Vein ConditionsRestless Leg Syndrome
Jennifer gets up from her desk once again to check on something-anything-to quench her urge to get up and move around. When she sits back down at her desk for an extended period of time, her legs really bother her, especially in the afternoon. She can’t quite put her finger on what is wrong, she just knows that she wants to massage her legs, move them around, and get up and walk. She recalls that the restlessness was not as noticeable a few years ago when she first took the job.
At night, when Jennifer is reading in bed, she massages her legs to alleviate the gnawing sensation. She gets up and walks to the kitchen and back to help relieve the discomfort. She finally falls asleep, but for her husband, Greg, there is a long night ahead. He hopes that her nighttime leg twitching that he has come to expect will not be too bad tonight. He has an early morning presentation and needs an uninterrupted night of sleep. Unfortunately, Jennifer’s restless leg movements wake him up a few times and he is a tired man in the morning.
Jennifer is one of the millions of Americans that have symptoms of Restless Leg Syndrome.
What is Restless Leg Syndrome (RLS)?
Rest leg syndrome is a condition in which the person has an uncontrollable and annoying urge to move their legs. Other symptoms can be present as well, particularly night cramps in the legs. The symptoms usually occur later in the evening, especially at night when the person goes to bed or when asleep.
Some doctors consider restless leg syndrome a sleeping disorder because it can interfere with a good night’s sleep. Some people can get the symptoms in the daytime as well, during periods of rest or immobility, such as prolonged sitting. Disruption of sleep can interfere with daily activities and have adverse long term effects of health.
What are symptoms of Restless Leg Syndrome
The most common sign or symptom of restless leg syndrome is the urge to move the legs when resting or sleeping.
Other signs or symptoms in the legs that can occur along with the urge to move the legs include:
- Night cramps in the legs
- Unpleasant sensation
- Skin crawling feeling
- Creeping feeling in the leg
- Pulling sensation
- Leg pain
- Sensation of electricity
- Tense feeling in legs
- Nighttime twitching
- Ankle and calf swelling
Signs or symptoms of restless leg syndrome may present differently from person to person. Schedule a consult with your VEINatlanta doctor if you suspect you have restless leg syndrome. Our doctors will work with you to develop a treatment plan customized to your case.
What causes Restless Leg Syndrome (RLS)?
The exact cause of restless leg syndrome and the mechanism of action is not known. There are a few theories about the causes of restless leg syndrome, but not a lot of research that proves the exact mechanism of cause and effect. Most likely, there are several different conditions that can cause restless leg.
- Venous Insufficiency. Probably the most common cause of restless leg syndrome is venous insufficiency. Venous insufficiency also called chronic venous insufficiency or venous reflux is a condition in which the one-way valves in the leg veins do not work properly which allows blood to pool in the leg veins under hydrostatic pressure. There are some clinical studies that show that in patients with RLS and venous insufficiency when the venous insufficiency is treated, the restless leg symptoms improve.
- Abnormal dopamine receptor function in the brain. The brain cells, or neurons, are connected and communicate to one another through synapses or synaptic gaps. Neurons release and detect chemicals called neurotransmitters at the synaptic gaps. Dopamine and serotonin are two examples of neurotransmitters. If the synapses do not function properly, this can lead to disease states. Some neurologists believe that some cases of restless leg syndrome may be due to synaptic gap dopamine receptor dysfunction, but there is no direct evidence to prove this theory. There are no tests to determine if a person has RLS due to a dopamine receptor problem.
- Iron transport across brain cell membranes. Like all human cells, brain cells, or neurons, have cell walls, or more correctly, cell membranes. Any substance that enters a cell must pass through the cell membrane. It is theorized by some researchers that some restless leg syndrome cases are caused by a dysfunction of iron transport across neuron cell membranes, leading to low iron levels inside the neuron. Serum (blood) iron levels do not correlate with neuron intracellular iron levels. Taking iron supplements does not improve restless leg syndrome.
How is Restless Leg Syndrome diagnosed?
Restless leg syndrome can be diagnosed during a clinic visit with your VEINatlanta doctor. During your visit, Dr. Prevosti, Dr. Fonger or Dr. Moore will take a full medical history to understand your symptoms and order a venous duplex ultrasound. The doctors will use the International Restless Legs Syndrome Study Group and International Classification of Sleep Disorders in addition to the results of the ultrasound to make the diagnosis.
These criteria include:
- You have a constant often uncontrollable urge to move your leg – accompanied by feelings of crawling, creeping, tingling or pulling in the legs.
- The symptoms you are experiencing intensify when you are resting, sitting or lying down or at night
- You can relieve your symptoms temporarily with activity such as walking or stretching
- Your symptoms can not be explained by another condition
What are the treatments for Restless Leg Syndrome?
If a patient has restless leg and venous insufficiency (venous reflux) identified on venous duplex ultrasound, then treating the venous insufficiency can reduce or eliminate the restless leg. We recommend a person seeking treatment for restless leg gets a venous duplex ultrasound from a vein clinic experienced at doing this specialized ultrasound. The office visit and ultrasound are usually covered by medical insurance plans (copay, coinsurance, and deductibles may apply).
Learn more about venous insufficiency treatment options.
There are several medications that are used for treating restless leg syndrome. Requip and Mirapex both work by affecting the dopamine receptor system in the brain. Both are primarily used for treating Parkinson’s disease but are also prescribed for restless leg syndrome. We have seen them work in some patients. In many patients, they can cause side effects that make the drugs unusable, such as sleepiness, insomnia, sense of uneasiness, nightmares, and dizziness. Many other side effects of these medications have been reported. Sometimes general neurological medications are prescribed, such as gabapentin (Neurontin), benzodiazepines, and sleeping pills. None of these try to treat the theoretical cause but rather try to reduce the symptoms associated with restless leg syndrome
What is the next step to get rid of restless leg syndrome?
The VEINatlanta provider team recommends people who suffer from restless leg syndrome to come in for a consultation and a venous duplex ultrasound. These services are usually covered by insurance, although co-pays and other deductibles may apply. If venous insufficiency is found, treatment of this disorder may reduce or eliminate the restless leg symptoms.