Restless legs syndrome, RLS or colloquially known as restless legs, is a condition whose causes are still largely unknown. Symptoms can be addressed with a variety of medical approaches.
What is restless legs syndrome?
Restless legs syndrome is a neurological disorder that usually affects a patient’s legs and feet. In rarer cases, restless legs syndrome affects the arms. Translated into German, restless legs syndrome means ‘syndrome of restless legs’. Symptomatically, the disease manifests itself, among other things, in a strong urge to move and sensory disturbances in the legs or arms. In addition, restless legs syndrome can lead to involuntary movements in sufferers, which often increase in situations of rest or even during sleep. A distinction is made, for example, between the idiopathic (independent) and secondary (developing on the basis of other disorders) forms of restless legs syndrome. According to estimates, restless legs syndrome is present in approximately 5-10% of the population in Germany; women tend to be more frequently affected by restless legs syndrome than men.
Causes
The causes underlying restless legs syndrome have not yet been conclusively clarified in science; among other things, the influence of an insufficient concentration of the neurotransmitter dopamine (a messenger substance of the nervous system, which is also colloquially referred to as the happiness hormone) and the influence of motor disorders (disorders of the musculoskeletal system) on restless legs syndrome are suspected. In addition, it is possible that various nerve pathways in people affected by restless legs syndrome react with above-average sensitivity or overexcitability. Restless legs syndrome in its secondary form can be caused, for example, by neurological diseases (such as Parkinson’s disease), deficiency symptoms or various medications. If restless legs syndrome is idiopathic (developed on its own), genetic causes are assumed in medicine.
Symptoms, complaints, and signs
Symptomatic in resting posture is an agonizing urge to move the legs. This may take the form of tearing, pulling, or burning during uncontrolled muscle movements. The involuntary muscle twitches occur both when awake and during sleep. The calves are often affected. Periodic leg movements occur during sleep, leading to frequent awakenings. The onset of discomfort is increased in the evening and at night and may be unilateral or bilateral. The sensory disturbances may be barely noticeable, but may also be intense for short or long periods of time. In more severe cases, restless legs syndrome (RLS) can lead to significant sleep disturbances despite existing fatigue. These can last until early morning. Due to daytime sleepiness, significant problems in coping with everyday life can occur next day. These include concentration problems, bad mood, irritability and depressive moods. When driving, microsleep may indicate the cause of restless leg syndrome. Signs of restless leg syndrome may include itching, pain, and numbness. In addition, an excessively rumpled bed in the morning, frequent waking up as well as getting up indicate this clinical picture. A sign of an RLS disease can also be already during the day the well-being when sitting is affected. Sensory disturbances in the legs may also include an unnatural feeling of cold or heat. Typical of restless legs syndrome is improvement of symptoms with exercise.
Diagnosis and course
Restless legs syndrome is usually diagnosed by a neurologist (also known as a neurologist). An appropriate tentative diagnosis is often made initially on the basis of observable symptoms or those described by the patient. Furthermore, the neurologist has various tests at his disposal that can confirm the diagnosis of restless legs syndrome: A corresponding test consists, for example, of a single administration of L-dopa (an active ingredient that is used, among other things, for dopamine deficiency); if there is an improvement in the symptoms as a result of this administration, this is indicative of restless legs syndrome.The course of the syndrome is related, among other things, to the form that the restless legs syndrome takes: If it is the idiopathic (independent) form, the onset of the disease in affected individuals is often observed in the third decade of life. Often, in idiopathic restless legs syndrome, a moderate (but often not continuous) increase in symptoms is observed over the lifetime of affected individuals. In general, symptoms in restless legs syndrome are relatively mild, so that in most cases drug treatments are not necessary.
Complications
Restless legs syndrome does not cause physical complications. However, the excruciating tingling, pain, and restlessness occur primarily during periods of rest. For this reason, the organism cannot relax. Furthermore, the symptoms intensify especially in the evening before going to bed, so that it is not possible to fall asleep and stay asleep. As a result, many sufferers are sleep-deprived and feel extremely tired and listless during the day. They often find it difficult to cope with daily life, as they are exhausted, depressed and listless. Patients with RLS can thus lose their complete ability to perform. As a result, sufferers also often experience negative social effects due to their fatigue and constant urge to move. Sitting comfortably with friends and acquaintances for long periods of time is not possible because there is always the urge to constantly run around. Since friends and family also often have no understanding for this behavior, it is not uncommon for social isolation to occur. On this basis, the psychological well-being of the sufferers is also severely impaired. Thus, restless legs syndrome can be the cause of other mental illnesses. Social isolation increases the risk of depression and suicidal thoughts. To improve the quality of life of those affected, psychotherapeutic support from a psychologist is recommended in addition to medication to treat the syndrome.
