He Restless legs syndrome (SPI), acromelalgia or Willis-Ekbom disease, is a neurological-sensory-motor disorder characterized by an uncontrollable need to move the lower extremities due to the presence of annoying and unpleasant sensations (Baos Vicente et al., 2008) .
People often describe these annoying sensations as burning, irritating, pricking, or painful (National Institute of Neurological Disorders and Stroke, 2015). These symptoms occur mainly when the individual is relaxed (AESPI, 2015). Thus, they tend to worsen in Rest or at night, and improve with movement (Fraguas Herráez et al., 2006).
This type of syndrome is usually associated with sleep disorders , Especially conciliation insomnia (Fraguas Herráez et al., 2006), since the majority Of people have difficulty in reconciling and maintaining sleep (Martínez García, 2008). It may also be associated with disorders Depressive or anxious (Fraguas Herráez et al., 2006).
The symptoms of Restless Legs Syndrome will greatly affect the quality of life Of people who suffer from it, since they influence both the Professional and family life and even in their state of mind (AESPI, 2015).
Many individuals who have RLS offer subjective complaints about the involvement of their work, their personal relationships and daily activities such as Consequence of fatigue. They also often show Difficulties of concentration , Memory deficits or inefficiency in the relation of daily tasks (National Institute of Neurological Disorders and Stroke, 2015).
Statistics of Restless Legs Syndrome
The different studies of the prevalence of RLS show that this is a very frequent pathology. In Europe and the USA, it is estimated that the prevalence of This disorder ranges from 5% to 15% of the population (Martínez García, 2008).
On the other hand, it is more frequent in women than in men, with a ratio of 2: 1 and also its frequency increases with age (Martínez García, 2008).
The syndrome can appear at any age from the earliest stages of life, most of the patients who suffer from it have a middle age or (National Institute of Neurological Disorders and Stroke, 2015).
Several studies have shown that between 5 and 10% of the population has a Age between 18 and 65 years old suffer from RLS, whereas this percentage increases from 15% to 20% in older people (AESPI, 2015 Older patients suffer Symptoms more often and for longer periods of time. (National Institute of Neurological Disorders and Stroke, 2015).
Although SPI is related to the impairment of quality of life, it is a disorder that is not diagnosed in clinical practice (Fraguas Herráez The al., 2006). Typically, people who suffer from these types of symptoms do not seek medical care because they think they do not have too much importance or That this type of pathology can not be treated.
In addition, many clinicians attribute the symptoms to insomnia, nervousness, stress, Aging, among others (National Institute of Neurological Disorders and Stroke, 2015).
Definition and symptoms of Restless legs syndrome
He Restless Leg Syndrome (SPI) or Restless legs syndrome (RLS) in English, it is a pathology known From the 17th century. However, it is not until 1945 when neurologist Karl-Axel Ekbom coined the term.
Frequently, terms Ekbom or Willis-Ekbom syndrome or disease To refer to this pathology (Martínez García, 2008).
SPI is a neurological movement disorder characterized by the irresistible need or desire to move the legs because of the Presence of unpleasant and annoying sensations in the lower limbs, which are usually very annoying, and which some patients describe as Painful (AESPI, 2015).
Individuals often have a burning, painful, stinging sensation or something creeping up their legs. Patients often describe Symptoms such as very disturbing feelings of tingling, burning, itching, pain, bubbling, feeling of running water or worms in the legs (Martinez .
The sensations that individuals perceive are usually called Paraesthesia (Abnormal sensations) or Dysesthesia (Abnormal sensations of type Unpleasant) and vary in severity of presentation as well as degree of irritability and / or pain (National Institute of Neurological Disorders and Stroke, 2015).
Most of the time these annoying sensations tend to diminish or disappear with the voluntary movement of the area, at least while the Movement is being executed. Relief can be partial or complete and is more likely to occur at the beginning of the movement (AESPI, 2015).
Anxious feelings and pain often worsen when the patient is resting and in a resting situation (Baos Vicente et al., 2008). The symptoms have a gravase at bedtime or when trying to relax, appear only at rest and have no relation to previous activities (Martínez García, 2008).
The sensations usually predominate in an evening or nocturnal stage, reason why the periodic movements of the extremities are going to cause both Difficulty in falling asleep as frequent"micro-awakenings"that will impair the capacity of maintaining sleep (Baos Vicente et al. 2008).
The periodic movements of the legs that are going to provoke the"micro-awakenings"are called nocturnal mycelia. Individuals will perform Flexion movements of the legs at knee and ankle height, with an extension of the thumbs. The movements are Organized and repetitive in intervals of 20 to 40 seconds and usually last between 0, 5 and 5 seconds (Martínez García, 2008).
