Restless Leg Syndrome
By Dr Banshari Mridha
Restless leg syndrome (RLS) manifests itself usually at night time as a crawling or creeping sensation in the leg with a strong urge to move it, a compulsion so strong that a person is unable to resist. Also, the limb may ache, burn, tingle, twitch or jerk. The individual wakes up in the morning feeling groggy and irritable due to poor sleep quality.
Surprisingly, another common presentation is a spouse complaining of bruise/injury due to their partners jerky/kicking movement while sleeping.
It is more commonly seen in pregnancy and in persons with iron deficiency anaemia.
SYMPTOMS
Abnormal, unpleasant crawling sensation in the legs or feet, usually on both sides, with muscle cramp or numbness and consistent desire to move the limbs.
The sensation typically begins when the person is lying down or has been sitting for an extended time, like in a car, airplane or movie theatre.
The sensation lessens with movement, such as stretching, jiggling the legs, pacing or walking.
Night time leg twitching or periodic limb movement in sleep, which causes the legs to twitch and kick, possibly throughout the night while asleep, is also an associated feature.
All of these may lead to excessive daytime drowsiness and fatigue.
CAUSE
*Anaemia: most commonly due to iron deficiency.
*Systemic diseases: such as Parkinsons, kidney failure, diabetes or peripheral neuropathy may also lead to this.
*Genetic: It may run in families, especially if symptoms emerge before 50.
*Drugs: allergy (antihistamines) or cold and sinus medications.
*Pregnancy: especially in the last 3 months. It usually disappears after delivery.
*Vitamins C, D or E deficiency
*Low levels of calcium and potassium in blood.
*Underlying varicose veins in the legs
*Smoking, drinking and sleep deprivation may all increase the severity of jerky motions in patients.
DIAGNOSIS
-Detailed history with physical and neurological examination by a physician is needed. Interviewing of a spouse regarding their partners in-sleep movements can aid the diagnosis.
-Blood tests for iron deficiency, electrolytes and vitamin levels.
TREATMENT
Treating the underlying pathology that leads to RSL may lead to disease remission.
Iron tablets, in case of anaemia. Remember, always take iron tablets with a glass of orange/lemon juice or vitamin C tablets as it helps absorb the iron better. Iron-rich foods, such as dark green vegetables, liver, kidney beans and lean beef can be preventive measures.
Vitamins and calcium supplements, in case of deficiency
Medication, such as Ropinirole, Gabapentin or Alprazolam, should be prescribed if the condition persists after treatment of primary causes.
In case of varicose veins, sclerotherapy is needed.
Additionally, over-the-counter muscle rubs like Bengay or Moov can sometimes be beneficial. Massaging with these ointments improve blood flow and relieve ache.
TIPS
Dont resist the need for movement, as suppressing the urge to move can make symptoms worse.
Combine heat and cold treatments. Dip legs in a comfortably hot bath for two minutes, then apply a cold pack to the legs for a minute. Repeat several times before bed.
Before sleeping, stretch legs to their full length and point the toes. Hold this position for 10-15 seconds and repeat 10 times.
Deep massaging of legs can relax the muscles.
Light to moderate exercise during the day has been shown to ease night time symptoms. Avoid exercising late at night, as it may intensify symptoms.
Intermittent muscle stretching rituals throughout the day may help. Try to take a 5-minute break every hour. Get up, stretch, walk around, then continue daily chores.
Avoid caffeine after noon, and give up smoking and drinking.
Activities that engage and distract the mind, like crossword puzzles or reading a book, can sometimes ease symptoms.
Establish a good sleep routine, as fatigue tends to worsen symptoms.
The writer is a doctor of internal medicine.
