Restless legs syndrome: symptoms and treatment

Have you ever experienced discomfort in your legs, an irresistible desire to move them and the inability to fall asleep at the same time? I think that quite many will answer this question in the affirmative. And if this is not an accident, but a systematic repetition from day to day? In this case, it may be symptoms of a condition such as restless legs syndrome. What is it?

The restless legs syndrome is a pathological state of the nervous system, in which a person develops unpleasant sensations mainly in the lower extremities with an irresistible desire to constantly move them. These symptoms prevent a sick person from sleeping, and sometimes cause depression. More than half of all cases of restless legs syndrome, the immediate cause of the disease can not be identified, that is, it arises independently and spontaneously. Other cases are provoked by other diseases and conditions of the body (most often as a result of chronic kidney failure, pregnancy and iron deficiency in the body).

The peculiarity of the disease is the absence of any signs during a neurologic examination, that is, the diagnosis of this condition is based only on clinical manifestations. Treatment is complex, requires the use of non-pharmacological and medication methods. In this article you can get acquainted with the causes, the main signs of restless legs syndrome and the ways of its treatment.

Statistics and historical information

Despite the seeming rarity of the disease, it occurs in 5-10% of the world's population. Simply singling out all the symptoms in a separate diagnosis is quite rare (unfortunately, due to the lack of awareness of medical personnel).

About the restless legs syndrome, mankind has known for a long time. The first description was given in 1672 by Thomas Villis, but this problem was sufficiently well investigated only in the 40s of the 20th century by the Swede Ekbomom, therefore sometimes this disease is used under names of these scientists - disease of Willis or illness or disease Ekboma.

The most common disease among people of middle and old age. The female sex suffers more often in , times. About 15% of cases of chronic insomnia occur due to restless legs syndrome.

Causes

All episodes of restless legs syndrome fall into two groups, depending on the cause of the onset. Accordingly, they are distinguished:

• primary (idiopathic) restless legs syndrome;
• secondary (symptomatic) restless legs syndrome.

This division is not accidental, because the tactics of treatment are somewhat different in idiopathic and symptomatic syndrome.

Primary restless legs syndrome is more than 50% of cases. At the same time, the disease arises spontaneously, against a background of complete well-being. Some hereditary connection is traced (some areas of 9, 12 and 14 chromosomes are revealed, changes in which cause the development of the syndrome), but to say that the disease is exclusively hereditary, it is impossible. Scientists suggest that in such cases hereditary predisposition is realized against the background of a coincidence of a number of external factors. As a rule, the primary syndrome of restless legs occurs in the first 30 years of life (then they talk about the early onset of the disease). The disease accompanies the patient all his life, periodically weakening his grip, periodically intensifying. There are periods of complete remission within a few years.

Secondary restless leg syndrome is a consequence of a number of somatic and neurological diseases, the elimination of which leads to the disappearance of symptoms. Among such conditions are more common:

• chronic renal failure (up to 50% of all of its cases are accompanied by restless legs syndrome);
• Anemia due to iron deficiency in the body;
• diabetes;
• insufficiency of certain vitamins (B1, B12, folic acid) and trace elements (magnesium);
• amyloidosis;
• rheumatoid arthritis;
• cryoglobulinemia;
• thyroid disease;
• alcoholism;
• violation of the blood supply of the lower extremities (both arterial and venous problems);
• radiculopathy;
• multiple sclerosis;
• tumors and spinal cord injuries.

Paradoxically, but the normal physiological state of the body can cause a secondary syndrome of restless legs. I mean pregnancy. Up to 20% of all pregnant women in the II and III trimester, and sometimes after the birth, complain of the symptoms characteristic of restless legs syndrome.

Another reason for the secondary syndrome of restless legs may be the use of certain medications: neuroleptics, calcium channel blockers, antiemetics based on metoclopramide, lithium preparations, a number of antidepressants, some antihistamines and anticonvulsants. Also, excessive consumption of caffeine can serve as a trigger for the appearance of signs of the disease.

Secondary restless leg syndrome occurs later than the primary, on average, after 45 years (except cases related to pregnancy). In this case, talk about the late onset of the disease. Its course depends entirely on the cause. As a rule, the secondary restless leg syndrome has no remissions and is accompanied by a slow but steady progression (in the absence of treatment for the disease that caused it).

With the help of modern research methods it was found that the restless legs syndrome is based on a defect in the dopaminergic system of the brain. Dopamine is one of the transmitting substances of the brain that carry information from one neuron to another. Dysfunction of neurons that produce dopamine leads to a number of signs of restless legs syndrome. In addition, some of the hypothalamic neurons that regulate circadian rhythms (sleep-wakefulness on the basis of night and day shifts) are also related to the onset of this syndrome. The appearance of the disease on the background of problems with the peripheral nervous system is associated with the realization of a hereditary predisposition against the background of the action of provoking factors. A reliable mechanism for the formation of restless leg syndrome is not known.