In summary, the main features Of the SPI are:
- Necessity or the irresistible desire to move the legs due to the presence of unpleasant and annoying sensations.
- Most of the time these annoying sensations tend to diminish or disappear with the voluntary movement of the zone.
- Annoying feelings and pain often worsen when the patient is resting and in a resting situation
- The sensations usually predominate in an evening or nocturnal stage.
Causes of Restless legs syndrome
Current research on determining the causes of RLS is limited and there is scarcely conclusive experimental evidence. It is said that that he SPI is idiopathic , That is, it does not present a known cause (AESPI, 2015). Thus, most cases are considered Idiopathic, especially those with early onset (Fraguas Herráez et al., 2006).
However, in approximately 50% of cases, there is a family history related to the disorder (National Institute of Neurological Disorders And Stroke, 2015). Thus, RLS may present a hereditary or genetic component, in this case the SPI is primary or familial (AESPI, 2015).
Generally, people with hereditary RLS are usually younger at the time of symptom onset and have a Slowed progression of the disease (National Institute of Neurological Disorders and Stroke, 2015).
On the other hand, RLS can also be related to other types of diseases, which give rise to their presentation or worsening, is known as Secondary SPI (AESPI, 2015).
Despite this, the National Institute of Neurological Disorders and Stroke (2015) lists the following factors or conditions with SPI:
- Low levels of iron or anemia .
- Chronic diseases such as kidney failure, diabetes, Parkinson's disease wave Peripheral neuropathy .
- Pregnancy. Particularly in recent months, up to 20% of women may have symptoms of RLS, which have to disappear after (AESPI, 2015).
- Some medicines for the prevention of nausea, seizures, Antipsychotics Or phlegm or allergy can aggravate the symptoms.
- Consumption of caffeine, alcohol or tobacco may aggravate or cause symptoms in patients with predisposition to RLS.
Among these, the most important and most frequent cause is iron deficiency Fraguas Herráez el al., 2006). Iron is an essential component of Dopaminergic (D2) receptors, which are widely localized in the basal ganglia. Its lack can interfere with the function of These receptors and provoke this type of movement disorder (Martínez García, 2008).
The alteration of cerebral metabolism of iron will lead to a dopaminergic dysfunction in a group of neurons projecting from the middle brain until the spinal cord, The limbic system and the cerebral cortex (Fraguas Herráez et al., 2006).
Iron concentrations below 45 μg / l may increase RLS symptoms. In addition, administration of dopaminergic drugs generally Improve the symptoms. All this suggests that both iron and Dopamine Are involved in the appearance of this clinical picture and that is related With a dopaminergic hypofunction (Martínez García, 2008).
Consequences of Restless legs syndrome
The main consequence of RLS is the alteration of normal and regular sleep patterns.
He insomnia Is the main consequence of SIP. Approximately 80% experience periodic movements of the lower extremities during the Sleep (AESPI, 2015).
A significant number of patients report disturbances or disturbances of sleep as conciliation insomnia and / or Maintenance and daytime sleepiness. Often, there is an increase in Latency Of sleep and a marked decrease in efficacy due to the Presence of successive micro-awakenings (Martínez García, 2008).
In addition, the presence of an unsatisfactory or restorative sleep will negatively affect the patient's functionality and daily activities. Daytime sleepiness will cause deficiency in the execution of daily or work tasks.
On the other hand, lack of sleep can have a significant impact on the cognitive component of the person. Alterations of memory, of attention , Difficulty concentrating, executive functions, etc.
This as a whole will have important consequences on the personal life of the person who suffers from it. In a study by Baos Vicente and (2008), shows that approximately 25% of patients with RLS report that their symptoms have a negative and detrimental effect on the Person with whom they share the bed, affecting the need for special arrangements to sleep in 73% of cases or affecting the relationship In 20% (Baos Vicente et al., 2008).
In general, continued or chronic deprivation of sleep and its consequences in the ability to concentrate during the day can affect its Capacity to work, to their ability to participate in social and leisure activities. It can also humor changes That can affect your Personal relationships (AESPI, 2015).
Diagnosis
At present we can not find a specific diagnostic test for RLS. This pathology is diagnosed clinically by performing a Integration of both the patient's history and the symptoms referred to and presented (National Institute of Neurological Disorders and Stroke, 2015).
Generally, the diagnostic criteria described by the International Study Group on Restless Legs Syndrome (IRLSSG):
Essential Criteria
- Desire to move the legs accompanied by generally unpleasant or annoying sensations.
