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What is Restless Legs Syndrome?
Restless Legs Syndrome (RLS) is a common sleep-related movement disorder, also known as Willis-Ekbom disease. It causes an unpleasant, "creeping" or "crawling" sensation deep within the legs, creating an irresistible urge to move them. In severe cases, it can disrupt deep sleep, leading to insomnia or hypersomnia.
It is said that over half of people with Restless Legs Syndrome also experience Periodic Limb Movement Disorder (PLMD). In PLMD, the legs or arms move involuntarily at regular intervals during lighter stages of sleep.
Symptoms and Causes of Restless Legs Syndrome
What symptoms appear?
With Restless Legs Syndrome, an uncomfortable, "creeping" sensation occurs deep within the legs, causing an irresistible urge to move them. This uncomfortable sensation tends to occur when at rest and worsens with inactivity, improving with movement. Additionally, symptoms typically worsen in the evening or at night compared to during the day.
As a result, it can lead to difficulty falling asleep, waking up shortly after falling asleep, fragmented sleep, and an inability to achieve deep sleep.
Unlike pruritus (itching) in the elderly, where the skin itself itches, Restless Legs Syndrome causes an abnormal sensation deep within the body, not on the surface. Some people experience not only a restless sensation but also pain or itching. It can also occur in the hands and arms, not just the legs.
What are the causes? Genetics? Age?
While several related genes have been identified, the cause remains unknown. However, recent findings indicate that RLS is more common in individuals with iron-deficiency anemia or those undergoing hemodialysis for kidney failure. It is believed that a decrease in iron levels in the central nervous system leads to impaired dopamine function.
The prevalence is said to increase with age, and it is considered more common in women than men.
Treatment for Restless Legs Syndrome
The treatment approach for Restless Legs Syndrome varies depending on whether it is an idiopathic condition with no known cause, or a secondary condition caused by other diseases (e.g., spinal cord or peripheral nerve disorders, chronic renal failure), iron deficiency, medication, excessive weight loss, or pregnancy.
If a secondary cause is suspected, the initial treatment focuses on addressing the underlying condition, treating iron deficiency, or discontinuing medications. If these measures do not resolve the symptoms, and a secondary cause is ruled out, then non-pharmacological and pharmacological treatments are considered for idiopathic RLS.
Non-pharmacological therapy should be the first line of treatment.
- Improve sleep environment.
- Advise avoidance of trigger factors such as smoking, alcohol, and caffeine.
- Reduce or discontinue medications that worsen symptoms, such as antidepressants.
- Recommend regular, moderate exercise.
In mild cases, these non-pharmacological treatments alone may lead to improvement.
If non-pharmacological therapy is insufficient, pharmacological treatment is initiated. Dopamine agonists are the first-line choice.
【Reference】
※ https://www.jsnt.gr.jp/guideline/img/restless.pdf
