Restless legs syndrome

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Restless Legs Syndrome ( RLS ) is a disorder that causes a powerful push to move a person's foot. Often there is an unpleasant feeling in the legs that somewhat improved by moving it. These are often described as sick, tingling, or crawling in nature. Sometimes the arm may also be affected. That feeling generally occurs when resting and therefore can make it difficult to sleep. Due to sleep disturbances, people with RLS may experience daytime sleepiness, low energy, irritability, and depressed mood. In addition, many who move the foot during sleep.

Risk factors for RLS include low iron content, renal failure, Parkinson's disease, diabetes mellitus, rheumatoid arthritis, and pregnancy. A number of drugs can also trigger disorders including antidepressants, antipsychotics, antihistamines, and calcium channel blockers. There are two main types. One is an early onset RLS that begins before age 45, runs in the family and worsens over time. The other is a slow onset RLS that begins after age 45, starts suddenly, and does not worsen. Diagnosis is generally based on a person's symptoms after exclusion of other potential causes.

Restless leg syndrome can resolve if the underlying problem is handled. Otherwise, treatments include lifestyle changes and medications. Lifestyle changes that can help include stopping the use of alcohol and tobacco, and maintaining cleanliness. Medications used include levodopa or dopamine agonists such as pramipexole. RLS affects about 2.5-15% of the American population. Women are more often exposed than men and it becomes more common with age.

Video Restless legs syndrome

Signs and symptoms

The RLS sensation ranges from muscle pain or pain, to "itching that you can not scratch", "humming sensation," "restlessness that will not stop," feelings of "crawling," or limbs jerking when awake. Sensations usually start or intensify during awake, such as when relaxing, reading, studying, or trying to sleep.

It is a "spectrum" disease with some people having only minor disturbances and others experiencing sleep disturbances and impairments in quality of life.

Sensation - and the need to move - may return immediately after stopping moving or at a later time. RLS can start at any age, including childhood, and is a progressive disease for some people, while symptoms can pass on to others. In a survey among members of the Foot Restless Syndrome Foundation, it was found that up to 45% of patients experience their first symptoms before the age of 20 years.

• "The urge to move, usually because of the uncomfortable sensations that occur mainly in the legs, but sometimes on the arm or elsewhere."

The sensation is unusual and unlike other common sensations. Those with RLS have a hard time describing them, using words or phrases such as discomfort, pain, anxiety, electricity, creeping, itching, pinching and needle, pulling, crawling, buzzing and numbness. Sometimes described as similar to a 'falling asleep' limb or an excessive positional awareness of the affected area. Sensation and encouragement can occur in any part of the body; the most cited location is the foot, followed by the arm. Some people have little or no sensation, but still, have a strong urge to move.

• "Motor anxiety, expressed as activity, which reduces the drive to move."

The movement usually brings immediate help, albeit temporarily and partially. The most common walking path; However, stretching, yoga, cycling, or other physical activity can relieve symptoms. Continuous and fast moving up and down movements, and/or rapidly moving the legs toward and away from each other, can keep the sensation at bay without having to walk. Special movements may be unique to everyone.

• "Deteriorating symptoms with relaxation."

Sitting or lying (reading, plane, watching TV) can trigger the sensation and drive to move. The severity depends on the severity of a person's RLS, level of anxiety, duration of inactivity, etc.

• "Variability during the day-night cycle, with symptoms worsening at night and early in the night."

Some experience RLS only at bedtime, while others experience it throughout the day and night. Most people experience the worst symptoms at night and at least in the morning.

• "An anxious leg feels like an urge to yawn, located in the leg or arm."

These RLS symptoms can make sleep difficult for many patients and recent polls show significant daytime difficulties resulting from this condition. These problems range from being late to work or events lost due to drowsiness. Patients with responding RLS reported more drowsy driving than patients without RLS. This daytime difficulty can be translated into safety, social and economic problems for patients and communities.

Individuals with RLS have higher levels of depression and anxiety disorders.

Primary and secondary

RLS is categorized as primary or secondary.

• Primary RLS is considered idiopathic or without known cause. Primary RLs usually start slowly, before about 40-45 years and may disappear for months or even years. It is often progressive and worsens with age. RLS in children is often misdiagnosed as growing pain.
• Secondary RLs often have sudden onset after the age of 40, and possibly daily from scratch. This is most related to certain medical conditions or the use of certain drugs (see below).

Maps Restless legs syndrome

Cause

RLS is often caused by iron deficiency (low total body iron status) and this accounts for 20% of cases. A study published in 2007 noted that the RLS feature was observed in 34% of people who had iron deficiency compared with 6% of controls.

