Restless legs
and Christiane Fux, medical editorMareike Müller is a freelance writer in the medical department and assistant doctor for neurosurgery in Düsseldorf. She studied human medicine in Magdeburg and gained a lot of practical medical experience during her stays abroad on four different continents.
More about the expertsChristiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.
More posts by Christiane Fux All content is checked by medical journalists.The term “Restless Legs” (also Restless Legs Syndrome, RLS) means “restless legs”. Affected people have an agonizing urge to move and often feel an uncomfortable pulling or tingling sensation in their legs. The complaints only occur in resting situations and improve with movement. Read here how to recognize restless legs and how to treat them.
Restless Legs: Quick Reference
Symptoms: strong urge to move, abnormal sensations in the legs, increase in symptoms at rest (especially at night), followed by sleep disorders, concentration problems
Treatment: L-dopa, decarboxylase inhibitors, opioids, carbamazepine, anticonvulsants, in the case of secondary RLS treatment of the initial disease
Causes: Suspected connection with dopamine messenger metabolism, heredity, with secondary RLS, among others. also certain drugs, polyneuropathy, pregnancy, rheumatism, kidney diseases, iron deficiency
Diagnosis: based on symptoms, L-dopa test, exclusion of other diseases through neurological tests, laboratory tests
Prognosis: gradual worsening, primary RLS not curable but treatable, secondary RLS partially curable
Restless legs: symptoms
The term "Restless Legs" means "restless legs". The main symptom is the indomitable urge to move that the patient feels. In addition, there are discomforts in the legs, sometimes in the arms. These can express themselves in different ways: some patients complain of pulling or tearing, others of tingling or tenderness.
What they all have in common is that the complaints usually come from deep within the leg. They are relieved for a short time by moving, standing up, or walking around.
Problems in everyday life
The symptoms typically arise or worsen at rest. Reading a book, going to the cinema, driving a car or sitting for a long time during work can trigger the discomfort and force the person affected to move. This severely limits the quality of life of people with restless legs.
Disturbed sleep
It becomes particularly difficult in the evening or at night. The complaints disrupt the patient's sleep. Many sufferers therefore suffer from tiredness, poor concentration or poor performance during the day. It is not uncommon for these to be the symptoms that move the patient to see a doctor.
Periodic movements
The periodic leg movements that patients involuntarily make while sleeping or waking are known as Periodic Limb Movements (PLM). In up to 80 percent of cases, they are signs of restless legs syndrome. But they also occur in other diseases in old age.
The symptoms vary greatly from person to person in terms of severity and frequency of occurrence. There are also those affected who feel an urge to move, but do not suffer from paresthesia in their legs.
Symptoms worsen over time
The disease is chronic and progressive. This means that it progresses slowly and the symptoms gradually worsen. At the beginning of the illness, the restless legs can still appear in episodes, in between those affected are symptom-free.
Restless legs: treatment
A primary RLS that is not based on another underlying disease cannot be treated causally. One can only try to alleviate the symptoms and thus improve the patient's quality of life.
If an RLS has a known cause, such as an illness or the use of certain medications (secondary RLS), it can sometimes be completely healed.
Restless leg medication
Restless legs therapy is medicated. First, L-Dopa and a so-called decarboxylase inhibitor (for example benserazide) are administered. The patient takes the preparations about an hour before going to bed, as the symptoms are worst at night when the disease begins. If L-Dopa no longer helps, a dopamine agonist can also be used against Restless Legs Syndrome.
Side effects
The most common side effects of restless legs syndrome therapy with or dopamine-like substances (dopaminergic therapy) include drowsiness, nausea and circulatory problems. It is therefore important to find the right dose for each individual and to start with the lowest possible amount of active ingredient.
When drugs make symptoms worse
In addition, such a dopaminergic treatment can lead to a so-called augmentation. This means that the therapy itself further exacerbates the symptoms. If the augmentation occurs during L-Dopa therapy, a dopamine agonist is used. If the patient also observes an augmentation, opiates are used.
These are also used when dopaminergic therapy does not work or patients are not allowed to take these substances for certain reasons. Alternatively, carbamazepine or gabapentin can also be prescribed. They are among the drugs that are otherwise used, for example, for seizure disorders (anticonvulsants).
