Restless Leg Syndrome

Introduction

What should I know about Restless Leg Syndrome?

Restless leg syndrome (RLS), also known as Ekbom’s syndrome, is a discomfort, not pain, verbalized as pins and needles, a crawling sensation, or cramping mainly in the calves but sometimes noted in the thighs or arms. (1) The sensation generally occurs only during rest and inactivity and is quickly relieved by walking or moving the legs. Males and females are equally affected, and RLS occurs most commonly in the elderly. Iron deficiency, pregnancy, and renal failure are associated with RLS. Caffeine, stress, or fatigue may worsen the symptoms. (2) , (3)

RLS can be a very disturbing condition. When a person who has RLS tries to go to sleep, the tingling and cramping causes them to get up and move about to relieve the symptoms. Then when the person attempts to resume sleep, the discomfort returns, causing insomnia. Clinical examination may reveal evidence of underlying systemic disease or mild peripheral neuropathy, but is more often normal. (4) Mild or intermittent symptoms usually require no treatment.

Statistic

National Institute of Health, 2001.

    More than 80 percent of people with RLS also experience a more common condition known as periodic limb movement disorder (PLMD).

Signs and Symptoms

[span class=alert]The following list does not insure the presence of this health condition. Please see the text and your healthcare professional for more information.[/span]

Restless leg syndrome is often described as a discomfort rather than a pain, using terms such as pins and needles or a crawling sensation in the legs when lying down. It is relieved by standing or walking, but may return when lying down again, often causing insomnia. People with restless leg syndrome have an irresistible urge to move the legs around to relieve the discomfort. The symptoms may worsen during times of stress.

General

  • Feeling of pins and needles or crawling sensation in the legs when lying down to rest
  • An uncontrollable urge to move legs around
  • Feelings go away when you get up and walk or move around
  • Feeling returns when you lie back down causing you to lose sleep
  • Seems to be worse during times of stress or worry

Treatment Options

Conventional

Benzodiazepines are usually the first drugs prescribed particularly for less severe cases and younger patients. Clonazepam, lorazepam, triazolam, and temazepam have been effective. Opiates, such as codeine and oxycodone, have been used; however, tolerance develops and abuse potential becomes a concern since the condition is chronic. Bromocriptine, clonidine, and carbamazepine have also been used. Since it is possible that tolerance to one drug may develop, a physician may alternate prescriptions. In the most severe cases, levodopa is used. In order to alleviate the symptoms that recur during the night a sustained release product may be used.

Nutritional Suplementation


Magnesium

A study reported that magnesium is therapeutically effective in the treatment of individuals with insomnia related to restless leg syndrome. In this study, 10 patients (mean age 57 years old) were suffering from insomnia related to periodic limb movement during sleep (PLMS) or mild-to-moderate restless leg syndrome (RLS). Magnesium was administered orally at a dose of 12.4 mmol in the evening over a period of 4-6 weeks. Following magnesium treatment, limb movement associated with arousals decreased significantly, down from 17 to 7 events per hour of total sleep time. Periodic limb movements without arousal were also moderately reduced from 33 down to 21 incidents per hour of total sleep time. Sleep efficiency improved from 75% to 85%.

In the 7 patients who estimated that their sleep and/or symptoms of restless leg syndrome as improved after therapy, the effects of magnesium on periodic limb movement with and without arousal were even more pronounced. This study indicates that magnesium treatment may be a useful alternative therapy in patients with insomnia due to mild or moderate restless leg syndrome or periodic limb movements during sleep related. (5)


Iron

In an examination of 18 elderly patients with restless leg syndrome, compared to 18 matched controls, it was found that there were no differences in serum iron, vitamin B12, folic acid, and haemoglobin levels between the two groups. However, it was discovered that serum iron levels were inversely correlated with the severity of restless leg syndrome.


