Restless Legs/Ekbom Syndrome (RLS)
Condition of abnormal unpleasant sensory symptoms of the legs that get worse in the evenings and at rest and remit when the leg is moved. Could affect up to 10-15% of population at some stage. Onset can be at any age, but more common in older age groups.
Most cases unknown (primary). May be related to disinhibition of flexor response during sleep.
Secondary cases associated with iron deficiency anaemia, renal failure (in 30% of those on dialysis), uraemia, pregnancy (up to 1/3), certain types of peripheral neuropathy.
Persistent compelling urge to move legs – legs feel intensely uncomfortable with a crawling or creeping sensation (not usually described as painful); deep paraesthesias; movement relieves symptoms, but recurs with rest; symptoms appear or are exacerbated at night and during inactive rest; have problems initiating sleep
Periodic limb or leg movements in sleep (PLMS) – can occur in those with RLS; repetitive movements of leg (typically hallux and ankle) during non-REM sleep.
Differential diagnosis – periodic limb movements of sleep (may coexist); anxiety; peripheral neuropathy; tic disorders; leg cramps; drug induced; akathasia; fibromyalgia; painful legs and moving toes syndrome
In children, may be misdiagnosed as ‘growing pains’, ADHS, anxiety disorders
International Restless Leg Syndrome Study Group Criteria for Diagnosis :
• a desire to move limbs usually associated with paraesthesia or dysaesthesias
• motor restlessness (during wakefulness patients move the limbs in an attempt to relieve the discomfort
• symptoms worse or exclusively present at rest with at least partial and temporary relief by activity
• symptoms worse in the evening or night
Regular exercise, especially before sleep may help some; caffeine reduction; stop smoking; limit alcohol consumption; relaxing routines prior to going to bed
Pharmacologic management if lifestyle changes unsuccessful and symptoms interfere with quality of life – dopaminergic agents first, then benzodiazepines
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Restless legs syndrome (Podiatry Arena)