Restless Legs Syndrome (RLS)
Although few people know much about Restless Legs Syndrome (RLS), an awful lot of people seem to suffer from it! It is sometimes known as Willis-Ekbom Disease, although it is not so much a disease as a medical condition.
RLS is characterised by a strong desire to move the legs which feel ‘fidgety’. Sufferers describe a feeling of creeping, crawling, insects or electricity in the lower part of the legs that causes a desire to move, and which brings temporary relief only before the feeling returns. Sufferers simply cannot keep their legs still, and things get worse if they try to. Symptoms are more common in the evening and are worsened by sitting, tiredness or exhaustion. Symptoms are usually not present earlier in the day. The arms can be affected also, but less often.
Symptoms are also common in bed, and may cause difficulty with falling asleep. In my own experience, patients referred by GPs with ‘insomnia’, but who have a raised Epworth Score which is uncharacteristic of insomnia, frequently confess to RLS stopping them from falling asleep. Treating the RLS in this group often cures their problem.
There is a strong tendency for RLS to run in families, and it is worth asking whether any close relatives are sufferers also. It is also more common in females, middle age and the elderly.
RLS is unpleasant and can disrupt normal life. It is difficult for sufferers to sit still and they may be unable to sit on an aircraft flight or go to the theatre or cinema, because they cannot sit still for any length of time.
RLS can be scored for severity according to international criteria laid down by the International Restless Legs Syndrome Study Group (IRLSSG), but in essence, patients distressed by their symptoms will probably benefit from treatment.
Despite the strong tendency for RLS to run in families, it may be caused by some underlying conditions.
The most frequent is that of lower than normal iron stores in the body, and this can be assessed by performing a blood test to assess serum ferritin levels.
Other associations include thyroid and renal dysfunction, and full blood screening may show other treatable abnormalities. In patients with chronic renal failure, the development of RLS suggests a poor prognosis.
Provided there is no underlying medical condition requiring independent assessment or treatment, it may not be necessary to commence treatment unless the symptoms are distressing if severe.
Because RLS is worse with tiredness and exhaustion, adequate amounts of sleep at night are recommended with regular habits. If iron stores are low, then iron supplements will be helpful.
RLS may respond to specific treatments with tablets.