Restless Legs Syndrome (RLS), now called Willis-Ekbom Disease (WED), is a sleep disorder in which a person experiences unpleasant sensations in the legs (or any other part of their body) described as creeping, crawling, tingling, pulling, or painful.
It most commonly affects the legs, but can affect the arms, torso, head and even phantom limbs. Moving the affected body part modulates the sensations, providing temporary relief. WED/RLS sensations range from pain or an aching in the muscles, to "an itch you can't scratch", an unpleasant "tickle that won't stop", or even a "crawling" feeling. The sensations typically begin or intensify during quiet wakefulness, such as when relaxing, reading, studying, or trying to sleep. Additionally, most individuals with WED/RLS suffer from periodic limb movement disorder (limbs jerking during sleep), which is an objective physiologic marker of the disorder and is associated with sleep disruption.
The sensations usually occur in the calf area but may be felt anywhere from the thigh to the ankle. One or both legs may be affected; for some people, the sensations are also felt in the arms. These sensations occur when the person with WED/RLS lies down or sits for prolonged periods of time, such as at a desk, riding in a car, or watching a movie. People with WED/RLS describe an irresistible urge to move the legs when the sensations occur. Usually, moving the legs, walking, rubbing or massaging the legs, or doing knee bends can bring relief, at least briefly.
WED/RLS symptoms worsen during periods of relaxation and decreased activity. WED/RLS symptoms also tend to follow a set daily cycle, with the evening and night hours being more troublesome for WED/RLS sufferers than the morning hours.
People with WED/RLS may find it difficult to relax and fall asleep because of their strong urge to walk or do other activities to relieve the sensations in their legs. Persons with WED/RLS often sleep best toward the end of the night or during the morning hours. Because of less sleep at night, people with WED/RLS may feel sleepy during the day on an occasional or regular basis. The severity of symptoms varies from night to night and over the years as well.
For some individuals, there may be periods when WED/RLS does not cause problems, but the symptoms usually return. Other people may experience severe symptoms daily.
Many people with WED/RLS also have a related sleep disorder called Periodic Limb Movement Disorder (PLMD). PLMD is characterized by involuntary jerking or bending leg movements during sleep that typically occur every 10 to 60 seconds. Some people may experience hundreds of such movements per night, which can wake them, disturb their sleep, and awaken bed partners. People who have WED/RLS and PLMD have trouble both falling asleep and staying asleep and may experience extreme sleepiness during the day.
As a result of problems both in sleeping and while awake, people with WED/RLS may have difficulties with their job, social life, and recreational activities.
Reasons for the name change:
- Eliminates incorrect descriptors. The condition often involves parts of the body other than legs.
- Promotes cross-cultural ease of use.
- Responds to trivialization of the disease and humorous treatment in the media.
- Acknowledges the first known description by Sir Thomas Willis in 1672 and the first detailed clinical description by Dr. Karl Axel Ekbom in 1945.
Common characteristics of Restless Legs Syndrome and common symptoms include:
* Unpleasant sensations in the legs (sometimes the arms as well), often described as creeping, crawling, tingling, pulling, or painful;
* Leg sensations are relieved by walking, stretching, knee bends, massage, or hot or cold baths;
* Leg discomfort occurs when lying down or sitting for prolonged periods of time;
* The symptoms are worse in the evening and during the night.
Other possible characteristics include:
* Involuntary leg (and occasionally arm) movements while asleep;
* Difficulty falling asleep or staying asleep;
* Sleepiness or fatigue during the daytime;
* Cause of the leg discomfort not detected by medical tests;
* Family members with similar symptoms.
WED/RLS occurs in both sexes. Symptoms can begin any time, but are usually more common and more severe among older people. Young people who experience symptoms of WED/RLS are sometimes thought to have "growing pains" or may be considered "hyperactive" because they cannot easily sit still in school. How Is WED/RLS Diagnosed?
There is no laboratory test that can make a diagnosis of WED/RLS and, when someone with WED/RLS goes to see a doctor, there is usually nothing abnormal the doctor can see or detect on examination. Diagnosis therefore depends on what a person describes to the doctor. The history usually includes a description of the typical leg sensations that lead to an urge to move the legs or walk. These sensations are noted to worsen when the legs are at rest, for example, when sitting or lying down and during the evening and night.
The person with WED/RLS may complain about trouble sleeping or daytime sleepiness. In some cases, the bed partner will complain about the person's leg movements and jerking during the night.
To help make a diagnosis, the doctor may ask about all current and past medical problems, family history, and current medications. A complete physical and neurological exam may help identify other conditions that may be associated with RLS, such as nerve damage (neuropathy or a pinched nerve) or abnormalities in the blood vessels. Basic laboratory tests may be done to assess general health and to rule out anemia. Further studies depend on initial findings.
In some cases, a doctor may suggest an overnight sleep study to determine whether PLMD or other sleep problems are present.
Please note that I'm presenting this PRIMARY/SECONDARY RLS information to you so that you understand the language.
