With this term, in English Restless Legs Syndrome (RLS), we mean a disorder characterized by urgent and unmanageable need to move your legs. Unpleasant sensations are associated with difficult definition (sensations assimilated to a cramp, tingling, electric shock or annoyance). With the movement the annoyance attends or disappears.
In some situations the upper limbs can also be affected. The unpleasant sensations of the restless legsand consequently the difficulty in being still, occur in the state of rest and inactivity. It follows that the disorder is revealed mainly in the evening or night hours with sleep impairment in all its phases. Over time insomnia can in turn compromise the psychic sphere, in the attentive and emotional component, and the state of health in general.
Fashion diagnosis?
Although it is a picture that only recently is receiving attention in the medical and non -medical world, the first descriptions of the disorder date back to the second half of the 1600s by the English doctor Sir Thomas Willis. The formulation of more detailed diagnostic criteria took place in 1945 and is due to Swedish neurologist Karl Axel Ekbom, who gave the syndrome the name we use today. The diagnostic criteria were validated in 1995 by the International Restless Legs Study Group and reviewed in 2002.
How frequent is restless legs syndrome?
In literature we find a prevalence in adulthood variable between 5 and 15%. In pediatric age, estimates concern 5-10% of children. These data are very vague and not very reliable since this diagnosis is not easily identified. The prevalences are probably higher.
Recent studies have observed that, on a group of subjects who presented i Symptoms of restless legs45% had not received a correct initial diagnosis.
Two forms of the disorder have been observed. One with debut before the age of 45, which tends to be hereditary, can already occur during childhood and usually persists throughout life. Over time, symptoms gradually worsen and tend to present themselves with increasing frequency. In milder forms you can also have long periods free from symptoms. Another form has a later debut, generally after 45 years of age, and does not seem to have large hereditary components. In the latter case the Restless legs syndrome It tends to appear suddenly and the symptoms tend to keep stable, not showing worse trends.
Symptoms of restless legs
The syndrome is characterized by several symptoms including characteristic ones are the following four:
- Uncontainable need to move the legs often, but not always, associated with unpleasant sensations with the lower limbs. In serious cases, the upper limbs are also involved.
- The symptoms are accentuated in moments of inactivity (e.g. if you are sitting or lying down in bed).
- These are alleviated by the movement, especially walking, helps to reduce unpleasant sensations.
- Symptoms often appear or are more intense in the evening or at night.
It is essential to express this symptomatic constellation in full in order to formulate the diagnosis. The name of the syndrome derives from the urgent need for move your legs In order to find relief. The actions that usually relieve the symptoms are: walking, shaking the legs, ironing, flexing or delicating them.
The unpleasant sensation is felt in the deep area of the legs; The annoyances rarely start from the surface seat. Both limbs are affected even if sometimes the prevalent interest of a single leg is observed.
Differential diagnosis
The symptoms reported by the subjects affected by the Restless legs syndrome They are qualitatively distinguishable from generic cramps. The latter often affect limited muscle groups that tend to tend during contracture; In addition, the pain of cramp is much more intense and is relieved only by the stretching of the muscle concerned.
Other pathologies that can simulate the symptoms of restless legs syndrome are the discomfort related to arthritic paintings or by peripheral arteriopathy. But in these last two situations the movement worsens the symptoms instead of improving it.
Another disorder that can be placed in differential diagnosis is the Disorder from periodic movements of the legs (PLMS). It is characterized by repeated contractions or spasms of the lower or superior limbs during sleep, frequently every 20-40 seconds. These patients usually complain of a fragmentation of sleep with excessive daytime sleepiness and usually ignore the movements and short awakenings that follow them. They also do not present abnormal sensations in the limbs.
How do you present in children?
In children i Symptoms of restless legs syndrome They can manifest themselves differently from what is observed in adults. There is a component of hyperactivity that sometimes poses differential diagnosis problems with other appearance disorders in childhood. One of the main problems of evolutionary age is that children actually cannot explain the symptoms clearly.
The children, most of the time, say they hear how “waves” on the legs, or as if they had animals who walk on their legs. What the parents observe, however, is the child’s inability to stand still even when he is sitting.
In pediatric age, this disorder also determines a series of daytime consequences, mainly on a behavioral level, as inattention and hyperactivity. Parents therefore ask for psychological advice both because the child has problems falling asleep and because he is inattentive to school or hyperactive. Recent literature has related to the Deficit syndrome of carelessness/hyperactivity (ADHD) with restless legs syndrome.
