Restless legs syndrome, a common and little-known disease

Restless Legs Syndrome (RLS) or Willis-Ekbom disease (WES) is a movement disorder closely linked, but not only, to the sleep period, appearing during periods of rest later in the day (it has a circadian rhythm preferably at night) and causing insomnia secondary to discomfort, often severe.

Restless Legs Syndrome (RLS) is a very common disease, affecting to a greater or lesser extent 10-15% of the Western population, and about 3-5% of them have discomfort of sufficient intensity to require treatment. In the latter cases, it causes a profound alteration in the quality of life and daily performance and, in time, in health, as it predisposes to cardiovascular and metabolic alterations. It is more frequent in women, in a ratio of 2 to 1 with respect to men. It can appear at any age, being most frequent between 25 and 40 years of age.

Despite this, Restless Legs Syndrome-EWE is still poorly understood, underdiagnosed and often underestimated in consultations, even in specialized ones, and often poorly managed in terms of treatment.

Restless Legs Syndrome Symptoms

It consists of an imperious, irresistible need to move the legs, which appears only at rest, sitting and/or lying down, in general or especially in the late afternoon-evening, which is relieved by movement of the legs for the duration of the same (kicking, stretching-shrugging, rubbing one leg against the other, walking…), usually reappears again with rest, and causes insomnia of conciliation and/or maintenance if the symptoms are intense.

In general, but not always, the need for movement is accompanied by unpleasant, sometimes ill-defined, internal sensory discomfort in the legs, which is difficult to describe. Periodic leg movements also frequently appear during wakefulness at rest (noticed by the affected person) and/or during sleep (mostly noticed by the partner or family members), consisting of brief involuntary jerks of the legs, with a defined periodic rhythm. Occasionally, less frequently, Restless Legs Syndrome-EWE may also affect the arms and/or other parts of the body.

Discomfort may also appear during prolonged rest in the afternoon, at rest times, long trips, in cinemas or theaters, meetings, dinners…, with the consequent alteration of the quality of life, leisure and social and work relationships. The need to get out of bed and eat at night, which can lead to weight gain, is more frequent than usual in those affected.

Causes of Restless Legs Syndrome

On the basis of genetic predisposition, it is considered that the problem lies in a low availability of iron at the level of the central nervous system (brain and spinal cord), due to alteration of its transport mechanism; this causes an alteration in the function of several neurotransmitters, such as dopamine, glutamate and adenosine, which causes the symptoms.

Restless Legs Syndrome-EWE has been classically divided into primary, the most frequent, with a strong genetic load and earlier onset; and secondary, associated with other processes that could trigger it, of later onset. Lately it is thought that this strict division may not be entirely appropriate; if the genetic load is very high, the disease appears earlier and without triggers; the lower the genetic load, the later the onset may be and the associated triggers may be more evident.

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A large number of processes associated with more or less “secondary” cases have been described. Those with the strongest scientific evidence are iron deficiency (iron deficiency in the blood) and advanced renal failure. With less evidence but also frequent, are pregnancy and certain medications that, if taken, can worsen or provoke symptoms in predisposed patients, some of them of very frequent use, being this fact very little known in general in consultations.

Restless Legs Syndrome in children

It can appear at any age, including very young children. In the pediatric age, secondary sleep deprivation causes behavioral disorders and school performance problems.

Children become scattered, very restless and sometimes irritable, it is their body’s way of “complaining” and they are often labeled with primary attention deficit hyperactivity disorder rather than a symptom of poor sleep quality (on the other hand, they can sometimes have both, it is not at all uncommon). In young children, symptoms are usually described by family members and may be somewhat atypical for adults.

Restless legs syndrome, treatment

It is a complex disease if there are other health problems and/or additional treatments. And, as far as the affected person is concerned, the only thing that should never be done is to do nothing, to put up with it, even if the symptoms are not yet very annoying, because if the process is moderate-intense it destroys the quality of life and health. But almost worse than doing nothing in this disease is to do the wrong thing, so it is important to put yourself in the hands of a professional expert in the disease, especially thinking in the long term.

If the frequency and intensity of the symptoms require it, the treatment is drug treatment, and it is chronic, long term (it is symptomatic, not curative). The drugs are specific for this disease, it is not useful to use generic sleeping pills, antidepressants, sedatives or muscle relaxants, which sometimes even worsen the process. There are three families of useful drugs: dopaminergic agonists, alpha 2 delta modulators and, occasionally and not continuously, some opiates (some other family of drugs are being investigated, with good initial perspectives). The age and circumstances of the patient are fundamental in choosing which drug to use from the beginning and how to use it, since excessive doses and/or inadequate schedules of some families of drugs can worsen the disease in the medium to long term.

It is also important to periodically control certain laboratory parameters, especially, but not only, the blood ferritin value, which if altered can worsen the symptoms, although there is a benefit if they are normalized (the benefit is more pronounced in children, it can considerably delay the taking of drugs). In some selected cases of difficult control, intravenous iron supplementation at high doses has recently been used, sometimes achieving remission of symptoms in the medium to long term. Specific measures of sleep hygiene and rhythm of life are always useful as an aid, but by themselves are never sufficient in moderate-intense cases.