I personally don't believe that RLS comes from two different sources. It comes from ONE source, which is inflammation. The fact that other conditions are intertwined with RLS is because the other conditions (as talked about in Dr. Weinstock's study) are also inflammation based. In other words, one condition did not cause the other. Both are caused by the presence of chronic inflammation.
If you have primary (idiopathic) WED/RLS - where the condition develops naturally, without an obvious cause - treatment will mainly be aimed at relieving your symptoms. In cases of mild to moderate RLS, the symptoms can often be improved by making some simple lifestyle changes. In more severe cases, a combination of lifestyle changes and medication may be recommended.
In most cases, WED/RLS is an idiopathic CNS disorder. Such idiopathic disease can be familial in 25-75% of cases. In the familial cases, it appears to follow a pattern of autosomal dominant or recessive inheritance. Progressive decrease in age at onset with subsequent generations (ie, genetic anticipation) has been described in some families. Patients with familial WED/RLS tend to have an earlier age at onset (less than 45 years) and slower progression. Psychiatric factors, stress, and fatigue can exacerbate symptoms of RLS.
According the the scientific community, if you have secondary Restless Legs Syndrome - where the condition is caused by another underlying health condition - diagnosing and treating that condition will help to alleviate your symptoms of RLS. For example, if your WED/RLS is caused by iron deficiency anaemia, taking iron tablets will increase the number of red blood cells in your blood, which may help to reduce your WED/RLS symptoms. In cases where pregnancy is the cause of RLS, the symptoms will usually disappear within four weeks following the birth.
WED/RLS can develop as a result of certain conditions or factors, particularly iron deficiency and peripheral neuropathy. These 2 conditions should be excluded before WED/RLS is labeled as primary. Because of the prevalence of these conditions in the general population, their association with WED/RLS needs to be interpreted with caution.
There are many theories (and I stress that they are theories) about how Restless Legs come about.
Included are folate or magnesium deficiency, amyloidosis, diabetes mellitus, lumbosacral radiculopathy, Lyme disease, monoclonal gammopathy of undetermined significance, rheumatoid arthritis, Sjogren syndrome, uremia, or vitamin B-12 deficiency. Women can be affected by WED/RLS during pregnancy, and the syndrome usually subsides within a few weeks after delivery. It affects 25-40% of pregnant women. WED/RLS also occurs in as many as 25-50% of patients who have end-stage renal disease and find their symptoms particularly bothersome during hemodialysis. One study found that hyperphosphatemia, anxiety, and a great degree of emotion-oriented coping with stress were independently related to the presence of WED/RLS in patients with uremia who were taking hemodialysis therapy.
Certain medications can also cause RLS. Antidopaminergic medications (such as neuroleptics), diphenhydramine, selective serotonin reuptake inhibitors (SSRIs), alcohol, caffeine, lithium, and beta-blockers have been known to cause or exacerbate the symptoms of RLS.
The pathogenesis of WED/RLS seems to involve more than one mechanism, which leads to restless legs as the final common pathway.
Restless Legs Syndrome National Institute for Health and Clinical Excellence: NHS Clinical Knowledge Summaries, www.cks.nhs.uk/patient_information_leaflet/restless_leg_syndrome/treatment
Ali M Bozorg, MD, "Restless Legs Syndrome." WebMD (Aug 19, 2011). emedicine.medscape.com/article/1188327-overview
In most people with RLS, no new medical problem will be discovered during the physical exam or on any tests, except the sleep study, which will detect PLMD if present.
In mild cases of RLS, some people find that activities such as taking a hot bath, massaging the legs, using a heating pad or ice pack, exercising, and eliminating caffeine help alleviate symptoms. In more severe cases, medications are prescribed to control symptoms. Unfortunately, no one drug is effective for everyone with RLS. Individuals respond differently to medications based on the severity of symptoms, other medical conditions, and other medications being taken. A medication that is initially found to be effective may lose its effectiveness with nightly use; thus, it may be necessary to alternate between different categories of medication in order to keep symptoms under control.
Although many different drugs may help RLS, those most commonly used are found in the following three categories:
* Benzodiazepines are central nervous system depressants that do not fully suppress WED/RLS sensations or leg movements, but allow patients to obtain more sleep despite these problems. Some drugs in this group may result in daytime drowsiness. People with sleep apnea should not use benzodiazepines.
* Dopaminergic agents are drugs used to treat Parkinson's disease and are also effective for many people with WED/RLS and PLMD. These medications have been shown to reduce WED/RLS symptoms and nighttime leg movements.
* Opioids are pain killing and relaxing drugs that can suppress WED/RLS and PLMD in some people. These medications can sometimes help people with severe, unrelenting symptoms.
Although there is some potential for benzodiazepines and opioids to become habit forming, this usually does not occur with the dosages given to most WED/RLS patients.
Most of the preceeding material was prepared by the National Center on Sleep Disorders Research (NCSDR), part of the National Heart, Lung, and Blood Institutes of Health. It appears here courtesy of the NCSDR. This article was originally published in 1996, and does not reflect developments in the treatment of restless leg syndrome since 1996. It is intended as an introduction and overview for those interested in learning about restless leg syndrome www.nhlbi.nih.gov/about
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