Restless Legs Syndrome - Diagnosis and Treatment

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In medical literature, restless legs syndrome (RLS) is described as an unpleasant sensation of constant tingling in the lower limbs, with predominantly nocturnal onset. We are not talking about a simple temporary disorder: restless legs syndrome is a real chronic pathological discomfort, of a neurological nature, which torments the sleep of those affected.

The patient with this syndrome tends to wake up continuously during the night, driven by the urgent desire to move the legs: only movement, in fact, seems to alleviate the agony that afflicts RLS patients so much.
Restless legs syndrome can sometimes be confused with other disorders, which share similar symptoms: differential diagnosis is very important to avoid confusing the diseases.
Many anemic patients with restless legs syndrome find relief from dietary iron supplementation; pregnant women predisposed to this syndrome should take more generous doses of vitamin B12 and folic acid (essential to prevent spina bifida and reduce the risk of onset of RLS).
In the course of this article, we will also focus on other possible treatments useful for relieving the symptoms of restless legs syndrome.

Diagnosis

There is no specific diagnostic test to detect restless legs syndrome with absolute certainty. However, the National Institutes of Health compiled a list of observable diagnostic criteria common to all patients with restless legs syndrome:

Extreme need to move the lower limbs, to find relief from paresthesia and tingling in the legs
Improvement of symptoms with leg movement (rubbing, stiffening, stretching, lifting, etc.)
Worsening of symptoms with rest, especially during sleep
Symptoms improve and worsen following circadian rhythms: the discomfort worsens during the night and begins to subside at dawn.

In addition to observing these important criteria, the physician may suspect restless legs syndrome by listening and carefully evaluating the symptoms reported by the patient. Often times, the victim is unable to describe in detail the pain perceived; it is not uncommon for it to occur. annoying perception is described with the terms "creeping pain", "tingling", "stretching of the legs", "itching of the limbs", "cramp-like pains".
Sometimes, the doctor may prescribe blood tests to the patient, to rule out other possible and suspected concomitant diseases. Only rarely, a sleep assessment test is required.

Differential diagnosis

The differential diagnosis of restless legs syndrome must be made with:

Akathisia: this is a particular psychomotor syndrome characterized by the inability to stay still, associated with anxiety, agitation, paraesthesia and restlessness. Unlike restless legs syndrome, akathisia is neither associated with circadian rhythms nor can it improve with the movement.
Leg cramps: these are involuntary muscle contractions of the lower limbs, extremely painful and palpable, almost always one-sided. Leg cramps, similar to the symptoms of restless legs syndrome, are also often governed by circadian rhythms; however, cramps are characterized by palpable tightening of the muscle, which does not occur in RLS syndrome.
Pain in the legs and feet after a stressful job
Neuropathies: The symptoms that characterize this disorder can easily be mistaken for those of RLS syndrome. However, in the context of neuropathy, leg movements are not generally associated with motor restlessness, and symptoms do not improve with motion.
Deep vein thrombosis e intermittent claudication: Patients with these conditions tend to have cold and swollen extremities, which are not noticeable elements in restless legs syndrome. Furthermore, the symptoms of vascular diseases do not follow circadian rhythms and do not improve with movement; caludicatio intermittens, on the other hand, is accentuated with movement.

Treatment

For further information: Restless Legs Syndrome Remedies

There is no complete cure for restless legs syndrome. In any case, the search for the triggering cause is essential to guide the doctor towards the choice of the most appropriate drugs to alleviate the symptoms. Adequate and specific therapy can correct the patient's clinical profile, improving the quality of life as much as possible.
The treatment of the triggering pathological condition alleviates the symptoms of restless legs syndrome: from what has been said, it is understandable that the diagnostic assessment is essential for the purposes of therapy.
When it is not possible to identify a precise cause, treatment focuses on modifying the patient's lifestyle and, if necessary, on the administration of drugs. The stretching exercises, specific massages and hot baths are particularly useful for therapy purposes.

Recall that the administration of some pharmacological specialties, such as antidepressants and antiemetics, can exacerbate the symptoms associated with restless legs syndrome.

What are the most popular drugs for restless legs syndrome?

For further information: Medicines for Restless Legs Syndrome

Restless legs syndrome dependent on iron deficiency should be treated with martial therapy, to be continued as long as the ferritin concentration in the blood exceeds the value of 20-50 mcg / L.
Compared to healthy women, pregnant women with restless legs syndrome should take a more generous supplementation of vitamin B9 (folic acid) and B12. We briefly recall that pregnant women should always supplement their diet with folic acid supplementation, which is essential to protect the unborn child from spina bifida. If pregnant women are predisposed to restless legs syndrome, they should take higher amounts of vitamin B9.
When restless legs syndrome weighs heavily on sleep quality, multiple medications can be used:
- tranquilizing drugs (e.g. clonazepam)
- antiparkinsonian drugs: ropinirole and pramipexole (approved by the FDA for the treatment of restless legs syndrome). The combination of levodopa + carbidopa (Sinemet) is also particularly suitable for relieving leg movements in the context of RLS.
- Antiepileptic drugs: eg. gabapentin
- antiparkinsonian drugs: benzodiazepines. The administration of these active ingredients is not useful to reduce pain in the legs, but rather to promote sleep in the patient suffering from RLS syndrome.
- Opioid drugs: codeine, oxycodone (considered second choice drugs for the treatment of restless legs syndrome).

Before taking any active ingredient, medical advice is recommended. Excessive use of drugs can exacerbate the symptoms of restless legs syndrome.