Restless legs syndrome( Willys disease, ecbom disease) - Causes, symptoms and treatment. MF.
Restless legs syndrome has several names that you can also meet: Willis disease, Ekbooma disease. All these terms refer to a state where unpleasant sensations in the legs or hands cause the movement and deprivation of sleep. The most interesting thing is that the movements cause relief.
This picture is attributed to neurological diseases. The syndrome of restless legs is more affected by adults, especially the elderly. Occurrence of restless legs syndrome after 60 years is 4 times higher than in children.
Possible causes of restless legs syndrome
Restless legs syndrome can appear without any obvious cause, in this case they speak of primary restless leg syndrome, or idiopathic .This is most often a hereditary variant of the disease, which can be found in half of the patient's close relatives.
More frequent secondary form of restless legs syndrome is associated with any disorder or disease, which is based on a violation of dopamine and iron metabolism in the central nervous system. This is often the case with:
• pregnancy,
• anemia,
• kidney failure,
• spinal cord injury,
• diabetes,
• toxic damage against alcoholism,
• use of certain medications.
In view of the fact that these medications are often prescribed to patients, we list them:
• Caffeine-containing preparations
• Alcohol. Its action is twofold - at first the muscles relax, and then the sensations increase, especially with alcoholism.
• Antiemetic drugs, such as prochlorperazine, metoclopramide. Their action is particularly pronounced.
• Antihistamine( from allergies), diphenhydramine( and other non-prescription antipyretic drugs)
• Tricyclic antidepressants
• Antidepressants from the SSRIs group( selective serotonin reuptake inhibitors).
• Lithium preparations
• Calcium channel blockers( to lower blood pressure)
• Typical antipsychotics( phenothiazines)
• Atypical antipsychotics( olanzapine and risperidone)
• Anticonvulsants( phenytoin, metksuximide, zonisamide)
Symptoms of restless legs syndrome
ManifestationsThe syndrome of restless legs is characterized by unpleasant sensations of all the options that can only come up.60% of patients have pain. There may also be convulsions, twisting, burning, tingling, crawling, pulling sensations in the legs. Sometimes they are even difficult to formulate.
However, it is fairly simple to answer the question what are the features of the RLS manifestation:
- They are unpleasant
- Symptoms worsen at rest
- Movements weaken sensations in restless legs syndrome
- Circadian pattern( intensified in the evening and in the first half of the night)
- Maybe motion in the dream( twitching or cramps of the legs or hands)
- Feelings interfere with falling
When you turn to the doctor with restless legs syndrome
If the discomfort does not prevent you from falling asleep and quietly doing what Inm would be desirable, it is enough to perform simple obscheprofilakticheskie event( see below), to cope with restless legs syndrome alone.
The reason for going to the doctor is usually the inefficiency of home methods and the development of insomnia, the appearance of daytime symptoms when it is impossible to sit in one place, away, in the car, in the plane. This depresses our patients, hinders their work and personal life. At this point they turn to the doctor.
Make it better sooner, because the solution can be very simple. In addition, it is not necessary to go to a neurologist. Any knowledgeable doctor can treat this condition. The doctor-somnologist in this respect is more aware, since restless legs syndrome is one of the leading causes of insomnia.
Diagnosis of Restless Leg Syndrome
The diagnosis of Restless Leg Syndrome is simple. There are criteria that are specific only for this disease. If they coincide, then additional diagnostic and analysis methods are not necessary. A doctor can start treatment to help you as soon as possible. But if not all the criteria fit your condition, or you want to know the true cause of restless legs syndrome and try to get rid of it, then you should think about a more careful approach.
What can help in a restless leg syndrome examination? First of all, you need to exclude similar conditions and diseases in order to choose the right treatment. Analyzes that can help in this:
• General blood test
• Blood serum
• Folate, vitamin B12
• Blood sugar
• Blood test for creatinine, urea, total protein
• Urine test: Reberga sample, albumin
• Thyroid hormones( TTG, T4 free, AT-TPO)
• Pregnancy test
As a result, it will be possible to evaluate the function of the kidneys, thyroid, anemia, pregnancy or diabetes. Of all the tests, the most sensitive is ferritin. If this value is below 45 ng / l, the probability of restless leg syndrome increases dramatically, although iron and other markers of anemia may still be normal. Instrumental methods for evaluating the conductivity of nerves: electron neuromyography.
It is possible that the doctor will prescribe you dopaminergic drugs to determine their effect. This is one of the diagnostic methods that indicates the correctness of the diagnosis. Actually, the scientists realized that the neurodiator dopamine is involved in the development of restless legs syndrome, which facilitates the transfer of nervous impulses to dopaminergic neural connections.
Polysomnography( PSG) is less commonly used. It helps to assess the effect of restless leg syndrome on sleep and to identify movements of the legs or hands in sleep that can periodically awaken the brain at night. PSG is performed in the following cases:
• The main symptom of restless legs syndrome is daytime drowsiness and there is a chance of insomnia.
