Adults And Diabetes

Restless Leg Syndrome

Restless Leg Syndrome (RLS) is a neurological disorder that causes a persistent need to move the legs while at rest. This urge can make it difficult to fall asleep and stay asleep, which can result in exhaustion and daytime fatigue and lead to mood swings and depression. While RLS can be diagnosed in anyone, it has been found that people with type 2 diabetes, especially those with peripheral neuropathy, are particularly susceptible to this disorder. There is no known cause for RLS.

According to the National Institute of Neurological Disorders and Stroke, RLS affects about 12 million Americans but it is often misdiagnosed and underreported as many patients are concerned that their condition is “all in their mind.”

RLS has been described as creeping, crawling, pulls, pins and needles, tingling, or burning sensations. Movement provides some relief but only temporarily. RLS has also been known to affect the arms.

To further complicate things, more than 80 percent of people with RLS also experience a condition known as periodic limb movement disorder (PLMD). Like RLS, the cause is unknown. PLMD is characterized by involuntary leg twitching or jerking movements during sleep that typically occur every 10 to 60 seconds, sometimes throughout the night. The symptoms cause repeated awakening and severely disrupted sleep. Unlike RLS, patients with PLMD are unable to control their movements. Although many patients with RLS also develop PLMD, most people with PLMD do not experience RLS.

While people of all ages and races are affected by this disorder – infants to adults – women have a slightly higher rate of incidence and the severity of the disorder increases with age.

Types of RLS

There are two types of RLS:

Primary RLS – Also called idiopathic RLS, this is the most common form of RLS. This condition is called primary because the cause is unknown. Primary RLS is a lifelong condition, though the severity of the symptoms range vary. Some may experience occasional symptoms and go for long periods of time with no symptoms at all. Others experience increasing symptoms as time goes on.

Secondary RLS – Secondary RLS is usually prompted by a disease such as diabetes or can result from the use of some medications. Symptoms usually go away as the disease improves or the medication is stopped.


RLS Causes

A cause has yet to be found for primary RLS. It is known, however, that primary RLS runs in families, thereby suggesting a genetic link, which increases a person’s chances of developing the disorder.

Secondary RLS, on the other hand, can have a variety of causes. Diseases such as diabetes and Parkinson’s, nerve damage, and pregnancy can all contribute to the onset of secondary RLS. In pregnant women, the disorder usually occurs during the last three months of pregnancy and improves or disappears after delivery.


Certain medications can also lead to secondary RLS such as
• Antiseizure medication
• Antinausea medication
• Antidepressants
• Some cold and allergy medicines

RLS symptoms usually dissipate upon stopping the medication.

Other substances that can prompt RLS or make it worse include caffeine, alcohol, and tobacco.

Diagnosis

If you are concerned that you may have RLS, discuss all your symptoms with your doctor. The symptoms are very important in the diagnosis of the disorder. Your doctor will then take a complete medical history, do a complete physical exam, and he/she may order other tests as well to look for underlying conditions that may cause RLS.

The diagnosis of RLS usually requires that four conditions be met:

• An urge to move the legs due to an unpleasant feeling in the legs.
• The urge to move the legs, or the unpleasant feelings in the legs, begins or gets worse when you are at rest or not moving around frequently.
• The urge to move the legs, or the unpleasant feelings in the legs is partly or completely relieved by movement (such as walking or stretching) for as long as the movement continues.
• The urge to move the legs, or the unpleasant feelings in the legs, is worse in the evening and at night, or only occurs in the evening or at night.

Treatment

Currently, medicines used to treat Parkinson’s are also used to help ease symptoms of RLS, the goal being to decrease movement and help facilitate rest:
• Levodopa – short-acting treatment for mild RLS cases
• Dopamine agonists, pramipexole, and ropinirole – long-acting treatment for moderate to severe RLS or when Levodopa stops working

Other medicines include:
• Strong pain relievers
• Sedatives
• Anticonvulsant medicines used to treat epilepsy
• Iron supplements (by doctor’s recommendation only)

The goal of treating RLS is to relieve symptoms, increase the amount and quality of sleep and to treat any underlying causes for the condition. Lifestyle and nondrug treatments can sometimes improve RLS.

Things to avoid include:
• Tobacco
• alcohol
• Caffeine
• Some medications such as antidepressants, antinausea medicines, antipsychotic medicines, and antihistamines.

Good sleep habits are suggested, such as:
• Keep your sleep area cool, quiet, comfortable, and free of unnecessary light.
• Use your bedroom for sleeping, not for watching TV or using the computer or cell phone,
• Go to bed every night at the same time and awaken at the same time every morning. It is important to get enough sleep to feel rested when you wake up.

Other activities include:
• Moderate exercise
• Taking a hot or cold bath
• Massaging the leg or arm
• Using heat or ice packs

Excerpted and adapted from The National Heart Lung and Blood Institute and the National Institute of Neurological Disorders and Stroke.

Reviewed by Francine Kaufman, MD. 4/08