it’s associated with pregnancy, it usually disappears on its own within four weeks of the birth.
Mild RLS not linked to an underlying health condition can be managed by lifestyle changes.
So what are the lifestyle changes that would help?
The following can ease the symptoms of RLS :
-avoiding caffeine , tobacco and alcohol in the evening
-taking regular exercise but avoid exercise near bedtime
-maintaining good sleep habit such as going to bed and getting up at the same time everyday as well as avoiding napping during the day.
– avoiding medicines ( mentioned above) that trigger the symptoms of RLS
What can you do during the episode of RLS?
During an episode of restless legs syndrome, the following measures may help relieve your symptoms:
massaging your legs
taking a hot bath in the evening
applying a hot or cold compress to your leg muscles
doing activities that distract your mind, such as reading or watching television
Relaxing exercises such as yoga or tai chi
Walking and stretching
What can one do when the above is not working ?
Medication can be used as a last resort. Dopamine agonists ( increase level of Dopamine) may be recommended if one is experiencing frequent symptoms of restless legs syndrome. They work by increasing dopamine levels, which are often low.
Dopamine agonists that may be recommended include:
rotigotine skin patch
My favourite that I prescribe a lot is pramipexole and the results so far are pleasing.
These medications can occasionally make one feel sleepy, so one should be cautious when driving or using tools or machinery after taking them.
A word of caution in using these drugs as there is a less common side effect called Impulse control disorder (ICD) associated with the use of these drugs. People with ICD are unable to resist the urge to do something harmful to themselves or others. For example, this could be an addiction to alcohol ,drugs, gambling, shopping, or sex (hypersexuality). However, the urges associated with ICD will subside once treatment with the dopamine agonist is stopped.
This article was compiled by Dr Brighton Chireka who is a GP in Folkestone Kent UK. You can contact him on firstname.lastname@example.org
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions.