Restless Legs Syndrome Essay Paper

Restless Legs Syndrome Essay Paper

Restless legs syndrome (RLS) may happen because of mental or physical problems, or it may be an adverse effect of some medications. It is also known as Willis-Ekbom disease.

Restless legs syndrome may be classed as mild or severe, depending on the frequency and severity of the symptoms, how well the symptoms can be relieved by moving around, and how much disturbance they cause.Restless Legs Syndrome Essay Paper

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It affects up to 1 in 10 people at some time during their life.

The vast majority of cases of RLS resolve on their own over time or once simple lifestyle changes have been made.

Fast facts on restless legs syndrome:
RLS can is classed as either primary or secondary.
Many people can treat the issues at home.
The condition is often caused by a combination of mental and physical factors.
Women are more likely to be affected with RLS during pregnancy.
Symptoms
womans legs on bed
RLS is classified as a sleep disorder.
Symptoms can occur when a person is awake in a confined space, such as an airplane seat or at the cinema.

As RLS leads to difficulty falling asleep and staying asleep, the person may be tired during the day. This can have an impact on learning, work, concentration, and routine tasks and activities.

Lack of sleep can eventually lead to mood swings, irritability, depression, an undermined immune system, and other physical and health problems.

What does it feel like?
A person with RLS has a strange and unpleasant sensation in the legs, and sometimes the arms, and a strong urge to move them. People have described these feelings as:

aching
burning
crawling
creeping
similar to electric shocks
itching
tugging
tingling
The only way to relieve the discomfort is by moving the legs. The sensations tend to occur when the individual is resting or inactive, and not only during the night. Symptoms often worsen in the evening and at night, and may be relieved for a short while in the morning.

What is restless legs syndrome?
Restless legs syndrome (RLS), also known as Willis-Ekbom disease, is a condition that causes uncomfortable sensations, most often in the legs. These sensations have been described as tingly, crawling, creeping feelings, and cause the overwhelming urge to move the affected limb.

RLS symptoms typically occur when the person is sitting, resting, or sleeping, and often happen at night. The movements caused by RLS are called periodic limb movements of sleep (PLMS). Because of these movements, RLS can cause serious sleep problems.Restless Legs Syndrome Essay Paper

Some people have primary RLS, which has no known cause. Others have secondary RLS, which is typically associated with nerve problems, pregnancy, iron deficiency, or chronic kidney failure.

For most people with RLS, symptoms are mild. But if your symptoms are moderate to severe, RLS can have a big impact on your life. It can prevent you from sleeping enough, and thus cause problems with daytime focus and thinking, your job, and your social activities.

As a result of these problems, RLS can lead to anxiety and depression. And the longer you have the condition, the worse it can get. It can even spread to other parts of your body, such as your arms (1Trusted Source).

Because of the effects RLS can have on your life, treatment is important. Methods of treatment are varied, as the root cause of RLS isn’t truly known. For instance, some researchers suggest that RLS is caused by problems with the brain chemical dopamine, while others suggest that it’s related to poor circulation.

Here we list the best treatments for RLS. Some of these you can try on your own. Others you can discuss with your doctor, who can help you create a treatment plan to help relieve your RLS symptoms.

1. Ruling out potential causes
Your first step in addressing RLS should be to figure out if something is causing it. While RLS can be related to things that are largely out of your control, such as genetics or pregnancy, other possible factors can be addressed.

These factors could be daily habits, medications you’re taking, health conditions you have, or other triggers.

Habits
The use of caffeine, alcohol, and tobacco can aggravate RLs symptoms. Limiting these substances could help reduce your RLS symptoms (2).

Medications
Certain medications can cause or worsen RLS symptoms. Examples include: (1Trusted Source, 2, 3).

older antihistamines such as diphenhydramine (Benadryl)
antinausea drugs such as metoclopramide (Reglan) or prochlorperazine (Compro)
antipsychotic drugs such as haloperidol (Haldol) or olanzapine (Zyprexa)
lithium (Lithobid)
selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), sertraline (Zoloft), or escitalopram (Lexapro)
tricyclic antidepressants such as amitriptyline (Elavil) or amoxapine (Asendin)
tramadol (Ultram)
levothyroxine (Levoxyl)
Make sure your doctor knows about all drugs you’re taking, both prescription and over the counter. Talk to your doctor about whether they could be making your RLS worse, especially if you’re taking any of the medications listed above.

RLS is treated in different ways, depending on the intensity of the symptoms. In some cases, RLS is a temporary disorder that resolves when other conditions are treated. But in cases of genetic-based RLS or RLS due to persistent medical disorders, specific treatment is necessary.

Since iron deficiency is a reversible cause of RLS, many sleep specialists recommend over-the-counter iron tablets (ferrous sulfate). A simple blood test can measure iron stores in the body and help physicians determine who might benefit from iron therapy.

When RLS symptoms are frequent or severe, physicians prescribe medications to treat the disorder. The preferred treatments are dopamine agonists that replace dopamine, a neurotransmitter in the brain, known to be deficient in RLS. Also used to treat Parkinson’s disease, these drugs control the urge to move and sensory symptoms in the legs as well as reduce involuntary leg jerks in sleep. Ropinirole (Requip®), pramipexole (Mirapex®) and the rotigotine patch (Neupro) are the FDA-approved dopamine agonists that are used for RLS.Restless Legs Syndrome Essay Paper

Anti-seizure medications are also used to treat RLS symptoms by slowing or blocking pain signals from nerves in the legs. Examples include gabapentin enacarbil (Horizant®), gabapentin (Neurontin®) and pregabalin (Lyrica®). These drugs are particularly effective in patients with painful RLS due to neuropathy. Gabapentin enacarbil is the only medication in this class that is FDA-approved. However, the others may be effective.

Benzodiazepines are sometimes prescribed for RLS but are usually reserved for more severe cases due to their addictive potential and side effects including daytime drowsiness. Clonazepam (Klonopin®) falls into this category.

Opioids, commonly used to treat pain, are occasionally used to alleviate aching and uncomfortable sensations in the legs in more severe cases when other agents are not effective. These are controlled substances that require a special type of prescription. Examples include codeine, oxycodone, and morphine.

Restless legs syndrome (RLS) is a serious, but treatable condition. The key to living with RLS is managing the symptoms. Lifestyle changes, like limiting caffeine and alcohol, taking iron supplements or a hot bath, or initiating an exercise plan, and seeing a heath care professional to discuss treatment options can help. Everyone experiences RLS differently, so it is important to work with your health care professional to determine the best way for you to control your symptoms. A detailed list of some other lifestyle changes you and your health care professional may want to consider include:

Checking to see if there is an underlying iron or vitamin deficiency and then possibly supplementing your diet with iron, vitamin B12 or folate.
Looking at medications you may be taking which could make RLS symptoms worse. These may include drugs used to treat high blood pressure, heart conditions, nausea, colds, allergies, and depression.
Looking at any herbal and over-the-counter medicines you may be taking to see if they could be worsening your RLS.
Identifying habits and activities that worsen RLS symptoms.
Looking at your diet to assure it is healthy and balanced.
Eliminating or lessening your alcohol intake.
Looking at various activities that may help you personally deal with RLS.
These could include walking, stretching, taking a hot or cold bath, massage, acupressure, or relaxation techniques.
Also keeping your mind engaged with activities like discussions, needlework or video games when you have to stay seated.
Implementing a program of good sleep habits.
Reducing or eliminating caffeine from your diet to aid in general sleep hygiene.
Foot Wrap Treatment For RLS
Using a specially designed foot wrap at night may help alleviate the symptoms of RLS. Before sleep, the wrap is placed on the foot and applies continuous pressure to targeted foot muscles. This device is thought to work by signaling the brain to relax the muscles of the leg and relieve the sensations of RLS.

Initial research found that patients who used the foot wrap reported a significant reduction in symptoms and lost significantly less sleep when using the device. This is a non-pharmacological (drug-free) treatment, so it doesn’t cause the adverse side effects that can be associated with some of the RLS medications. Patients in the initial study noted mild side effects that were solved by loosening the straps.Restless Legs Syndrome Essay Paper

This RLS treatment is cleared by the FDA and available by prescription from your doctor.

Vein Treatment for RLS
98% of patients affected by RLS in a recent study found symptom relief after treating varicose veins in their legs with non-surgical sclerotherapy*. Many physicians believe that it is the underlying vein problems that are causing the Restless Leg Syndrome, and by treating this with an outpatient procedure, patients can get relief.

How it works: Varicose veins are caused by unhealthy valves within the veins. When these valves fail or leak, the blood falls backward through the poorly functioning valves causing the blood to pool and appear enlarged, twisted or bulging. Scientists first theorized a connection with RLS due to the similar side effects of varicose vein sufferers including pain, fatigue, itching, burning, cramping, restlessness and throbbing.

The modern treatments for varicose veins (and the corresponding RLS symptoms) are highly effective, and don’t require surgery. A specialist called a Phlebologist does a procedure called sclerotherapy, which has little to no pain, and usually takes an hour. The patient is able to walk afterwards and then resume normal activities.

Drugs Approved to Treat RLS
Horizant® (gabapentin enacarbil) was approved by the FDA in 2011 for the treatment of moderate-to-severe primary RLS.
Mirapex® was approved by the FDA in 2006 for the treatment of moderate-to-severe primary RLS.
Requip® (ropinirole hydrochloride), a drug commonly used to treat Parkinson disease, was given FDA approval at lower doses for the treatment of moderate-to-severe primary RLS in 2005.
All three drugs may cause side effects, such as sedation, nausea and dizziness and may cause patients to fall asleep without any warning, even while doing normal daily activities such as driving.

In addition to Horizant®, Requip®, and Mirapex®, there are several drugs approved for other conditions that have been shown to alleviate RLS symptoms. They are:Restless Legs Syndrome Essay Paper

Dopaminergic agonists — reduce RLS symptoms
Dopaminergic agents — reduce RLS symptoms
Benzodiazepines — allow for a more restful sleep
Opiates — induce relaxation and diminish pain
Side Effects of RLS Drugs
Side effects of RLS drug therapy may include daytime sleepiness (dopaminergic agonists and benzodiazepines), hallucinations and nausea (dopaminergic agents) or constipation and dependency (opiates). Before taking any medication, discuss the possibility of side effects with your doctor.

In 1996, Drs. Allen and Earley from Johns Hopkins University described a phenomenon called augmentation, in which RLS symptoms are more severe, spread to parts of the body other than the legs, and begin earlier in the evening as a result of taking dopaminergic agents to treat RLS symptoms. If augmentation occurs it can be managed with dose and medication adjustments.

Home Treatment of RLS
There are also a number of self-directed activities for managing the symptoms of RLS including walking, massaging the legs, stretching, hot or cold packs, vibration, and acupressure. Practicing relaxation techniques such as meditation or yoga have been known to alleviate symptoms. For many people, treating an underlying cause or effective pharmacological treatment of primary RLS and implementation of coping strategies provides relief from most symptoms. However, sometimes medications need to be changed over time or doses adjusted and regular consultation with a physician is recommended.

Health conditions
Certain health conditions have been found to be related to RLS. End-stage renal (kidney) disease, or ESRD, and nerve damage from diabetes have been linked with RLS. Iron deficiency anemia also has a strong connection with RLS (see iron below) (4, 5Trusted Source, 6Trusted Source).

People with restless legs syndrome (RLS) experience an overwhelming need to move the legs, particularly at night or as they fall asleep. But a simple treatment that may help reduce RLS symptoms is often overlooked as a potential first line of defense.

“The concern is that people are being started on medications first when iron might be a valuable treatment. It’s simple, with relatively few side effects,” says Dr. John Winkelman, an RLS specialist at Harvard-affiliated Massachusetts General Hospital.

Understanding RLS
An estimated 2.5% of Americans — more women than men — have frequent and bothersome RLS. Symptoms include tingling, crawling, aching, pulling, or painful sensations that can be relieved only by moving the leg (or, sometimes, arm) in which it occurs. Some people have RLS symptoms only when immobile on long plane or car rides.

Four out of five people who have RLS also have another condition called periodic limb movements of sleep (PLMS), which causes involuntary jerking or twitching movements in the legs during sleep.

Movements occur every 20 to 40 seconds for a few minutes or a few hours at a time, leading to disrupted sleep, daytime sleepiness, and fatigue for both the person who has PLMS and his or her bed partner.

RLS causes
The exact cause of RLS is unclear. People with iron deficiency (see “The importance of iron”) are much more likely to experience the disorder. “But many doctors don’t know that iron deficiency is one cause of RLS, and therefore don’t test for it, particularly in men, in whom iron deficiency is uncommon,” explains Dr. Anthony Komaroff, editor in chief of the Health Letter.

The link between RLS and iron does not just depend on low blood iron levels. Instead, RLS may be caused by low levels of iron in the brain. “It’s possible to have a low brain level of iron but a normal blood level of iron. The two levels are different,” says Dr. Winkelman.

Diagnosing low brain iron
Brain iron deficiency should be one of the first considerations when looking for a cause of RLS. But diagnosing low brain iron is tricky.

“We don’t have a way of assessing brain iron outside of specialized brain imaging,” Dr. Winkelman says. “We have to infer it from blood levels and make the jump that if you have low blood iron, your brain levels are probably low as well.”

Doctors use several tests to measure iron in the blood. One test measures iron levels directly. But the best way to diagnose iron deficiency, says Dr. Winkelman, is a blood test measuring ferritin, the primary form of stored iron in the body. The ferritin level also provides guidance as to which type of iron therapy should be recommended.

Treating RLS with food
“Dietary iron may sometimes be enough to treat RLS if your ferritin level is at or below 50 micrograms per liter (mcg/L). Red meat is really the best way,” notes Dr. Winkelman.Restless Legs Syndrome Essay Paper

However, consuming excessive amounts of red meat, especially cured meats like ham or salami, is associated with an increased risk for developing cardiovascular disease, diabetes, diverticulitis, and some types of cancer. Legumes are a healthier iron source, but absorption of iron from them is less efficient.

You should discuss with your doctor how your health history might impact your RLS, especially if you have any of these conditions.

There are no cures for primary restless legs syndrome, or RLS, although various treatments often can help relieve symptoms. Treatment for secondary restless legs syndrome (RLS caused by another medical problem) involves treating the underlying cause.

The First Step in Treating Restless Legs Syndrome
The first line of defense against restless legs syndrome is to avoid substances or foods that may be causing or worsening the problem. Stay away from alcohol, caffeine, and nicotine. This may help relieve your symptoms. In addition, review all medications you are taking with your doctor to determine if any of these drugs could be causing the problem.

Any underlying medical conditions, such as anemia, diabetes, nutritional deficiencies, kidney disease, thyroid disease, varicose veins, or Parkinson’s disease, should be treated. Dietary supplements to correct vitamin or mineral deficiency may be recommended. For some people, these treatments are all that is needed to relieve RLS symptoms.

You may also benefit from physical therapy and self-care treatments, such as stretching, taking hot or cold baths, whirlpool baths, applying hot or cold packs to the affected area, limb massage, or vibratory or electrical stimulation of the feet and toes before bedtime. Exercise and relaxation techniques also may be helpful.

Medications for Restless Legs Syndrome
Daily medication is usually recommended only for people who have symptoms of restless legs syndrome at least three nights a week, or as determined by your doctor. Keep in mind that drugs used to treat primary RLS do not cure the condition, but only relieve symptoms. People whose RLS symptoms occur sporadically may be prescribed medication to take only when they have symptoms.

The following medications are the most widely prescribed to treat RLS. They may be given alone or, in certain cases, in combination. Your doctor will prescribe the best treatment plan for you.

Dopamine agonists: These are most often the first medicines used to treat RLS. These drugs, including pramipexole (Mirapex), rotigotine (Neupro), and ropinirole (Requip), act like the neurotransmitter dopamine in the brain. Side effects include daytime sleepiness, nausea, and lightheadedness.
Dopaminergic agents: These drugs, including Sinemet — a combination of levodopa and carbidopa — increase the level of dopamine in the brain and may improve leg sensations in RLS. However, they may cause a worsening of symptoms for some people after daily use. Side effects can also include nausea, vomiting, hallucinations, and involuntary movements (dyskinesias).
Benzodiazepines: Benzodiazepines, such as alprazolam (Xanax), clonazepam (Klonopin), and temazepam (Restoril), are sedatives. They do not so much relieve symptoms as help you sleep through the symptoms.
Opiates: These drugs are most often used to treat pain, but they can also relieve RLS symptoms. Because opiates are very addictive, they are usually used only when other drugs don’t work. Hydrocodone (Vicodin, Norco) is one example.
Anticonvulsants: These agents, such as gabapentin (Neurontin) and gabapentin enacarbil (Horizant), may help relieve the symptoms of RLS as well as any chronic pain or nerve pain.
Alpha2 agonists: These agents stimulate alpha2 receptors in the brain stem. This activates nerve cells (neurons) that “turn down” the part of the nervous system that controls muscle involuntary movements and sensations. The drug clonidine (Catapres) is an example.Restless Legs Syndrome Essay Paper

Epidemiology
It is estimated that up to 10% of individuals may experience symptoms of restless legs syndrome, with 2-3% of adults reporting moderate to severe symptoms. However, it is difficult to determine the exact prevalence, as many individuals with mild symptoms do not seek medical advice.

It can affect individuals of any age, including the elderly and young children, and the symptoms typically worsen with age. Both genders can suffer from the syndrome, but is it significantly more common in women.

Symptoms
The characteristic symptoms of restless legs syndrome include throbbing, pulling, crawling, itching, tingling, aching or creeping sensations in the legs, accompanied by an irrepressible urge to move them. The uncomfortable sensations tend to be relieved by movement of the legs.

Symptoms usually present at nighttime when the affected individual is at rest and trying to relax. They can vary significantly in severity but often initiate as a mildly uncomfortable sensation but can become more severe as the night continues, sometimes to be described as painful.

As a result of the need to move the legs to relieve the associated sensation, many patients with RLS have difficulty falling or remaining asleep at night. Consequently, patients are more likely to become sleep deprived and experience excessive daytime sleepiness, which can affect their performance at work or in studies.

Cause
There is no clear identifiable cause for most individuals with restless legs syndrome. It can have a familial link in some cases, but many individuals with the condition do not have a family history of the syndrome.

It has been suggested that the symptoms may be caused by changes in the action of dopamine in the body. This neurotransmitter plays an essential role in controlled muscle movement and abnormalities may be responsible for causing the sensations noted in RLS.Restless Legs Syndrome Essay Paper

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There can also sometimes be an underlying cause of the condition, resulting in secondary RLS. Associated conditions may include iron deficiency anemia or kidney failure. Additionally, pregnant women are more likely to be affected by the syndrome, although this is usually temporary.

Management
The management of restless legs syndrome depends on the severity of the condition and many people with mild cases will not require any medical treatment but simple lifestyle changes can suffice. These may include:

Maintaining regular sleep schedule
Avoiding consumption of alcohol, caffeine or nicotine before bed
Keeping physically active during the day
When a patient experiences an episode or RLS, there are several techniques they can use to relieve the symptoms. This could involve massaging or applying a hot or cold compress to the affected area. Light exercise to relax, such as walking, stretching, yoga or tai chi, may also be beneficial.

If there is an underlying medical condition, such as iron deficiency anemia or kidney failure, that is likely to be worsening symptoms, this should be addressed before treatments specifically for RLS are used.

For patients with more severe symptoms associated with idiopathic RLS, medications may be needed to regulate the dopamine level in the body or aid sleep at night.Restless Legs Syndrome Essay Paper

Restless Legs Syndrome
I. History of Disorder
Restless legs syndrome is a neurological disorder that has been studied for hundreds of years. The earliest documentation of the syndrome was recorded nearly 400 years ago by Thomas Willis, a 17th century English physician who served King Charles II. Willis described cases of people having trouble sleeping because of constant contractions of tendons in the legs. Soreness resulted from these contractions and would hinder sleep for days at a time. The condition he was describing was almost positively Restless Legs Syndrome (RLS), but little was known about it at the time. There were other accounts of the disease throughout the centuries and in 1923 Hermann Oppenheim discovered it to be a neurological disorder. But it wasn’t until 1944 that Professor Karl-Axel Ekbom gave the disease its current name and studied it in greater detail. RLS is also commonly known in the medical world as “Ekbom disease” because of his efforts and studies (www.restlesslegs.org). II. Symptoms

The basic symptoms of RLS are fairly obvious. Patients experience soreness in the legs that worsens with lack of movement. The condition usually forms slowly and continues to affect the legs more and more over time. Soreness often becomes more apparent in the evening or at night, which is a more common time to be resting or sleeping (Sheil, 2006). Patients often develop insomnia because the soreness is so overpowering when they sleep. The soreness and painful sensations are described as strange itching, tingling, or “crawling” sensations occurring deep within the legs, causing an urge to move the limbs to relieve the pain. Restlessness often results in floor pacing, tossing and turning in bed, and rubbing the legs and this can keep people awake for hours or even days at a time (www.emedicinehealth.com, 2005). Symptoms usually worsen while sitting or lying down and, depending on the severity of the case, may or may not improve upon physical activity

How long will restless legs syndrome last?
Symptoms of primary or idiopathic RLS typically worsen over time, but, for some people, weeks or months may pass without any symptoms. If the RLS stems from a condition, illness, pregnancy, or medication, it may go away as soon as the trigger has gone.

Pregnancy
RLS can pose problems for women during pregnancy.

Women who already have RLS can find that symptoms get worse during pregnancy. However, becoming pregnant can lead to RLS in its own right. Symptoms tend to get worse as the pregnancy progresses and are especially likely in the third trimester.

The cause of the increased incidence of RLS during pregnancy is unknown, but the following factors are believed to be involved:

low levels of minerals or vitamins, such as iron and folate
sleep deprivation as a result of changes in the body and discomfort
changes in the hormones
increased sensitivity of the senses
This condition has not been widely researched during pregnancy. However, some of the drug treatments used outside of pregnancy, such as rotigotine and gabapentin, have not been assessed for safe use in women who are pregnant.

Behavioral treatments, such as mild exercise and a healthy sleeping pattern, are often recommended as a first-line treatment for women during pregnancy.Restless Legs Syndrome Essay Paper

If iron levels are low and thought to be the cause of RLS, oral iron supplements are safe to prescribe during pregnancy. In severe cases, higher concentrations may be administered intravenously (IV) through a drip.

If another cause is suspected that may require medication, and the above treatments do not have the desired effect, drugs should be prescribed at the lowest possible dosage to reduce risk.

