• Restless Legs Syndrome (RLS, restless legs)

    Posted on August 20, 2021 by in Ailments

    Restless Legs Syndrome

    With Restless Leg Syndrome there is an agonizing feeling of restlessness and the urge to move the legs, especially in the evening and at night.

    In a nutshell: What is Restless Legs Syndrome?

     

    Restless legs syndrome (RLS, restless legs, Wittmaack-Ekbom syndrome) causes excruciating restlessness and tension in the legs, possibly also tingling, pulling or stinging. The arms are less often affected. The unpleasant sensations occur almost exclusively at rest, especially in the evening and at night, and rob you of sleep. Movement brings only short-term improvement.

    Restless legs occur during pregnancy. The symptoms usually go away after birth.

    If the restless legs are due to another disease than they will mostly resolve once the disease is taken care of. Otherwise, CBD oil is helpful or as a last resort, medication will help if the symptoms are severe.

    Experts estimate that RLS affects around 5 to 10 percent of the population. The risk increases with age.
    There is a family form. Here the disease may already be noticeable before the age of 30.
    In rare cases, restless legs appear in children. The symptoms can then be mistaken for growing pains or attention deficit hyperactivity disorder (ADHD).

    What are the typical symptoms of RLS?

     

    It is not always easy for those affected to describe their symptoms. Symptoms can vary from patient to patient. Nevertheless, there are distinctive features:

    • Those affected feel an uncomfortable feeling of tension and restlessness in the legs, and less often in the arms. Some patients also describe tingling, tearing, or stinging
    • They have an insatiable need to move, to tense or stretch their leg muscles
    • The unbearable restlessness occurs especially in the evening and at night, when those affected actually want to rest or sleep
    • The symptoms improve temporarily through activity – for example when the sick stand up and walk around. Some people give their legs a cold shower or massage. Afterwards, however, the complaints often return immediately
    • The restlessness in the legs makes it difficult for those affected to fall asleep, often not sleeping through the night, and they are tired and exhausted during the day

    Restless legs syndrome can severely restrict everyday life. Sitting for long periods – for example in the cinema, on the plane or in a restaurant – becomes torture. Friends and family do not always understand.

    Causes: How does Restless Legs Syndrome develop?

     

    Restless legs probably arise because the transmission of messages in the nervous system is disrupted. The exact causes have not yet been clarified.

    Researchers assume that restless legs are partly inherited, as the syndrome often affects several family members (familial RLS). If parents or siblings are ill, your own risk increases. In addition, certain changes in the genetic makeup (genes) increase the likelihood of developing restless legs.

    Restless legs can occur due to external influences or accompanying them (secondary RLS):

    • Iron deficiency
    • Kidney dysfunction
    • Pregnancy
    • Neurological diseases such as polyneuropathy or Parkinson ‘s disease

    Some medications can trigger or worsen Restless Legs Syndrome.

    How do you diagnose RLS?

     If RLS also occurs in family members, this makes the diagnosis more likely. The following four points speak in favor of restless legs syndrome:

    • Those affected feel an uncomfortable urge to move, mostly in the legs, possibly associated with sensory disturbances or pain
    • Symptoms mainly occur at rest
    • Exercise temporarily relieves symptoms
    • The symptoms are particularly noticeable in the evening and at night

    A neurological examination sometimes also provides indications of an (accompanying) nerve disease.

    Restless legs syndrome can be the result of other diseases or disorders. To find them, your practitioner can do additional tests:

    • A blood test can rule out an iron deficiency. The ferritin value should be in the upper normal range
    • The kidney values ​​in the blood provide information about the kidney function
    • The thyroid values ​​can reveal thyroid disorders

    Symptoms of RLS sometimes resemble those of the nerve disorder polyneuropathy. In order to delimit them, a doctor can measure the nerve conduction speed (electroneurography) and the functioning of the muscles (electromyography).

    If sleep disorders and pronounced daytime sleepiness are in the foreground, an examination in the sleep laboratory can be informative. The doctors use special measuring devices to record involuntary leg movements during sleep, for example. In this way, other causes of disturbed sleep can be identified.

    L-dopa test

     

    The L-Dopa test can confirm the suspicion of restless legs. The drug L-Dopa turns into dopamine in the brain. This influences the signal transmission of the nerves. In the L-Dopa test, the patient receives L-Dopa as soon as the symptoms set in. If the symptoms improve, this indicates a high probability of restless legs syndrome. However, if there is no improvement, this does not speak against RLS.

    Therapy: what helps with Restless Legs Syndrome?

     

    Whether restless legs syndrome should be treated is always an individual decision.

    RLS can occur during pregnancy. Then it often disappears after delivery.

    If the syndrome developed due to a disease or disorder, sometimes treating it is enough:

    • In the case of iron deficiency, the patient is given iron as a preparation or infusion
    • Severe renal impairment must be treated appropriately

    Some medications can make restless legs syndrome worse. It may be possible – in consultation with the doctor – to swap the drugs for more suitable ones.

    Therapy with drugs

    If the cause of Restless Legs Syndrome is unknown, symptoms can be treated with medication. The syndrome itself is currently incurable.

    Many people affected are helped by active ingredients that are also used in higher doses against Parkinson’s disease, such as dopamine preparations. Similar to the body’s own messenger substance dopamine, these drugs act on the communication between nerve cells. With all of these drugs, side effects such as nausea or dizziness can occur, especially in the first time after starting therapy.
    In addition to the Parkinson’s medication, an opiate (oxycodone and naloxone) is approved for severe RLS, which is slowly released into the bloodstream after ingestion (retarded).

    “Augmentation” problem

    Sometimes dopamine supplements exacerbate the symptoms of Restless Legs Syndrome, which is medically called augmentation. The risk of augmentation increases the higher the dose of Parkinson’s medication. The symptoms develop earlier in the day and not in the evening or at night. Often they are more agonizing than before. They set in more quickly when they are at rest and can spread to other parts of the body. Augmentation can be treated by switching to another drug.

    What else can help?

     

    Some patients have good experiences with home remedies such as alternating showers or light gymnastics. Some try homeopathy. It is unclear whether magnesium supplements will help. Some patients have good results with CBD oil.

    Restless legs syndrome can severely impair the quality of life and psychological well-being. In such cases, the possibility of psychotherapeutic support should be considered. The exchange with other affected persons – for example in a self-help group – may have relief.

    It is unlikely that colonics will help with restless legs as such, and we don’t know yet if our microbiome can help with this problem. But seeing that about 50% dopamine is produced in the gastrointestinal tract by enteric neurons and intestinal epithelial cells, it makes sense that it is important to keep it well functioning.

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