Restless Legs Syndrome

Whilst it might sound comical, restless leg syndrome is so much more than just a case of the fidgets. Causing sleep disturbance, making it dangerous to drive, and ruling out trips to the cinema, this condition is not to be underestimated. Here is Winchester GPs own Dr Stephanie with some facts and advice on this not-so-funny condition. 

Restless legs syndrome (RLS) is a neurological disorder characterized by an irresistible urge to move the legs, accompanied by uncomfortable feelings in them. Symptoms are typically worse in the evenings, and can disturb sleep. It’s a common condition, affecting about a tenth of the population, and it has another fancy name – Willis-Ekbom disease. It is not known exactly what causes RLS, but there is probably a problem (as yet unidentified) with the part of the sufferer’s brain which controls movements. RLS can sometimes be due to another medical condition, such as being low in iron or having poorly functioning kidneys, so your doctor may well want to carry out some tests to rule these out – however, the majority of cases don’t seem to have any underlying reason. Some medications, such as antidepressants, have RLS as a recognized side effect, and RLS is more common in pregnancy (one in five pregnant women will develop RLS, usually in the third trimester).

Patients suffering from RLS frequently describe an overwhelming urge to move their legs, and this urge is either due to, or accompanied by, unpleasant sensations in the legs. This urge is worse in the evenings and at night, is worse when the patient is resting, and is relieved by activity such as walking or stretching. People with RLS also often describe periodic jerky movements of their limbs (Periodic Limb Movements or PLM) happening whilst asleep or whilst falling asleep. It is important to for the doctor to be able to be confident that the symptoms do represent RLS, and not another disorder such as poor circulation in the legs, or leg cramps, so listening carefully to your account will be a crucial part of the assessment. There aren’t really any tests which can be done to confirm the diagnosis, and physical examination is usually completely normal. PLM can be confirmed during sleep studies in a specialist unit, if necessary.

RLS can really get in the way of everyday life
Some patients with RLS describe nothing more than a minor annoyance – they are the lucky ones. Other RLS patients really find that their lives are blighted by the condition – sleep disturbance at night, with the resultant daytime fatigue, is a major issue for lots of people; and many have had to give up jobs involving driving, or another activity where sleepiness is dangerous. Many RLS patients have given up trying to share a bed, because their twitching and sleeplessness drive their partner mad. Simple things that most of us take for granted, like a trip to the cinema, can be a nightmare for RLS sufferers, who would love to be able to sit back, relax and watch the movie but who are always wondering when they will need to get up and move in order to relieve their symptoms. Travelling long distances, especially at night, can be quite unbearable, and some patients have resorted to pacing up and down the aisle of a plane all the way through a night flight. RLS is no fun!

For those lucky patients, who are not too badly affected by RLS, simple explanation of the condition and reassurance that it is not dangerous, is enough. Self-help measures, such as stopping smoking and avoiding caffeine and alcohol, or massaging or applying heat pads to the legs, can also be useful. However, for patients who are losing significant sleep or who are otherwise distressed by their symptoms, there are a number of medical treatments. A short course of sleeping tablets can help get patients’ body clocks back on track, but they aren’t a long term option. Painkillers are helpful if people find the condition painful. Specific medications that can help significantly are ropinrole (this is also used in the treatment of Parkinson’s disease) and its close relatives; they are licensed for the treatment of RLS. Unlicensed treatments for RLS include pregabalin and gabapentin, which are often used to treat nerve pain. Together, you and your doctor should be able to find a treatment that works for you. Ultimately, some patients need to see a neurologist or sleep specialist.

***The Drugs and Therapeutics Bulletin has released today (14/04/2016) the news that another sort of medication, called Targinact (a mixture of oxycodone, a morphine-based painkiller, and naloxone, which counteracts some of the known side effects of such painkillers) is now able to be prescribed for RLS.***

If you have symptoms of RLS, or care for someone who does, and particularly if the symptoms are distressing or getting worse, then don’t suffer in silence – see your GP. The website is a mine of useful information, tips and support.