Treatment
Warm baths are a simple home remedy that can help relieve symptoms.
Warm baths are a simple home remedy that can help relieve symptoms.
If a person cannot manage symptoms of RLS alone, they may be prescribed medications.

Medication

The medication will depend on the individual but might include:

Iron: Supplementation with iron may help people who have low iron levels. This, in turn, may help improve symptoms. Iron supplements are available for purchase online.
Alpha 2 agonists: These may help in cases of primary RLS, but they will not affect on periodic limb movement during sleep.
Painkillers: Ibuprofen, a non-steroidal anti-inflammatory drug (NSAID), may help with mild symptoms. Ibuprofen is available for purchase online.
Anticonvulsants: These treat pain, muscle spasms, neuropathy, and daytime symptoms. Neurontin, or gabapentin, is a popular anticonvulsant.
Benzodiazepines: These are sedative medications that help people with persistent and mild symptoms to sleep through the effects of RLS. Restoril, or temazepam, Xanax, or alprazolam, and Klonopin, or clonazepam, are examples.
Dopaminergic agents: These medications raise the levels of dopamine, a neurotransmitter, in the brain. They can treat the unpleasant leg sensations associated with RLS. Levodopa and carbidopa are common dopaminergic agents.
Dopamine agonists: These also raise brain dopamine levels and treat unpleasant leg sensations. They may cause adverse effects in older patients, although some report more side effects with levodopa.
Opiates: Treat pain and can relieve RLS symptoms. Doctors may prescribe these when other medications have failed. Codeine and propoxyphene are low dose opiates, while oxycodone hydrochloride, methadone hydrochloride, and levorphanol tartrate are common high-dose opiates.
Parkinson’s disease and epilepsy drugs are sometimes used for RLS as they can reduce involuntary movements.

If certain underlying conditions triggers the RLS, and those conditions are treated, the RLS may go away or improve. This is often the case with iron deficiency and peripheral neuropathy.Restless Legs Syndrome Essay Paper

Restless Legs Syndrome (RLS) is a neurological disorder characterised by unpleasant sensations in the legs and the compelling need to move the legs, usually experienced when trying to sleep. The strange sensation, usually in the calves, has been described as a type of cramp, soreness or a creeping, crawling feeling. Some liken the sensation to shooting darts of electricity, or even squirming insects inside the legs. The sensations range in severity from uncomfortable to irritating to painful.

The most distinctive feature of the condition is that lying down and trying to relax brings on the symptoms. As a result, most people with RLS have difficulty falling asleep and staying asleep. Left untreated, the condition can cause exhaustion and daytime fatigue.

People with RLS feel uncomfortable sensations in their legs, especially when sitting or lying down, accompanied by an irresistible urge to move about. These sensations usually occur deep inside the leg, between the knee and ankle; more rarely, they occur in the feet, thighs, arms, and hands. Although the sensations can occur on just one side of the body, they most often affect both sides.
Because moving the legs (or other affected parts of the body) relieves the discomfort, people with RLS often keep their legs in motion to minimize or prevent the sensations. They may pace the floor, constantly move their legs while sitting, and toss and turn in bed.

More than 80 percent of people with RLS also experience a more common condition known as periodic limb movement disorder (PLMD). PLMD is characterized by involuntary leg twitching or jerking movements during sleep that typically occur every 10 to 60 seconds, sometimes throughout the night. The symptoms cause repeated awakening and severely disrupted sleep. Unlike RLS, the movements caused by PLMD are involuntary – people have no control over them.

Most people find the symptoms of RLS to be less noticeable during the day and more pronounced in the evening or at night, especially during the onset of sleep. For some people, the symptoms disappear by early morning, allowing for more refreshing sleep at that time. Other triggering situations are periods of inactivity such as long car trips, sitting in a movie theatre, long-distance flights, immobilisation in a cast, or relaxation exercises.