Folic Acid

One study in the scientific literature notes that restless leg syndrome is one of the neurological symptoms that can accompany folic acid deficiency. This study reports on six women between the ages of 31 to 70, who had folate deficiency and neuropsychiatric disorders. Some of the symptoms in three of the women with acquired folic acid deficiency included permanent muscular and intellectual fatigue, mild symptoms of restless legs, depressed ankle jerks, and a vibration sensation in the legs. All these symptoms resolved with folic acid therapy. The other three women were members of a family with restless legs syndrome, fatigability and diffuse muscular pain, in addition to a variety of other problems. Folic acid supplementation resulted in dramatic improvement of symptoms. These authors state that restless legs syndrome may represent the main clinical expression of acquired and familial (or inborn) folate deficiency in adults. (6)

Herbal Suplementation


Kava

In European phytomedicine, kava has long been used as a safe, effective treatment for mild anxiety states, nervous tension, muscular tension, and mild insomnia. (7) , (8) Studies have reported that kava preparations compare favorably to benzodiazepines in controlling symptoms of anxiety and minor depression, while increasing vigilance, sociability, memory, and reaction time. (9) , (10)


Valerian

Valerian has long been used as an agent to soothe the nervous system in response to stress. It has been reported that valerian helps improve sleep quality. (11) , (12) , (13) The usefulness of valerian is reported to be due to several principal components, including valepotriates, valeric acid, and pungent oils which have a sedative effect on the central nervous system, as well as a relaxing effect on the smooth muscles of the GI tract. (14) , (15)


Passionflower

Passionflower has been reported to have sedative, hypnotic, antispasmodic, and anodyne properties. It has traditionally been used for neuralgia, generalized seizures, hysteria, nervous tachycardia, spasmodic asthma, and specifically for insomnia. (16) The bioactive constituents have been shown to have CNS (central nervous system) sedation, anticonvulsant activity (high doses), and a reduction in spontaneous motor activity (low doses) in laboratory animals. (17)

References

  1. View Abstract: Ambrogetti A, Olson LG, Saunders NA. Disorders of movement and behavior during sleep. Med J Aust. 1991;155:336-340.
  2. Jermain DM. Sleep Disorders. In: DiPiro JT, Talbert RL, Yee GC, et al, eds. Pharmacotherapy, A Pathophysiologic Approach, 4th ed. Stamford, CT; 1999:1215.
  3. View Abstract: Krueger BR. Restless legs syndrome and periodic movements of sleep. Mayo Clin Proc. 1990;65:999-1006.
  4. Aminoff MJ. Parkinson’s Disease and other extrapyramidal disorders. In: Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison’s Principles of Internal Medicine, 14th ed. New York: McGraw-Hill; 1998:2362.
  5. View Abstract: Hornyak M, et al. Magnesium therapy for periodic leg movements-related insomnia and restless legs syndrome: an open pilot study. Sleep. Aug1998;21(5):501-5.
  6. View Abstract: Botez MI, et al. Neurologic disorders responsive to folic acid therapy. Can Med Assoc J. Aug1976;115(3):217-23.
  7. View Abstract: Volz HP, et al. Kava-kava Extract WS 1490 Versus Placebo in Anxiety Disorders--A Randomized Placebo-controlled 25-week Outpatient Trial. Pharmacopsychiatry. Jan1997;30(1):1-5.
  8. View Abstract: Singh YN. Kava: An Overview. J Ethnopharmacol. Aug1992;37(1):13-45.
  9. View Abstract: MunteTF, et al. Effects of Oxazepam and an Extract of Kava Roots (Piper methysticum) on Event-related Potentials in a Word Recognition Task. Neuropsychobiology. 1993;27(1):46-53.
  10. Drug Therapy of Panic Disorders. Kava-specific Extract WS 1490 Compared to Benzodiazepines. Nervenarzt. Jan1994;65(1Supp):1-4.
  11. View Abstract: Lindahl O, Lindwall L. Double Blind Study of Valerian Preparations. Pharmacol. Biochem. Behav. 1989;32(4):1065-66.
  12. View Abstract: Leathwood PD, et al. Aqueous Extract of Valerian Root (Valeriana officinalis L.) Improves Sleep Quality in Man. Pharmacol Biochem Behav. 1982;17:65-71.
  13. View Abstract: Balderer G, et al. Effect of Valerian on Human Sleep. Psvchopharmacology. 1985;87:406-09.
  14. Wagner H, et al. On the Spasmolytic Activity of Valeriana Extracts. Planta Med. 1979;37(1):84-86.
  15. Hendriks H, et al. Pharmacological Screening of Valerenal and Some Other Components of Essential Oil of Valeriana officinalis. Planta Medica. 1985;51:28-31.
  16. Newall CA, et al. Herbal Medicines: A Guide for Health Care Professionals. London: The Pharmaceutical Press; 1996:206-207.
  17. Kimura R, et al. Central Depressant Effects of Maltol Analogs in Mice. Chem Pharm Bull. Tokyo. Sep1980;28(9):2570-2579.