Restless leg syndrome – Causes and Symptoms

Introduction

Restless leg syndrome or Willis-Ekbom disease is a type of movement disorder in which there is an irresistible urge to keep moving the leg.  

There is an uncomfortable tingling, aching, creeping- crawling, pulling or even burning type of sensation. It is more common while at rest and especially during sleep and can cause sleep and mood disturbance. It can be associated with various underlying diseases.

What are the causes of restless leg syndrome?

There are two types of restless leg syndrome. The cause for type 1 is unknown, and it can begin at a young age and progress with varying symptoms and duration.

In secondary type of disease, there is sudden onset, especially at an older age, due to the underlying diseases and drug interactions. The micro level cause is due to alteration in levels of dopamine, which is a neurotransmitter in the brain.  

The various causes of restless leg syndrome are

• Genetics:  Restless leg syndrome is an autosomal dominant type of inheritance that can run in families.

• Deficiency: Iron deficiency can aggravate this disease as low levels of iron in the blood can cause a decrease in the production of dopamine in the brain. Apart from this, even folate and magnesium deficiency can cause the problem.  

• Kidney diseases: The terminal stage of kidney disease involving haemodialysis leads to alterations in the balance of substances, causing restless leg syndrome.  

• Medications: Most antidepressant, antipsychotic and anticonvulsant drugs can cause the disease.

• Diseases: Certain diseases have restless leg syndrome as associations like attention deficit hyperactivity disorder, Parkinson’s disease and Multiple sclerosis. It can occur even in the late stage of pregnancy. In such cases, after delivery, the symptoms go away.

Symptoms and signs of restless leg syndrome

The main symptom of restless leg syndrome is the uncomfortable urge to move legs. It can vary from mild to severe symptoms.

There is a feeling of tingling, aching, creeping- crawling, pulling or even burning type of sensations in the legs.

Usually, it affects the legs but can occur in any limb. This weird feeling causes one’s limb to keep moving.

The symptoms are relieved temporarily, but once the leg is stationary, it immediately returns back.  

This uncontrollable urge to keep the limbs moving results in irritation and tiredness. Over a period of time, the mind gets fatigued, and depression begins. This results in a loss of sleep and low mood, affecting the day-to-day activities.  

How to get tested?

There are no lab tests to diagnose this disease. The diagnosis of restless leg disease is made with the help of a doctor consultation, whereby history, physical examinations and clinical tests are done.

However, there are lab tests to check the associated diseases like iron deficiency anaemia. Restless leg syndrome should be differentiated from routine leg cramps, arthritis, neuropathy, radiculopathy, habitual foot tapping and other vascular diseases.   

How to get cured?

The treatment depends on the type of restless leg syndrome. Treatment consists of treating the associated diseases and causes, and in severe cases of restless leg syndrome, medications are given for the control of movements.  

• Physical activities: Regular exercises involving strengthening of calf muscles can bring tension in fibres and control the muscles. Just before bedtime, mild stretching exercises will decrease the symptoms.  

• Physiotherapy: Apart from exercises, heat and cold compress and manoeuvres are also helpful in relieving symptoms.  

• Sleep: Following a regular sleep-wake cycle and timings would regulate the circadian rhythm and prevent anxiety and low mood.  

• Foods: Avoid nervous system stimulating foods like tea, coffee and chocolate in late hours. Smoking and alcohol must be avoided too.  

• Supplementation: Iron, magnesium, folic acid and antioxidants are to be taken when deficiency is the cause of the disease.

• Medications: Depending on the clinical features, various medications like dopamine agonists, antidepressants and opioids are prescribed to control severe restless leg syndrome.  

Conclusion

Restless leg syndrome is not a severe disease. Hence it is often overlooked, and in due course of time, it will affect one’s mental health and daily activities. Timely consultation will help in early diagnosis.

Taking medications for the treatable cause would reverse the disease, and following good physical and mental therapy would help relieve the symptoms.  

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