When should you see a doctor?
Having restless legs does not in itself have any disease value. Too much caffeine consumption or nervousness can be the cause. However, if restless legs syndrome is present, it can be assumed to have a disease value. It is a more or less pronounced neurological disorder. This requires a visit to a neurologist. Restless legs syndrome can occur, for example, as a side effect of taking antidepressants. About 5-10 percent of the population is affected by restless legs syndrome. However, medical treatment is only necessary for one in five of those affected, namely when the symptoms are very severe. It is usually a felt sense of suffering that drives people to see a doctor. A strong urge to move, which mostly affects the legs, reduces the quality of life. If increasing social isolation and avoidance of sedentary activities result from restless legs syndrome, a visit to the doctor should no longer be postponed. The doctor may be able to determine and eliminate the causes of restless legs syndrome. For example, if it is medication side effects, other medications with identical main active ingredients may be prescribed. In other cases, depressant preparations can be prescribed to alleviate the symptoms of restless legs syndrome. It should be noted that other medications are often already being taken. These must be compatible with each other. Therefore, the doctor should know which diseases the affected person suffers from and which medications he or she has to take regularly.
Treatment and therapy
Medical treatment for restless legs syndrome is usually based on the individual patient’s level of suffering. Because restless legs syndrome often contributes to limitations in sleep quality, therapy in many cases starts with a corresponding improvement. Patients in whom restless legs syndrome is associated with pronounced symptoms and a high level of suffering are often treated with medication; depending on the symptoms, such treatment can be continuous or demand-oriented. In restless legs syndrome, for example, active substances are used that represent a precursor of the neurotransmitter dopamine and are converted into dopamine by the body. Dopamine agonists (substances that are similar to dopamine) are also used in restless legs syndrome: These substances can help sensitize nerve cells to take up dopamine.If restless legs syndrome is relatively mild, non-drug methods such as massage are sometimes used. Hot or cold showers are also described by some patients as relieving. If restless legs syndrome is present in a secondary form, therapy usually begins by addressing corresponding underlying diseases or disorders.
Prevention
Because the causes of restless legs syndrome have not yet been conclusively determined, there are currently few ways to prevent the syndrome. To prevent restless legs syndrome from developing in a secondary form, consistent therapy of possible underlying diseases may be helpful.
Follow-up
Because restless legs syndrome is not completely curable, follow-up treatment of restless legs syndrome is closely related to its therapy. Lifelong use of medication is therefore necessary even after the symptoms of restless legs syndrome have subsided. The goal of follow-up treatment should be to prevent the need to take opiates if they are not already being taken for restless legs syndrome. Opiates can cause organ damage if taken continuously. Because of the drug use, regular blood checks should be done for follow-up treatment. Liver and kidney function values in particular must be monitored intensively. If these deteriorate seriously, the patient must be switched to another drug. In addition, checking iron levels and, if necessary, taking iron supplements can prevent a recurrence of the disease or a worsening of symptoms. If possible, the use of sleeping pills (Z-drugs), antidepressants, neuroleptics and beta-blockers should be avoided, as these medications can cause an exacerbation or renewed onset of restless legs syndrome. A healthy sleep hygiene, i.e. a regular sleep rhythm with sufficient recovery phases is sustainably beneficial against restless legs syndrome. In addition, sporting activity that puts strain on the legs is beneficial for their blood circulation. In this way, a worsening of the symptoms can be prevented. Caffeine and stimulants, which include nicotine, should be avoided.
What you can do yourself
Affected people who suffer from restless legs syndrome can also help themselves to at least relieve the symptoms. For example, when restless legs occur, many find it helpful to take a cold shower. The cold causes the blood vessels to contract and also calms the nerves. In addition, patients describe a positive effect from exercise. Thus, restlessness can be alleviated by regular walks in the evening. Yoga and Pilates also have a calming effect. Furthermore, a healthy and balanced diet is of great importance in RLS. Poor food often causes nutrient deficiencies in the body. In particular, a lack of magnesium and iron are associated with Restless Legs. This store can best be replenished through food. Alcohol and too much sugar should be avoided. Many patients also describe an improvement in symptoms through targeted massage of the legs, especially the affected areas. Since the causes of RLS have not yet been conclusively researched, regular relaxation exercises can also help to lower the stress level in the body and thus calm the nerves. It is important to note that the symptoms do not disappear overnight, but take effect after a few weeks.