Other associated conditions include varicose veins or venous reflux, folate deficiency, magnesium deficiency, fibromyalgia, sleep apnea, uremia, diabetes, thyroid disease, peripheral neuropathy, Parkinson's disease, POT, and certain autoimmune diseases such as SjÃÆ'¶gren syndrome, celiac disease, and rheumatoid arthritis. RLS can also worsen in pregnancy. In a 2007 study, RLS was detected in 36% of people attending the phlebology clinic (vascular disease), compared with 18% in the control group.

ADHD

A relationship has been observed between attention deficit hyperactivity disorder (ADHD) and RLS or periodic limb movement disorders. Both conditions appear to be related to dysfunction associated with dopamine neurotransmitters, and common drugs for both conditions among other systems, affect the level of dopamine in the brain. A 2005 study showed that up to 44% of people with ADHD had comorbid (ie co-existing) RLS, and up to 26% of people with RLS had confirmed ADHD or symptoms of the condition.

Drugs

Certain drugs may cause or worsen the RLS, or cause it secondary, including:

• Certain antemetics (antidopaminergic)
• Certain antihistamines (especially first-generation H1 sedative antihistamines often use over-the-counter cold medicines)
• many antidepressants (both older TCAs and newer SSRIs)
• certain antipsychotics and anticonvulsants.
• the rebound effects of sedative-hypnotic drugs such as benzodiazepine withdrawal syndrome from benign sedative benzodiazepines or sleeping pills.
• Alcohol withdrawal may also cause restless leg syndrome and other movement disorders such as akathisia and parkinsonism usually associated with antipsychotics
• the withdrawal of opioids is associated with causing and worsening RLS.

Both primary and secondary RLS may be aggravated by any operation; However, back surgery or injury may be associated with causing RLS.

Causes vs. the effect of certain conditions and behaviors observed in some patients (eg overweight, lack of exercise, depression or other mental illness) is not well known. Sleep loss due to RLS can cause a condition, or a drug used to treat a condition may cause RLS.

Genetics

More than 60% of RLS cases are familial and are inherited autosomally dominant with variable penetration.

Brain research and autopsy have involved dopaminergic systems and iron insufficiency in nigra substansia. Iron is understood as an important factor for the formation of L-dopa, dopamine precursor.

The six genetic loci found by the relationship are known and listed below. In addition to the first, all link loci were found using an autosomal dominant inheritance model.

• The first genetic site was found in a large Canadian family and charted on a 12q chromosome. The locus was found using an autosomal recessive recessive model. Evidence for this locus was also found using a disequilibrium transmission test (TDT) in 12 Bavarian families.
• Map of the second RLS locus onto chromosome 14q and found in one Italian family. The evidence for this locus is found in one French Canadian family. Also, an association study in a large sample of 159 European descendants showed some evidence for this locus.
• This map maps to the 9p chromosome and is found in two unrelated American families. The evidence for this locus is also found by TDT in large Bavarian families, where significant associations to this locus are found.
• This map maps to the 20p chromosome and is found in a large Canadian French family with RLS.
• This map maps to the 2p chromosome and is found in three related families of isolated populations in South Tyrol.
• The sixth place lies on chromosome 16p12.1 and is found by Levchenko et al. in 2008.

Three genes, MEIS1, BTBD9 and MAP2K5, were found to be associated with RLS. Their role in the pathogenesis of RLS remains unclear. Recently, the fourth gene, PTPRD was found to be associated with RLS

There is also some evidence that the movement of the periodic legs in sleep (PLMS) is related to BTBD9 on chromosomes 6p21.2, MEIS1, MAP2K5/SKOR1, and PTPRD. The presence of a positive family history indicates that there may be genetic involvement in the etiology of RLS.

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Mechanism

Most research on the mechanisms of restless legs syndrome has been focused on dopamine and iron systems. This hypothesis is based on the observation that iron and levodopa, dopamine prodrugs that can penetrate the blood brain barrier and be metabolized in the brain into dopamine (as well as other mono-amine neurotransmitters of the catecholamine class) can be used to treat RLS, levodopa to be a drug to treat hypodopaminergic conditions ( low dopamine) such as Parkinson's disease, as well as findings from functional brain imaging (such as positron emission tomography and functional magnetic resonance imaging), autopsy series and animal experiments. Dopamine and iron-related marker differences have also been shown in individual cerebrospinal fluid with RLS. The relationship between these two systems is demonstrated by the finding of low iron levels in the substantia nigra of RLS patients, although other areas may also be involved.