Possible causes of the restless legs
Numerous studies pay attention to the genetic component which appears high. In fact, in cases with an onset in childhood it is observed that between 70 and 80% of children affected by the disorder have at least one close family member (parent or grandfather) who meets the criteria to formulate the same diagnosis. Even in cases where the pathology is revealed in adulthood, there is an estimated familiarity between 40 and 50%.
The syndrome can be unleashed by numerous disorders, pathologies and pharmacological therapies. The presence of defects in the use of the iron by the body or one has been hypothesized iron deficiency. The link between iron e Restless legs syndrome It is explained by the fact that the brain uses iron in the dopamine synthesis processes, a neurotransmitter involved in multiple mechanisms including control of movements.
There are several pathologies that can modify the iron levels present including renal failure, Parkinson’s disease, diabetes mellitus, rheumatoid arthritis.
Also the pregnancy It can certain iron deficiency. Usually the symptoms occur in the third trimester of gestation and disappear after childbirth, even if in some women the disorder can remain even after, albeit in an attenuated form. There are paintings that can increase the risk of suffering from this syndrome through a mechanism that sees nervous impairment, eg diabetes.
Among the drugs and other substances we find alcohol and tobacco, some therapies used in the treatment of nausea, some antidepressants and antipsychotics, antihistamines, calcium-antagonists used in the treatment of arterial hypertension. In drug -induced paintings, the symptoms improve to disappear after the suspension of the substance taken.
Prognosis of syndrome
The prognosis is variable: over time i Symptoms of restless legs syndrome They can improve until they completely disappear for temporal arches even a few months. In other situations they can worsen over time. In secondary forms to other pathologies or pharmacological therapies, the picture improves by taking care of the basic disorder or suspending responsible therapies.
The outcome of the disorder also depends on the patient’s availability to change his lifestyle, such as avoiding alcohol and tobacco or being able to maintain the blood sugar levels within the limits.
Restless legs care
While not having specific drug therapies at the moment, there are several molecules capable of mitigating the symptoms until they are completely reduced. It is often necessary to change different molecules and adjust the doses in order to obtain the most effective result. These drugs usually act by optimizing the functioning of the nerve streets that see the dopamine as neurotransmitter.
As we have already said above, in the forms of restless legs syndrome due to other organic pathologies, the primary disorder must be treated in the first instance. Generally these pharmacological therapies in addition to the modifications of the lifestyle lead to appreciable improvements.
Among the activities to be recommended Peri relieve symptoms Remember:
- walk
- stretch
- Take a hot or cold bath
- ignite the affected limb
- use the hot water or ice bag on the affected limb
- engage in activities that commit the mind.
In situations that require a permanence in a sitting position, such as cinema or transposed means, it is preferable to choose a place that allows you to easily change the position of the lower limbs. Practice aregular physical activity It can be a help factor, in addition to what has been said above. In fact, patients report that, by increasing daytime activity, the symptoms decrease.
Living with restless game syndrome can be a source of stress. For this reason it is important that patient and family members manage to ask for the right emotional support and keep the motivation to treatment high, since often this picture is chronic. Behavioral psychotherapy can be a valid help to motivate to follow drug therapies over time, to build and maintain a more suitable lifestyle, to learn relaxation techniques to be used even in sleep interruptions and to prevent the disorder from becoming the fulcrum of one’s attention.
Bibliography
- Bruni o, Novelli L, Verrillo E. Sleep disorders in the first and second childhood: evaluation and diagnosis. In “Psychosomatic in evolutionary age” by Rita Cerutti and Vincenzo Guidetti. The scientific thought publisher, pp 151-181. (2007).
- Trendkwalder C et al. Ropinirole in the Treatment of restless Legs Syndrome: Results from the Treat RLS 1 Study, at 12 Week, Randomized, Placebo Controlled Study in 10 European Countries. J Neurol Neurosurg Psychiatry 2004; 75: 92-7.
- Walters as et al. Ropinirole is effects in the Treatment of restless Legs Syndrome. Treat RLS 2: at 12 Week, Double, Blind, Randomized, Parallel-Group, placebo-Controlled Study. Mov disords 2004; 19: 1414-23.
- Trentkwalder C et al. Effectcy of Pergolide in Treatment of restless Legs Syndrome: The Pearls Study. Neurology 2004; 62: 1391-7.
