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Restless Leg Syndrome

BASIC INFORMATION on RESTLESS LEG SYNDROME (RLS)
Including Likely Causes, Treatments, and Medications

What is Restless Leg Syndrome?

• You have a strong urge to move your legs which you may not be able to resist. The need to move is often accompanied by uncomfortable sensations. Some words used to describe these sensations include: creeping, itching, pulling, creepy-crawly, tugging, or gnawing.

• Your RLS symptoms start or become worse when you are resting. The longer you are resting, the greater the chance the symptoms will occur and the more severe they are likely to be.

• Your RLS symptoms get better when you move your legs. The relief can be complete or only partial but generally starts very soon after starting an activity. Relief persists as long as the motor activity continues.

• Your RLS symptoms are worse in the evening especially when you are lying down. Activities that bother you at night do not bother you during the day or didn't when symptoms first started occurring.

What non-drug treatments are recommended for RLS?
In addition to medications, there are other things you and your doctor can consider when trying to help you deal with RLS. These options may include:

• Checking to see if there is an underlying iron or vitamin deficiency and then possibly supplementing your diet with iron, vitamin B12 or folate.

• Looking at medications you may be taking which make RLS worse. These may include drugs used to treat high blood pressure, heart conditions, nausea, colds, allergies and depression.

• Looking at any herbal and over-the-counter medicines you may be taking to see if they could be worsening your RLS.

• Identifying habits and activities that worsen RLS symptoms.

• Looking at your diet to assure it is healthy and balanced.

• Discussing whether or not antihistamines could be contributing to your RLS.

• Eliminating your alcohol intake.

• Looking at various activities that may help you personally deal with RLS. These could include walking, stretching, taking a hot or cold bath, massaging, acupressure, or relaxation techniques.

• Attempting to keep your mind engaged with activities like discussions, needlework or video games when you have to stay seated.

• Implementing a program of good sleep habits.

• Possibly eliminating caffeine from your diet to aid in general sleep hygiene.

• OTC simple analgesics like Tylenol, Ibuprofen, or Aleve.

Medications that can make RLS worse?
These drugs include calcium-channel blockers (used to treat high blood pressure and heart conditions), Reglan (metoclopramide), most antinausea medications, some cold and allergy medications, major tranquilizers (including haloperidol and phenothiazines), and the antiseizure medication, phenytoin. Most medications used to treat depression increase the symptoms of RLS.

Are there any substances that should be avoided?
The use of caffeine often intensifies RLS symptoms. Caffeine-containing products, including chocolate and caffeinated beverages such as coffee, tea, and soft drinks should be avoided. The consumption of alcohol also increases the span or intensity of symptoms for most individuals.

Is there a known cause for RLS?
Extensive research into the cause of RLS is occurring worldwide. A single unifying cause has not been identified, but we are getting closer. Here is what we do know:

• RLS often runs in families. This is called primary or familial RLS. Researchers are currently looking for the gene or genes that cause RLS.

• RLS sometimes appears to be a result of another condition, which, when present, worsens the underlying RLS. This is called secondary RLS.

• Up to 25% of women develop RLS during pregnancy but symptoms often disappear after giving birth.

• Low iron levels with out without anemia frequently contribute to a worsening of RLS.

• RLS is very common in patients requiring dialysis for end-stage renal disease.

• Damage to the nerves of the hands or feet (i.e., peripheral neuropathy) from any number of causes including diabetes contributes to RLS.

What is augmentation?
If augmentation occurs, your usual dose of a dopaminergic agent (Mirapex or Requip) will relieve your symptoms so that you are able to sleep at night, but eventually, the unpleasant sensations will develop earlier in the day. Augmentation of RLS symptoms may occur after an initial period of relief with dopaminergic agents, and unfortunately, increasing your dosage will probably worsen your symptoms. If augmentation occurs, you and your doctor can work together to find a new drug regimen that will work for you.

Restless Legs Syndrome Rating Scale

• Have the patient rate his/her symptoms for the following ten questions.

• The patient and not the examiner should make the ratings, but the examiner should be available to clarify any misunderstandings the patient may have about the questions.

• The examiner should mark the patient's answers on the form.

In the past week…

(1) Overall, how would you rate the RLS discomfort in your legs or arms? __ (4) Very severe __ (3) Severe __ (2) Moderate __ (1) Mild __ (0) None	(6) How severe was your RLS as a whole? __ (4) Very severe __ (3) Severe __ (2) Moderate __ (1) Mild __ (0) None
(2) Overall, how would you rate the need to move around because of your RLS symptoms? __ (4) Very severe __ (3) Severe __ (2) Moderate __ (1) Mild __ (0) None	(7) How often did you get RLS symptoms? __ (4) Very often (6-7 days/week) __ (3) Often (4-5 days/week) __ (2) Sometimes (2-3 days/week) __ (1) Occasionally (1 day/week) __ (0) Never
(3) Overall, how much relief of your RLS arm or leg discomfort did you get from moving around? __ (4) No relief __ (3) Mild relief __ (2) Moderate relief __ (1) Either complete or almost complete relief __ (0) No RLS symptoms to be relieved	(8) When you had RLS symptoms, how severe were they on average? __ (4) Very severe (8+ hrs/day) __ (3) Severe (3-8 hrs/day) __ (2) Moderate (1-3 hrs/day) __ (1) Mild (< 1 hr/day) __ (0) None
(4) How severe was your sleep disturbance due to your RLS symptoms? __ (4) Very severe __ (3) Severe __ (2) Moderate __ (1) Mild __ (0) None	(9) How severe was your tiredness or sleepiness during the day due to your RLS symptoms? __ (4) Very severe __ (3) Severe __ (2) Moderate __ (1) Mild __ (0) None
(5) Overall, how severe was the impact of your RLS symptoms on your ability to carry out your daily affairs, for example carrying out a satisfactory family, home, social, school or work life? __ (4) Very severe __ (3) Severe __ (2) Moderate __ (1) Mild __ (0) None	(10) How severe was your mood disturbance due to your RLS symptoms - for example angry, depressed, sad, anxious or irritable? __ (4) Very severe __ (3) Severe __ (2) Moderate __ (1) Mild __ (0) None

Sum of scores =
Scoring criteria are: Mild (score 1-10); Moderate (score 11-20); Severe (score 21-30); Very severe (score 31-40) Answers for this IRLS are scored from 4 for the first (top) answer (usually 'very severe') to 0 for the last answer (usually none). All items are scored. The sum of the item scores serves as the scale score.

The International Restless Legs Syndrome Study Group holds the copyright for this scale.