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Diagnosis

There are no specific tests for RLS, but non-specific laboratory tests are used to rule out other causes such as vitamin deficiency. According to the National Institute of Health's National Institute of Neurological Disorders and Stroke, four symptoms are used to confirm the diagnosis:

• A strong push to move limbs, usually associated with uncomfortable or uncomfortable sensations.
• It starts or worsens during off or rest.
• This improves or disappears (at least temporarily) with activity.
• Worse at night or night.
• These symptoms are not caused by medical conditions or behavior.

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Differential diagnosis

Other conditions that can produce similar symptoms include: akathisia and nocturnal foot cramps.

Peripheral arterial disease and arthritis can also cause foot pain but this usually worsens with movement.

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Prevention

In addition to preventing the underlying cause, there is generally no predefined or learned RLS prevention method. If RLS is due to specific treatable causes (certain drugs or treatable conditions), then the causative treatment may also eliminate or reduce RLS. Otherwise, the medical response focuses on treating the condition, either symptomatic or by targeting lifestyle changes and body processes that are capable of altering its expression or severity.

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Treatment

Treatment of restless leg syndrome involves identifying the cause of symptoms whenever possible. The treatment process is designed to reduce symptoms, including reducing the number of nights with RLS symptoms, the severity of RLS symptoms and waking up at night. Improving quality of life is another goal in care. This means improving overall quality of life, reducing daytime sleepiness, and improving sleep quality. Pharmacologic treatments involve dopamine or gabapentin enacarbil agonists as first-line drugs for daily restless leg syndrome, and opioids for treatment of resistant cases. RLS drug therapy is not curative and has side effects such as nausea, dizziness, hallucinations, orthostatic hypotension, or daytime sleep attacks. The algorithms created by the Mayo Clinic researchers provide guidance to doctors and caring patients, including nonpharmacologic and pharmacological treatments.

Treatment of RLS should not be considered until the possibility of medical causes is excluded, especially venous disorders. Secondary RLS can be cured if medical conditions trigger (anemia, venous disorders) are managed effectively. Secondary conditions that cause RLS include iron deficiency, varicose veins, and thyroid problems.

Physical measurements

Stretching the leg muscles can bring temporary relief. Walking and moving the legs, as the name "legs agitated" implies, carries temporary relief. In fact, those with RLs often have an almost uncontrollable need to walk and therefore relieve symptoms as they move. Unfortunately, symptoms usually return as soon as the moves and runs stop. Vibration counter-stimulation devices have been found to help some people with primary RLS to improve their sleep.

Non-drug treatments include foot massages, hot baths, heating pads or ice packs applied to the feet, good sleeping habits and nighttime vibratory pads.

Iron

According to some guidelines, everyone with RLS should have their serum ferritin level tested. The ferritin level, the size of the body iron, should be at least 50 Âμg/L (or ng/mL, equivalent units) for those with RLS. Oral iron supplements can increase ferritin levels. For some, increased ferritin will eliminate or reduce the symptoms of RLS; 50 Âμg/L ferritin levels are insufficient for some and increase levels up to 80 Âμg/L may reduce further symptoms. However, at least 40% of people will not see any improvement. It is not advisable to take oral iron supplements without first having tested ferritin levels, as many people with RLS do not have low ferritin and take iron when not asked to offer no therapeutic benefits while still causing side effects. All parenteral iron treatment requires a diagnosis with laboratory tests to avoid excess iron.

Drugs

For those whose RLS interferes with or prevents sleep or ordinary everyday activities, drugs may be useful. Evidence supports the use of dopamine agonists including: pramipexole, ropinirole, rotigotine, and cabergoline. They reduce symptoms, improve sleep quality and quality of life. Levodopa is also effective. One review found pramipexole better than ropinirole.

However, there are problems with the use of dopamine agonists including augmentation. This is a medical condition where the drug itself causes symptoms to increase severity and/or occur earlier in the day. Dopamine agonists may also cause rebounds when symptoms increase when the drug runs out. In many cases, the longer the dopamine agonist is used, the higher the risk of augmentation and rebound and the severity of the symptoms. Also, recent research has shown that dopamine agonists used in restless leg syndrome can lead to an increase in compulsive gambling.

• Gabapentin or pregabalin, non-dopaminergic treatment for moderate to severe primary RLS
• Opioids are only indicated in severe cases that do not respond to other measures because of the high rates of adverse events.

Benzodiazepines, such as diazepam or clonazepam, are generally not recommended, and their effectiveness is unknown. However they are sometimes still used as the second line, such as adding an agent. Quinine is not recommended because of the risk of serious side effects involving blood.

