It was just a normal night before going to bed for Pallavi, a 29-year-old woman working in an IT company in Hyderabad. But, as she went to bed, her legs start aching. She had the urge to get out of bed and move her legs.
She walked inside her room for some time and again tried to sleep. But the urge to move her feet and walk again did not let her.
She was awake the whole night and went to the office the next day tired and sleepy.
This was not the first time she experienced such an aching sensation in her leg.
For the past few years, she had been facing the same problem, but it increased in intensity only recently.
It included itching on her legs, and a pins-and-needles sensation that kept her awake the whole night.
She decided to visit a doctor and was asked to see a neurologist. After hearing a detailed history of her suffering, the neurologist diagnosed her with Restless Legs Syndrome (RLS).
What is Restless Legs Syndrome?
RLS is a neurological disorder characterised by an overwhelming urge to move the legs, often accompanied by uncomfortable sensations such as tingling, crawling, or aching.
“People have an uncomfortable sensation in their legs, as the name suggests. Sometimes, it will be difficult in describing what they are feeling,” Hyderabad’s Apollo Hospitals neurologist Dr Sudhir Kumar told South First.
“RLS is a symptom complex. There will be pain and can be of different varieties, discomfort, and tickling sensations. There will be difficulty below the knee, especially the calf area, and these symptoms are more in the night when the patient lies down. There will be a constant urge to walk around,” Hyderabad’s Yashoda Hospitals Consultant Neurologist Dr Mohan Krishna Narasimha Kumar Jonnalagadda told South First.
He added that the patient would massage their legs or walk around. “There will be a partial improvement for some time, but the urge to walk will return. That’s why it is called restless,” said Jonnalagadda.
Kumar explained that although RLS occurs mainly in the leg, but other parts of the body such as the hands and the chest can also be affected by it.
“Typically, the symptoms are worst when the body is at rest — during periods of inactivity like when driving for long distance, sitting and watching movies for a long time, or when you go to sleep. The symptoms tend to worsen, which causes sleep disturbance in patients and can lead to daytime fatigue,” he said.
Other symptoms of RLS may include:
- Difficulty falling asleep or staying asleep
- Daytime fatigue
- Difficulty concentrating
- Increased sensitivity to pain
The symptoms may vary in intensity and frequency, and could change over time.
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Cause of RLS
The exact cause of RLS is not known, but it is believed to be related to abnormalities in the brain’s dopamine system, which is involved in controlling muscle movement.
“It is based on the dopamine pathway. Dopamine is required for the proper and smooth movements of many muscles. With RLS, the pathway of dopamine becomes defective, and that is the underlying mechanism,” said Kumar.
“In most cases, the cause is not known. In a small number of patients, it is due to a genetic disorder or genetic defect that is believed to be the primary cause of RLS,” he added.
Other potential causes or risk factors include iron deficiency, certain medications, pregnancy, and certain medical conditions such as diabetes and peripheral neuropathy.
Certain groups of medications, such as those meant to control vomiting or treat some psychiatric disorders like antidepressants or antipsychotics, also cause RLS-like symptoms as side effects. These are the secondary cause of RLS.
“Many patients of Parkinson’s disease can get RLS. Also, the people who get RLS first can develop Parkinson’s disease,” said Kumar.
Jonnalagadda said that chronic diseases such as kidney failure, diabetes, and Parkinson’s disease may increase the risk of RLS.
“Also, RLS is common during pregnancy, particularly in the last trimester, but it usually disappears after delivery,” he added.
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Diagnosis of RLS
“The diagnosis of Restless Leg Syndrome is typically made based on the patient’s reported symptoms and a physical examination. It is symptom complex, it depends on what the patient tells, and the typical history of pains and discomfort in the legs,” said Jonnalagadda.
To be diagnosed with RLS, a person must experience these four symptoms:
- An urge to move the legs, often accompanied by uncomfortable sensations, that begins or worsens during periods of rest or inactivity.
- The urge to move or discomfort is partially or totally relieved by movement, such as walking or stretching.
- The symptoms are worse in the evening or at night.
- The symptoms are not caused by another medical or behavioural condition.
A healthcare professional may also perform tests, such as a blood test to check for iron levels, or nerve conduction studies, to rule out any other underlying medical conditions that may be causing similar symptoms.
“It’s important to note that the diagnosis of RLS is a clinical diagnosis and there is no definitive test for RLS. So, the diagnosis is based on patient’s history, physical examination, and the ruling out of other possible causes,” said Jonnalagadda.
He added that if a person was experiencing these symptoms for two or more days in a week, they needed to visit a neurologist. “If you have less than two per week, you can manage with a general physician,” said the doctor.
Jonnalagadda also said that the important part of the diagnosis was to identify the triggers, “because when you come to the management part, it is more to identify the causes, rather than treating the RLS symptomatically.”
“It’s worth noting that RLS is not always caused by a single factor and that a combination of different factors may contribute to the development of the disorder,” said Kumar.
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Treatment of RLS
The treatment for RLS can be managed with medications, lifestyle changes, and therapies.
The treatment would depend on the severity of the symptoms and the underlying cause, if any. The main goal of treatment is to reduce the frequency and severity of symptoms and improve sleep.
“The Initial treatment will be dependent on symptoms. In 90 percent of cases, a secondary cause is identified as the reason and the patient is treated accordingly,” said Jonnalagadda.
He added that iron deficiency, which has been linked to RLS iron supplements, will be given to the patients.
If a patient has RLS due to some medication, then it should be reduced or stopped. “We have to reduce the doses, or stop or modify the drug that can help those patients,” said Kumar.
He added that for the primary cause, one was anti-epileptic drugs and another one was dopaminergic drugs. “Both drugs, can help reduce symptoms of RLS,” he added.
The doctors also suggested that lifestyle changes — such as avoiding caffeine, alcohol, and tobacco, and maintaining a consistent sleep cycle — could help in managing RLS.
Some people may find relief with behavioural therapies, such as relaxation techniques or a warm bath before bed.
It’s worth noting that treatment for RLS may need to be adjusted over time as symptoms can change, and what may work for one person may not work for another.
Additionally, medications for RLS may have side effects, so it’s important to work closely with the doctor to find the treatment that is right for you.
It can affect any age group and any gender, but women are slightly more affected.