Alternative procedures
In addition to conventional medical treatment, some patients with restless legs use alternative treatment options to alleviate their symptoms. While it has not been proven to be effective, many patients report experiencing relief from it. This includes:
- homeopathy
- acupuncture
- Bioresonance therapy
- Magnetic Therapy
Restless legs - what you can do yourself
A healthy lifestyle can reduce the stresses associated with the disease. This includes
- regular physical exercise
- regular sleep rituals
- iron-rich diet
- Do not drink stimulating substances such as coffee or alcohol immediately before going to bed
Restless legs: causes and risk factors
To date, it has not been conclusively clarified what the cause of restless legs is. But there are some indications.
Key role of dopamine
Therapy with the neurotransmitter dopamine or dopamine agonists alleviates the symptoms. It is therefore assumed that a disturbance in the dopamine balance plays an essential role in the development of restless legs.
Inheritance
More than half of the patients have a positive family history, which means that at least one case of restless legs is known in their family. This and some research suggest that the condition can be inherited. Six genes have already been found that play a role in this. How exactly these genes influence the course of the disease has not yet been conclusively clarified.
Secondary restless legs syndrome
But there are also cases in which restless legs are the result of other illnesses or circumstances. This includes:
- Hyperthyroidism or hyperthyroidism
- Rheumatic diseases
- pregnancy
- other nerve disorders such as polyneuropathies (especially in diabetes mellitus) or radiculopathies (irritation or damage to a nerve root on the spinal cord)
- Iron deficiency
- Kidney disease which causes breakdown products to appear in the blood that are normally excreted in the urine (uremia)
- Coordination disorder of movement sequences due to a progressive loss of nerve cells in the cerebellum and spinal cord (spinocerebellar ataxia)
- Medications (such as some antidepressants, neuroleptics, thyroid, or seizure medications)
Restless legs: examinations and diagnosis
In order to be able to diagnose restless legs syndrome, the doctor first asks about the medical history (anamnesis). For example, he asks how the complaints are expressed, when they occur and whether there is already someone in the family who is affected by restless legs.
As patients often find it difficult to precisely describe the abnormal sensations in their legs, the conversation can take some time. In addition, it can be the case that the consequences of the sleep disorder, such as concentration problems, are in the foreground and not the urge to move or the abnormal sensations.
anamnese
Then the doctor will perform a physical and neurological exam. It serves to rule out other possible causes for the complaints. With restless legs, the results are usually normal.
Restless legs are diagnosed when the following criteria are met:
- Urge to move the legs, often accompanied by paresthesia in the legs. Sometimes the arms or other parts of the body are also affected.
- The symptoms begin or worsen at rest (e.g. sitting or lying down).
- The symptoms improve with exercise (e.g. standing up or running).
- The symptoms are worse in the evening or at night than during the day or only occur in the evening or at night.
L-dopa test
With the so-called L-Dopa test, the suspected diagnosis of restless legs can be confirmed with relative certainty. A test dose of the drug L-Dopa is administered to the patient. If the symptoms improve as a result, restless legs syndrome is likely. If the effect does not occur, however, restless legs cannot be ruled out.
Further points that corroborate the suspected diagnosis of "restless legs" are:
- Another family member has already developed RLS.
- Involuntary movements of the legs while sleeping or waking (PLM) occur.
Since the restless legs syndrome not only triggers symptoms such as the urge to move and abnormal sensations in the legs, but can also be caused by other diseases, the following examinations are sometimes useful for clarification:
- Blood tests (determination of iron, kidney and thyroid values, vitamin B12 and folic acid)
- electrical examinations of the nerves and muscles (electroneurography, electromyography)
- Examination of sleep (polysomnography, actigraphy)
Restless legs: disease course and prognosis
Restless legs are one of the most common nerve disorders in Germany. Women are more often affected than men. If restless legs are familial, the disease usually begins early, before the age of 30.
If, in rare cases, children or adolescents suffer from restless legs symptoms, this is quickly misinterpreted as hyperactivity syndrome or growing pains.
The prognosis for restless legs varies greatly from person to person. At the beginning of the disease, many sufferers have hardly any symptoms or are symptom-free for weeks to months. In most cases, the restless legs syndrome is chronically progressive. That is, the patient's condition is progressively deteriorating. However, since the disease progresses slowly, many patients do not need treatment until they are older.
No causal therapy
There is no therapy that can eliminate the causes of restless legs. However, therapeutic measures can alleviate the symptoms and their consequences, such as sleep disorders and poor concentration. This gives those affected a great gain in quality of life.
Good prognosis for secondary restless legs
If restless legs are due to another disease, the prognosis is good. Treatment of the underlying disease can usually also improve the symptoms of the restless legs or even go away completely.
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