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Prognosis

The symptoms of RLS may gradually worsen with age, although more slowly for those with an idiopathic RLS form than patients who also have a related medical condition. However, current therapy can control the disorder, minimize symptoms and improve periods of restful sleep. In addition, some patients have remission, a period in which symptoms decline or disappear for days, weeks, or months, although symptoms usually resurface eventually. Diagnosed with RLS does not show or shadow other neurological diseases.

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Epidemiology

RLS affects about 2.5-15% of the American population. A small number (about 2.7% of the population) has daily or severe symptoms. RLS is twice as common in women as in men, and Caucasians are more vulnerable to RLS than people of African descent. RLS occurs in 3% of individuals from the Mediterranean or Middle East region, and in 1-5% of those from the Far East, indicating that different genetic or environmental factors, including diet, may play a role in the prevalence of this syndrome.

With age, RLS is becoming more common, and RLS diagnosed at older ages runs more severely.

RLS is even more common in individuals with iron deficiency, pregnancy, or end-stage renal disease. Poor public health is also linked.

Neurologic conditions associated with RLS include Parkinson's disease, spinal cerebral atrophy, spinal stenosis, lumbosacral radiculopathy and Charcot-Marie-Tooth type 2 disease. Approximately 80-90% of people with RLS also have periodic limb movement disorders (PLMD) slow. "jerk" or flexion of affected body parts. It occurs during sleep (PLMS = periodic leg movement during sleep) or upon awakening (PLMW - periodic leg movement during waking).

The National Sleep Foundation's 1998 Sleeping States show that up to 25 percent of pregnant women develop RLS during the third trimester.

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History

The first known medical description of the RLS was by Sir Thomas Willis in 1672. Willis emphasized the sleep disorders and limb movements experienced by people with RLS. Originally published in Latin ( De Anima Brutorum , 1672) but later translated into English ( The London Practice of Physics , 1685), Willis wrote:

The term "anxiety in the feet" has also been used as early as the nineteenth century.

Furthermore, other descriptions of the RLS were published, including those by Francois Boissier de Sauvages (1763), Magnus Huss (1849), Theodur Wittmaack (1861), George Miller Beard (1880), Georges Gilles de la Tourette (1898), Hermann Oppenheim 1923) and Frederick Gerard Allison (1943). However, it was not until nearly three centuries after Willis, in 1945, that Karl-Axel Ekbom (1907-1977) provided a detailed and comprehensive report of this condition in his doctoral thesis, Restless Legs: a clinical study that has until now been neglected. disease . Ekbom coined the term "restless legs" and continued to work on this disorder throughout his career. He describes important diagnostic symptoms, differential diagnoses of other conditions, prevalence, association with anemia, and common events during pregnancy.

The work of Ekbom was largely ignored until rediscovered by Arthur S. Walters and Wayne A. Silence in the 1980s. Subsequent landmark publications include paper 1995 and 2003, which revise and update diagnostic criteria. The Journal of Parkinsonism and RLS is the first peer-reviewed, online, open-access journal dedicated to publishing research on Parkinson's disease and established by Canadian neurologist Dr. Abdul Qayyum Rana.

Nomenclature

For decades the most widely used name for the disease is restless leg syndrome, and it's still the most commonly used. In 2013, the Restless Leg Syndrome Foundation changed its name to the Willis-Ekbom Disease Foundation, and encouraged the use of the name Willis-Ekbom's disease; the reasons cited are as follows:

A point of confusion is that RLS and delusional parasitosis are completely different conditions that are both called "Ekbom syndrome", because both syndromes are described by the same person, Karl-Axel Ekbom. Today, calling WED/RLS "Ekbom syndrome" is an outdated usage, since unambiguous names (WED or RLS) are preferred for clarity.

Controversy

Some doctors have expressed the view that the incidence of restless leg syndrome is exaggerated by the drug manufacturers used to treat it. Others believe it is an unrecognized and persecuted disorder. Furthermore, GlaxoSmithKline running ads, while not promoting off-license use of their drug (ropinirole) for the treatment of RLS, did link to the web site Ekbom Support Group. The website contains a statement that advocates the use of ropinirole to treat RLS. ABPI decides against GSK in this case.

References

External links

• Restless leg syndrome in Curlie (based on DMOZ)
• "National Institutes of Health: What is Restless Legs Syndrome?".
• "Restless Leg Syndrome Information Page: National Institute of Neurological Disorders and Stroke (NINDS)". Ã,

Source of the article : Wikipedia