American research suggests that about five out of every 100 people will suffer from RLS at some time. Usually, both legs are affected, but it is not uncommon to experience the unpleasant sensations in only one leg.Restless Legs Syndrome Essay Paper

The cause is unknown but people with a family history of RLS make up approximately 50% of cases, and people with low iron levels or anaemia, chronic diseases such as kidney failure, diabetes, Parkinson’s disease, and peripheral neuropathy, some pregnant women in their last trimester and people taking certain medications – such as anti-nausea, anti-seizure, and antipsychotic drugs, and some cold and allergy medications – appear to be more likely to suffer from RLS.

RLS can affect anyone of any age, although the disorder is more common with increasing age. It occurs in both genders, although the incidence may be slightly higher in women. Sometimes people will experience spontaneous improvement over a period of weeks or months. Although rare, spontaneous improvement over a period of years also can occur. If these improvements occur, it is usually during the early stages of the disorder. In general, however, symptoms become more severe over time.

The clinical diagnosis of RLS is difficult to make. Physicians must rely largely on patients’ descriptions of symptoms and information from their medical history, including past medical problems, family history, and current medications. Patients may be asked about frequency, duration, and intensity of symptoms as well as their tendency toward daytime sleep patterns and sleepiness, disturbance of sleep, or daytime function. If a patient’s history is suggestive of RLS, laboratory tests may be performed to rule out other conditions and support the diagnosis of RLS. Blood tests, studies to measure electrical activity in muscles and nerves, and Doppler tests be to evaluate muscle activity in the legs may be recommended. Such tests can document any accompanying damage or disease in nerves and nerve roots (such as peripheral neuropathy and radiculopathy) or other leg-related movement disorders. Negative results from tests may indicate that the diagnosis is RLS.Restless Legs Syndrome Essay Paper

TREATMENT
Movement brings temporary relief from the symptoms of RLS, but the disorder can be controlled by treating any underlying disorder such as diabetes or anaemia.

For patients where there is no apparent associated medical condition, treatment is directed at relieving symptoms. For those with mild to moderate symptoms many doctors suggest certain lifestyle changes and activities to reduce or eliminate symptoms, such as decreased use of caffeine, alcohol, and tobacco. It may be appropriate that certain individuals take supplements to correct deficiencies in iron, folate, and magnesium. Studies also have shown that maintaining a regular sleep pattern can reduce symptoms. Some individuals, finding that RLS symptoms are minimized in the early morning, change their sleep patterns. Others have found that a program of regular moderate exercise helps them sleep better; on the other hand, excessive exercise has been reported by some patients to aggravate RLS symptoms. Taking a hot bath, massaging the legs, or using a heating pad or ice pack can help relieve symptoms in some patients. Although many patients find some relief with such measures, rarely do these efforts completely eliminate symptoms.

A number of medications may be tried to treat the disorder, including central nervous system depressants, opioids and anticonvulsants. The major class of medication that helps in restless legs syndrome are those that increase dopamine transmission in the central nervous system. These include both common levodopa preparations (Sinemet and Madopar), as well as the dopamine agonists pergolide and cabergoline. These drugs are effective in the majority of RLS patients. However no one drug is effective for everyone with RLS. What may be helpful to one patient may actually worsen symptoms in another. Further, medications taken regularly may lose their effect, making it necessary to change them periodically.Restless Legs Syndrome Essay Paper

PROGNOSIS
RLS is generally a lifelong condition for which there is no cure. Symptoms may gradually worsen with age (though more slowly for those with the form of RLS not associated with any other disorder than for patients who also suffer from another medical condition such as those mentioned above). Nevertheless, current therapies can control the disorder, minimising symptoms and increasing periods of restful sleep. In addition, some patients have remissions – periods in which symptoms decrease or disappear for days, weeks, or months, although symptoms usually eventually reappear. A diagnosis of RLS does not indicate the onset of another neurological disease. Restless Legs Syndrome Essay Paper