- Need to move legs, which starts or worsens during periods of inactivity or rest (lying down or sitting).
- Partial or total improvement of the symptomatology with the activity.
- Worsening of unpleasant sensations in the legs in the evening and at night.
- Unpleasant sensations in the legs are not attributable to any other disease (venous insufficiency, edemas, myalgias, arthritis, cramps In the legs, poor posture, peripheral neuropathy, anxiety, myalgias and / or myopathy, local leg injury, drug akathisia, myelopathy, Vascular or neurological claudication, orthostatic tremor or pain in the legs).
In addition to these criteria, some lab tests may also be used to rule out other diseases and support the diagnosis of RLS according to
Describes the National Institute of Neurological Disorders and Stroke (2015), as follows:
Blood tests should be performed to rule out anemia, reduced iron storage, diabetes , And renal dysfunction.
You can also recommend a Electromyography And nerve conduction studies to measure electrical activity in muscles and nerves and You can use Doppler ultrasonography to assess muscle activity in the legs.
These tests can document any collateral damage or Nerve and nerve roots (such as peripheral neuropathy and radiculopathy) or other movement disorders related to the legs. Negative results from these tests may indicate that the diagnosis is RLS.
In some cases, sleep studies are performed as a polysomnography (a test that records brain waves, heart rate, and respiration Of the patient throughout the night) to identify the presence of PLMD.
Treatment
The treatment of RLS is symptomatic generally, not etiological. For the Mild conditions , With moderate symptoms than in most Cases have to disappear with the movement, many specialists recommend changes in the Lifestyle And in the activities carried out (National Institute of Neurological Disorders and Stroke, 2015).
Thus, the Spanish Association of Restless Legs Syndrome (2015) recommends the following lifestyle changes:
- Eliminate substances that promote the appearance of symptoms (caffeine, alcohol, tobacco), ingestion of necessary vitamin and mineral supplements (Iron, folate or magnesium) and engage in self-directed activity (walking, stretching, taking baths with temperature changes, etc.)
- Sleep hygiene programs (lie down and get up regularly at the same time at times with symptoms or have a quiet and comfortable sleep).
On the other hand, physicians may also prescribe a variety of medications for the treatment of the SPI National Institute of Neurological Disorders And Stroke, 2015).
- Dopaminergic agents Dopamine receptor agonists, such as Pramipexole and the Ropinirole . They are usually prescribed in low doses and Increasing slowly so as to reduce possible side effects, such as nausea and hypotension (AESPI, 2015).
- Sedatives: Are often used to alleviate symptoms that appear aggravated at night. It is not usually Continued as they may cause daytime sedation and cognitive problems (AESPI, 2015).
- Analgesics : People with severe restlessness are employed. Their use is controversial since they present Addiction (AESPI, 2015).
- Anticonvulsants : Are particularly effective for the treatment of painful symptoms that do not respond to type drugs Dopaminergic (AESPI, 2015).
On the other hand, due to the consequences Lack of sleep And chronic pain may have on the cognitive functioning of many individuals who Have RLS, it is likely that, in many cases, some kind of neuropsychological intervention is required.
The intervention on memory, attention and executive functions through the development and empowerment of workers and the compensation of Deficits can have a significant positive impact on the quality of life of patients.
How To Know if You Have Restless Legs Syndrome
First, look at these four basic criteria for diagnosis:
You feel an uncontrollable desire to move your legs when you have strange sensations like drag, tingling or jerking.
Symptoms appear or worsen when you are at rest: lying down or sitting.
Symptoms worsen at night.
You move your legs all the time so the sensations go away.
If you feel identified with this description, then you should consult the doctor. There is no test that can perform the diagnosis, the doctor should be guided by the symptoms that you report.
It will ask you how frequent they are, their duration and intensity and if they prevent you from sleeping properly at night.
Your doctor may suggest some studies to rule out other possible causes.
It is important that you make the medical appointment. Do not think that your symptoms are too mild or have no solution.
Some doctors mistakenly think that the symptoms are due to nervousness, stress, To insomnia Or muscle cramps, but do not give up.
If you have Restless Legs Syndrome, your symptoms may find relief.
5 keys to control the syndrome and rest better
Change your lifestyle to promote sleep
First of all, what you should do is favor a good night's rest.
If you reduce caffeine, alcohol, and tobacco consumption, it is possible that the symptoms will be relieved and you can rest better.
On the other hand, if you go to bed and get up at the same time, this can also help you sleep better at night.
Visit this article To receive other tips to combat insomnia.