• There are suspicions of the presence or combination with other sleep disorders( obstructive or central sleep apnea syndrome, parasomnia).
• Ineffective treatment with dopaminergic drugs.
• Atypical course of the disease.
• Severe symptoms in patients under 30 years of age.
During the diagnosis it is worth to distinguish the restless legs syndrome from diseases that give similar symptoms:
• side effects of drugs - akathisia,
• nocturnal muscle cramps,
• peripheral neuropathy,
• diabetes,
• thyroid diseases,
•fibromyalgia,
• rheumatoid arthritis, vascular diseases( varicose veins, for example),
• anxiety disorders.
Treating Restless Leg Syndrome
The treatment for restless legs syndrome is simple. The earlier you go to the doctor, the easier and faster to get rid of unpleasant sensations.
In cases where the sensations and movements that they cause do not cause special hassle during the day and do not interfere with sleep, you can use general preventive measures :
1. Restriction of caffeine in any form( coffee, tea, cola, chocolate, energyetc.)
2. Compliance with hygiene of sleep. Later, falling asleep and lifting will save the necessary duration of sleep and avoid daytime sleepiness. To improve sleep, it is important to provide comfortable conditions for sleep, as well as to avoid factors for awakening( for example, taking diuretics).
3. Unintentional exercise before bedtime immediately after the onset of symptoms. A later start will not bring the desired result. Symptoms can even increase, as with excessive intensity of sports. When choosing the type of exercise, give preference to anaerobic stress, for example, yoga, pilates, stretching, relaxation. Aerobic classes, such as running, jumping, volleyball, skis are less effective.
4. Intensive massage or rubbing your legs before going to bed.
5. Very hot or very cold foot baths.
6. An abstraction that requires concentration of attention( debates or discussions, creative classes, strategic video games, programming, etc.).
7. The use of physiotherapy procedures, such as massage, lymphopressure, mud therapy, magnetic field, can have some effect, however, not all.
8. Exclusion of drugs that can cause restless legs syndrome( see above).
A more pronounced restless leg syndrome implies a different tactic. already uses medicinal methods and combats the underlying cause of , if any. Here it is important to understand that if you can not eliminate the cause, then the treatment will be long, sometimes lifelong. In this regard, it is important to ensure minimal risks of side effects and the development of "addictive"( "enhancement phenomenon") during treatment.
That's why self-medication or treatment with folk methods is unacceptable. You simply deprive yourself of the opportunity to fully cope with unpleasant sensations, and in a year or two you will again begin to suffer from the restless legs syndrome.
The doctor takes into account all factors and chooses the most optimal options. Here it is important to adhere to the basic principles:
1. Application of minimally effective dosages of drugs.
2. Gradual increase in dosage until the appearance of the result( elimination of symptoms of RLS).
3. Consecutive selection of the most effective medication with a possible change of several drugs.
4. It is possible to simultaneously combine several drugs with different mechanisms of action if necessary.
For the treatment of RLS, the following drug groups are used:
1. Essential drugs( non-ergotamine agonists of dopamine receptors, dopaminergic drugs)
2. Additional drugs( hypnotics, anticonvulsants, tranquilizers, opioids).
A group of nonergolyamine dopamine receptor agonists( eg, pramipexole).With them, the selection of medications begins, because they rarely give the "amplification phenomenon" when the symptoms intensify or appear in the daytime despite a change in dosage.
Dopaminergic drugs are the second most frequently used in the treatment of Parkinson's disease. With restless legs syndrome, the dosage is several times lower, which allows you to be treated longer.
Other groups of drugs are considered alternative, in case of inefficiency of the first or development of the "amplification phenomenon".This is due to the fact that hypnotics, anticonvulsants and tranquilizers have large side effects and deprive patients of the ability to drive or work with complex mechanisms.
Opioids are rarely used, with severe pain syndrome, which is not removed by other analgesic medicines. First, the risk of dependence is great, all the same it's drugs. Secondly, in Russia there are no suitable forms for patients with restless legs syndrome( opioid pumps), which allow themselves to determine when the drug should act.
With regard to drug treatment of secondary restless leg syndrome, iron deficiency is standard in the assignment of iron-containing drugs with blood control until complete elimination of anemia.
In renal failure, especially in the terminal stage, the possibility of using erythropoietin is added to the pharmacotherapy of the main groups. The most effective is kidney transplantation.
In pregnancy, it is useful to explain the nature of the sensations and the temporality of these manifestations. Possible reception of iron preparations of the second generation. The first generation of this group is toxic and unsafe for the fetus. Other groups of drugs that are recommended for non-pregnant patients are advisable to use only with severe manifestations of restless legs syndrome and the threat of gestation. Consult your doctor when choosing a treatment.
Elena Tsareva, doctor-somnologist,
Unison-Clinic,
www.clinic.unisongroup.en