Symptoms

The main signs of the disease are:

• unpleasant sensations in the lower extremities. The word "unpleasant" means a whole range of phenomena: tingling, burning, a feeling of crawling, twitching, tingling, stretching, itching, dull brain or cutting pain. Sometimes patients can not choose a word to describe their feelings. Most often these sensations arise in the legs, but not symmetrically, but with a predominance in one or the other limb. Perhaps one-sided onset of the disease, but then the process will still embrace both extremities. After the shins, these signs appear in the feet, knees, hips. In severe cases, hands, torso, and perineum are involved. Then the sensations become simply unbearable;
• the need to constantly move the limbs, in which there were unpleasant sensations. Why the need? Because in another way a person simply can not get rid of these sensations, and the movement brings noticeable relief or even the disappearance of symptoms. But as soon as a person stops, obsessive unpleasant sensations appear again;
• sleep disturbance. The fact is that the occurrence of unpleasant sensations in the legs is associated with a daily rhythm. As a rule, they appear after a few minutes after going to bed, which means they do not let you fall asleep. Also, such feelings arise during the rest period. The maximum severity of symptoms falls on the first half of the night, in the morning it decreases, and in the morning, symptoms may be absent altogether. It turns out that a person can not sleep. He is forced to constantly move his feet, shake and rub his limbs, toss and turn in the bed, get up and wander around the house to get rid of the sensations. But as soon as he lies back in bed, a new wave is rolling in. Lack of sleep at night leads to daytime drowsiness, reduced efficiency. In severe cases, the daily rhythm is lost, and the symptoms become permanent;
• the appearance of periodic movements of limbs in a dream. If the patient still manages to fall asleep, then in his sleep, the muscles of his legs involuntarily contract. For example, the fingers on the foot extend and / or fan out, the knees are bent, and sometimes the hips. Movements are usually stereotyped. In severe cases, hands are involved. If the movements are insignificant in their amplitude, then the person does not wake up. But most often such movements lead to awakening and so exhausted by the lack of sleep of the patient. Such episodes can be repeated an infinite number of times per night. This time of day becomes torture for the patient;
• the emergence of depression. Prolonged absence of sleep, incessant unpleasant sensations in the limbs, loss of working capacity and even fear of nightfall may trigger the onset of depressive disorders.

From all of the above, it becomes clear that all the main symptoms of restless leg syndrome are associated with subjective sensations. In most cases, a neurological examination of such patients does not reveal any focal neurological symptoms, sensitivity disorders or reflexes. Only if restless legs syndrome develops against the background of the existing pathology of the nervous system (radiculopathy, multiple sclerosis, tumors of the spinal cord, and so on), then changes in the neurological status are confirmed that confirm these diagnoses. That is, in itself, the restless legs syndrome has no manifestations, which can be revealed during examination.

Diagnostics

Periodic movements in the limbs are recorded during polysomnography.

Precisely because the main signs of restless leg syndrome are associated with subjective sensations that are presented patients in the form of complaints, the diagnosis of this disease is based solely on clinical signs.

Additional methods of investigation in this case are conducted in order to find the possible cause of the disease. After all, some pathological conditions can go unnoticed for the patient, manifested only by the syndrome restless legs (for example, iron deficiency in the body or the initial stage of a tumor of the spinal cord). Therefore, such patients carry out a general blood test, a blood test for sugar, a general urine test, determine the level of ferritin in plasma (reflects the saturation of the body with iron), make electroneuromyography (shows the state of nerve conductors). This is not the whole list of possible examinations, but only those that are conducted almost to every patient with such complaints. A list of additional research methods is determined individually.

One of the research methods, indirectly confirming the presence of restless leg syndrome, is polysomnography. This is a computer study of the phase of a person's sleep. At the same time, a number of parameters are recorded: electrocardiograms, electromyograms, leg, thoracic and abdominal wall movements, a video of the dream itself and so on. During polysomnography, periodic movements in the limbs that accompany the restless leg syndrome are recorded. Depending on their number, conditionally determine the severity of the syndrome:

• easy flow - up to 20 movements per hour;
• average weight - from 20 to 60 movements per hour;
• heavy current - more than 60 movements per hour.

Treatment

Treatment of restless legs syndrome depends, first of all, on its variety.

Secondary restless leg syndrome requires treatment of the underlying disease, as its elimination or reduction in manifestations contributes to the regression of signs of restless legs syndrome. Elimination of iron deficiency, normalization of blood glucose level, replenishment of a deficiency of vitamins, magnesium and other similar measures lead to a significant decrease in symptoms. The rest is completed by medicamentous and non-medicamentous methods of treating the restless leg syndrome itself.

The primary syndrome of restless legs is treated symptomatically.

All measures of care for this disease are divided into non-drug and medicamentous.