Relieves feelings with hot or cold compresses
Some people with restless legs syndrome have been able to relieve strange sensations in their legs by applying cold or hot compresses before going to sleep.
You can do this by applying a bag of hot water or an ice pack on your legs, a while before going to bed.
Taking a hot shower and massaging your legs can also help.
Perform moderate exercise to improve circulation
Mild or moderate exercise, especially those that strengthen the lower legs, may help reduce the nuisance sensation.
But be careful, excessive exercise can be counterproductive and worsen symptoms rather than relieving them.
Compression and infrared therapy devices can also be useful
If with these simple measures your symptoms are not relieved, do not worry. There are still many other treatments you can follow to control the syndrome.
For example, compression stockings may be useful for eliminating tingling or pulling sensation.
They are made of strong elastic material, which will gently compress your legs and stimulate blood circulation, while avoiding strange sensations.
Another good option may be pneumatic compression devices. They are covers for the legs that are inflated by means of a small pump to compress the legs.
This is a treatment that can be very effective to eliminate the sensations and so that you can leave your legs still. So you can rest well during the night. There is also evidence that infrared light therapy may help.
An infrared light device applied to the legs helps improve circulation and may also be effective in preventing the symptoms of restless legs, although more research is still needed to show how effective it is. Anyway, you lose nothing with trying.
Medications to control symptoms
If you have not been able to avoid the sensations with the previous treatments, do not despair, the doctor can prescribe some medicines to relieve the annoying sensations in your legs and to help you sleep better.
However, not all medications are equally effective in all patients and you may have to try different medications before finding the most effective treatment for you.
Dopamine agonist medications
They are commonly used for Parkinson's disease , But they can also be helpful in relieving restless legs.
Both pramipexole, ropinirole and rotigotine skin patches have been shown to be effective as they relieve symptoms, improve the patient's quality of life and improve sleep.
In general, these are the medications that are recommended as initial treatment of preference, in patients who have not been able to relieve their legs by changing their lifestyle or by applying other therapies without medication.
Anticonvulsant medications
You do not need to have seizures for your doctor to prescribe these types of medications.
Pregabalin, gabapentin and gabapentin enacarb have also been shown to improve the patient's nocturnal symptoms and rest, which of course improves his quality of life.
Benzodiazepines
They are medicines that will help you sleep better. It is not that they relieved the symptoms of restless legs exactly, but they will relax your muscles and you will be able to rest properly.
Clonazepam, diazepam, oxazepam and temazepam are some examples of this class of drugs. If you take them at night, you may feel a bit lethargic the next day.
If you have sleep apnea, then these types of medications do not suit you, as the symptoms can become worse.
Opioids
If the symptoms of restless legs are intense and not easily relieved, your doctor may prescribe powerful painkillers so you can rest at night, such as opioids.
Oxycodone, codeine, and morphine are some examples. The downside is that they can cause adverse symptoms, such as dizziness, nausea and dependence or addiction.
Treatment with iron
It is indicated only for those who have low iron levels in your body. As you may have read at the beginning, having little iron can trigger the symptoms of restless legs.
Therefore, treatment with intravenous iron or iron pills may be effective in these cases.
CONCLUSIONS
Restless Legs Syndrome can affect the quality of life, since sometimes problems of conciliation and maintenance of sleep, in addition produces Painful and unpleasant symptoms when the person tries to relax (AESPI, 2015).
Thus, sleep deprivation can negatively affect the individual's functional abilities by producing deficits in his ability to Concentration, labor problems, social deficits, etc. (AESPI, 2015)
The picture is usually chronic, and in severe patients, the quality of life can be very affected (AESPI, 2015).
References
- AESPI. (2015). Spanish Association of Restless Legs Syndrome . Retrieved from http://www.aespi.net/
- Baos Vicente, V., Grandas Pérez, F., Kulisevsky Bojarski, J., Lahuerta Dal-Ré, & Luquin Piudo, R. (2009). Restless Legs Syndrome: Detection,
Diagnosis, health consequences and use of health resources. Rev Clin Esp., 209 (8), 371-381. - Fraguas Herráez, D., Terán Sedano, S., Carazo Gimenez, S., & Rodríguez Solano, J. (2006). A case of retinal legs syndrme: importance of diagnosis. Psiq. Biol, 13 (4), 145-7.
- Martínez Garcia, M. (2008). A review of restless legs syndrome. SEMERGEN, 34 (2), 80-6.
- NIH. (2015). National Institute of Neurological Disorders and Stroke . Obtained from Restless Legs Syndrome