Clinicians who see patients with restless leg syndrome (RLS) will hear it described in many different ways. Some patients describe their experience as miserable, unpleasant and painful, whereas others may say that they are itching inside, or that they have the creepy crawlies or the jitters. All patients with RLS will agree that movement is the only way to relieve the sensation.
RLS is sometimes confused with symptoms of anxiety, which can cause patients to move constantly or shake their leg, but the two are different. A single question identified in a collaborative study involving the United States and Italy has 95% sensitivity in diagnoses:
When you try to relax in the evening or sleep at night, do you ever have unpleasant, restless feelings in your legs that can be relieved by walking or movement?
If the answer is “yes,” your patient may have RLS.
Patients with RLS have the most difficulty in the evenings and when sitting still for any length of time. Many complain that they cannot sit still to watch television or that flying on an airplane is very uncomfortable.
RLS involves a dysfunction in dopaminergic transmission and is related to abnormalities of iron transport and storage. The disorder is fairly common, effecting 5% to 15% of the population, and is more prevalent in elderly patients. There is also thought to be a genetic predisposition, so be sure to take a family history in patients suspected of RLS.
Most RLS patients present with a chief complaint of poor sleep because they are often moving or feel uncomfortable during sleep. Bed partners often complain that RLS disturbs their sleep, too, which can lead to marital discord and frustration in relationships.
RLS is more common in women. More than 20% of women experience the sleep disorder during pregnancy, when the developing fetus depletes folate and ferritin reservoirs.
Patients with fibromyalgia, ADHD, hypothyroidism, uremia and anemia also have higher RLS prevalence, so be on the look out for these comorbidities.
Those taking antidepressants are another at-risk population, as this class of medication can exacerbate RLS. The exception is buproprion, which can actually help symptoms, because of its dopamine-enhancing capabilities.
First-line RLS treatment is with dopaminergic agonists, such as pramipexole and ropinirole, but patients may also benefit from gabapentin and clonazepam. In some cases, if the pain is severe enough, opiates may also be prescribed. Recognizing and treating RLS early can drastically improve a patient’s quality of life very quickly.
Sharon M. O’Brien, MPAS, PA-C, works at Presbyterian Sleep Health in Charlotte, N.C. Her main interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.