How is Restless Leg Syndrome Treated?

Restless Leg Syndrome (RLS) refers to a syndrome in which uncomfortable discomfort occurs in the deep part of the calf during rest, which can be temporarily relieved by exercise and massage. Describes restless leg syndrome, also known as Ekbom syndrome. Its clinical manifestations are usually extreme discomfort in both lower limbs during sleep at night, forcing patients to move their lower limbs or walking down, resulting in severe sleep disorders . Although the disease is not harmful to life, it seriously affects the quality of life of patients. Epidemiological data abroad show that the prevalence rate is 1% to 10% of the total population. The prevalence rate in China is estimated to be 1.2% to 5%, which is common in middle-aged and elderly people.

Basic Information

nickname

Restless limb syndrome, Ekbom syndrome

English name

restless legs syndrome, RLS

Visiting department

Neurology

Multiple groups

Middle-aged and elderly

Common locations

Lower limbs

Common causes

unknown

Common symptoms

An abnormal feeling of spontaneous, intolerable pain in the lower limbs

Contagious

no

Causes of restless leg syndrome

At present, restless legs syndrome is considered to be a central nervous system disease, and the specific cause has not been fully elucidated. It is mainly divided into primary and secondary. Patients with primary restless leg syndrome are often accompanied by family history. At present, genes such as BTBD9, Meis1, MAP2K5, and LBXCOR1 may be related to restless leg syndrome. Signs of symptoms can be seen in iron deficiency anemia, pregnant or maternal, late kidney disease, rheumatic disease, diabetes, Parkinson's disease, type II hereditary motor sensory neuropathy, type / spinal cerebellar ataxia, and multiple sclerosis, etc. .

Clinical manifestations of restless legs syndrome

The clinical feature is a spontaneous, unbearable painful abnormal sensation that occurs in the lower extremities. The gastrocnemius muscle is most common, and occasionally the thighs or upper limbs can appear, usually symmetrically. Patients often complain of tearing, peristalsis, tingling, burning, pain, or itching deep in the lower limbs. The patient has a sense of urgency and intense exercise and leads to excessive activity. Symptoms occur at rest, and activities can partially or completely relieve symptoms. Under normal circumstances, the symptoms become intense when bedridden at night and peak after midnight. Patients are forced to kick, move their joints or massage their legs. Patients often describe "there is no comfortable place to put their legs." Get up and walk non-stop to get relief. Insomnia is an inevitable consequence. Most patients are accompanied by periodic limb movements of sleep (PMS). PMS is a rigid, repetitive flexion of the legs that occurs during REM sleep, and can wake patients up. Due to nighttime sleep disturbances, patients suffer from severe daytime sleepiness and decreased work capacity.

Restless Leg Syndrome

The diagnosis of restless legs syndrome mainly depends on clinical manifestations, but auxiliary examinations can exclude some secondary causes, mainly including serum ferritin, transferrin, serum iron binding, renal function, blood glucose, etc .; in some cases, examination may be required Skull MRI, EEG, EMG, polysomnography, CT or MRI of lumbar spine, color Doppler ultrasound of lower limbs, etc.

Restless Leg Syndrome Diagnosis

Diagnostic criteria: The International Restless Legs Syndrome Study Group (IRLSSG) has developed a minimum diagnostic criteria of four symptoms.

1. Abnormal sensation: due to the indescribable discomfort of the limbs, there is a strong desire to exercise the limbs, mainly the lower limbs. These abnormal sensations often occur deep in the limbs, rather than on the surface, such as the skin.

2. Symptoms of exercise: Patients cannot fall asleep and exercise their limbs constantly to relieve abnormal feelings. Mainly manifested by walking back and forth, shaking or flexing to stretch the lower limbs, or rolling the other side on the bed.

3. Symptoms worsen at rest, and activity can be temporarily relieved.

4. Symptoms worsen at night and peak at midnight.

5. There is a very unpleasant physical sensation in the gastrocnemius muscle, often accompanied by temporary pain and itching in the legs.

6. The symptoms cannot be explained by medical and psychiatric disorders.

7. There may be other sleep disorders.

Restless Leg Syndrome Treatment

Dopaminergic drugs such as compound dopa preparations or dopa receptor agonists such as pramipexole or ropinirole are preferred. For patients who are preparing to fly or drive long distances, the compound dopa preparation is particularly suitable. 70% to 90% of patients have a good response to dopa receptor agonists, so they are often the first choice, especially those with a higher frequency of attacks. Rotigotine patches have a slow-release effect, and may be a good choice for patients who also have symptoms during the day or who rebound in the early morning. Receptor agonists may have side effects such as nausea, drowsiness, headache, dizziness, hypotension, and external edema. Some patients may have symptoms of impulse control disorders such as pathological gambling, excessive shopping, and hypersexuality. In addition, antiepileptic drugs such as gabapentin, carbamazepine, and pregabalin have a certain effect on some patients, especially when dopaminergic drugs have poor efficacy, ineffectiveness, or side effects can not be tolerated. Other drugs, such as hydrazine, clonazepam, and zolpidem, have some effects on some patients. For patients with secondary restless leg syndrome, the first step is to treat the primary disease. As the cause disappears, the patient's symptoms may disappear. Such as renal transplantation in patients with uremia, iron treatment in patients with iron deficiency anemia, folic acid supplementation in patients with folic acid deficiency and so on. For some severely refractory patients, opioids such as codeine, hydrocodone, methadone, oxycodone, tramadol and other drugs can be used, which has a better effect on patients who do not respond to dopa receptor agonists. . Some patients may cause constipation, urinary retention, drowsiness, and cognitive changes. Occasionally, opioids that can cause respiratory depression and large doses with short half-lives can lead to drug dependence.