The restless legs syndrome is a very common problem in which the affected person has a variety of uncomfortable sensations such as tingling, aching or other hard to describe sensations. The result of these sensations is an intense desire, or compulsion, to move the legs. The restlessness typically worsens during the day, reaching a peak in the hours before or at bedtime. In restless legs syndrome (RLS) of severe degree, the discomfort begins earlier and earlier in the day, and some patients have symptoms all through the day. These feelings are difficult for people to describe exactly, some describe them as an “antsy” feeling and some have used the term “heebie-jeebies”. RLS can become first an irritation and eventually, a very disruptive, even unbearable problem.
The causes are several, but the most common associated abnormality is iron metabolism. Recent studies have demonstrated a decrease in the iron levels in the substantia nigra and the red nucleus, both areas of the brain. While it is difficult to measure the brain iron content and turn-over, serum levels of ferritin parallel the brain levels and can be used to evaluate RLS. The level of ferritin is measured as a simple blood test. Other conditions associated with RLS are spinal stenosis and peripheral neuropathy. The bedside neurological exam is often enough to rule these problems in or out.
The RLS was first described in the 1600’s by Thomas Willis. He gave a good description of the disorder and recognized a successful treatment for RLS, laudanum. RLS was relatively forgotten until the mid-40’s when Ekbohm published a modern description of RLS. He examined several potential causes, but he did recognize an association with iron deficiency. Since the description by Ekbohm, interest in and recognition of RLS has gradually grown. Now, approximately 10% of the population over the age of 60 has RLS. This means that an extremely large number of people suffer with the discomfort of RLS.
Treatment begins with an evaluation to determine, if possible, the precise cause of the RLS. After the reversible cause of RLS are ruled out, treatment with a dopamine agonist such as pramipexole usually is successful. If the ferritin level is low, iron replacement may be very helpful. Other medications that are used include a seizure medication, gabapentin, and narcotics. If a primary cause is found, treating the underlying cause is usually the first option. For most people, significant or complete relief with the treatment is possible.