Non-pharmacological methods:

• abolition of medications that may exacerbate symptoms (neuroleptics, antidepressants, antiemetics and so on. The list of drugs was voiced above). If possible, they should be replaced by other means;
• It is necessary to avoid the use of caffeine (coffee, strong tea, coca-cola, energy drinks, chocolate) and alcohol;
• to give up smoking;
• creating comfortable conditions for falling asleep. It implies a retirement to sleep at the same time, a comfortable bed, a peculiar ritual of retiring to bed;
• walk before going to bed;
• moderate exercise during the day. Only not exciting type: yoga, pilates, swimming will do. But from basketball, volleyball, Latin American dances and that detailed training it is better to abstain;
• a warm foot bath or rubbing the feet before going to bed;
• warm shower;
• percutaneous electrostimulation;
• vibromassage;
• acupuncture;
• physiotherapy methods: magnetotherapy, darsonvalization, mud therapy.

In cases of mild disease, only these measures can be sufficient, and the disease will recede. If they do not help, and the disease causes a persistent violation of sleep and life, then resort to medications.

Medication methods:

• dopaminergic agents (preparations containing L-Dopa-Nakom, Madopar, Sinemet, dopamine receptor agonists -Pramipexol Pronoran, Bromocriptine). These drugs are the first line of choice, they begin treatment. For preparations containing L-Dopa, the initial dosage is 50 mg of levodopa 1-2 hours before bedtime. If this is not enough, then about a week later increase the dose by another 50 mg. The maximum dose is 200 mg. Dopamine receptor agonists exert an effect comparable in effect to L-DOPA preparations. Pramipexole is prescribed, starting at 0.125 mg, the dosage can be increased to 1 mg, Bromocriptine - from 1.25 mg (up to 7.5 mg), Pronoran - from 50 mg (up to 150 mg). If one dopamine receptor agonist is ineffective, it is advisable to replace it with another. There is only one feature of dopaminergic drugs: they do not normalize sleep. Therefore, in cases where the elimination of discomfort and periodic movements in the limbs is not accompanied by the restoration of the structure of sleep, resort to the addition of sedatives;
• benzodiazepines. Among this chemical group, clonazepam is more commonly used (starting from 0.5 mg at night and up to 2 mg) and Alprazolam (0.25 mg to 0.5 mg per night). Benzodiazepines have a greater effect on sleep than on discomfort and periodic movements in the legs, which is why they are referred to as "emergency" drugs for the treatment of restless legs syndrome;
• anticonvulsants (Gabapentin, Neurontin, Carbamazepine) and opioids (Tramadol, Codeine, Dihydrocodeine, Oxycodone). These drugs are used last, only if dopaminergic and benzodiazepine drugs have been ineffective or have had significant side effects. Gabapentin is prescribed in an increasing dosage starting from 300 mg and reaching a maximum dose of , 00 mg (stop at the dose that has an effect). The entire dose taken at night for one reception. Tramadol is taken at 50-400 mg per night, Codeine - 15-60 mg, Dihydrocodein - 60-120 mg, Oxycodone - 2.5 - 20 mg. These drugs are used only in especially severe cases of restless legs syndrome, as they can be addictive.

The peculiarity of medical treatment of restless legs syndrome is that it may take long (for years) taking medications. Therefore, it is necessary to try to achieve the effect of treatment at a minimum dosage. Gradually, the development of some addiction to the drug, which requires an increase in dose. Sometimes you have to change one drug to another. In any case, one should strive for monotherapy, that is, for the removal of symptoms with a single drug. The combination should be resorted to in the latter case.

There are cases when the patient needs to take medicines only during a significant increase in symptoms, and the rest - only by non-drug methods.

If restless legs syndrome leads to the development of depression, then, in this case, it is treated with selective monoamine oxidase inhibitors (Moclobemide, Bethol and others) and Trazodone. The remaining antidepressants may contribute to the worsening of restless legs syndrome.

Usually the application of all measures in a complex gives a positive result. The disease can be muted, and the person returns to the normal rhythm of life.

Treatment of pregnant women presents great difficulties, since most drugs are contraindicated in this condition. Therefore, they try to identify the cause (if possible) and eliminate it (for example, to compensate for the shortage of iron by receiving it from outside), and also dispense with non-drug methods. In extreme cases, with a particularly severe course, prescribe Clonazepam for a while or a small dose of Levodopa.

Thus, restless legs syndrome - this is a fairly common disease, the symptoms of which sometimes do not attach importance even the doctors themselves. They may not be considered as a separate disease, but only as part of the standard complaints of patients with sleep or depression disorders. And the patients continue to suffer. But in vain. After all, the restless legs syndrome is quite successfully treated, it is only right to recognize it.

European clinic "Siena-Med", video on "Treatment of Restless Leg Syndrome. Clinic, diagnostics »:

Treatment of Restless Leg Syndrome. Clinic and diagnosis of restless legs syndrome.

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