Medical Associates Clinic

 Quality Care Close To Home

Gettysburg Medical News
 The Clinical View
 by P.E. Hoffsten, M.D.
 13 JULY 2005

RESTLESS LEG SYNDROME

            Over the past many years, there has been a slow but progressive increase in the recognition that disorders of sleep play a critical part in a person’s general health.  Problems of inability to get to sleep or stay asleep (insomnia), sleep apnea in which the person ceases to breath while they are asleep, and restless leg syndrome are three major components of the inability to sleep.  Insomnia and sleep apnea have been covered in previous columns.  A lady recently asked about the restless leg syndrome and what could be done to help it.

            The restless leg syndrome has four features:  1.  The person with restless leg syndrome has an urge to move their legs abnormally frequently in order to relieve vague unpleasant sensations that occur.  2.  The urge to move the legs begins or worsens when the person tries to go to sleep or relax.  3.  The frequent movement somehow seems to alleviate the uncomfortable sensation the person has in their legs.  4.  This unpleasant sensation the person has necessitating continuous leg movements somehow seems to be worse in the evening and at bedtime.

            As a last stipulation, the person will have a normal examination and no specific illness causing this syndrome.  Heart failure, kidney failure, diabetes, and osteoarthritic problems all will make the restless leg syndrome worse but are not the primary cause of the problem.  The restless leg syndrome tends to get worse with time, most frequently beginning in middle age and becoming very problematic as the person ages.  Its impact on the ability of the person to get to sleep and stay asleep can be very substantial.  This tends to make other illnesses worse because of the person’s poor sleep pattern.

            In order to improve the person’s quality of sleep and alleviate the symptoms of restless leg syndrome, there are four groups of medications that are tried.  None are specific or reliable to treat all cases of the restless leg syndrome.  By accident, it was found that the drugs that were used to treat Parkinson’s disease seemed to have a very beneficial effect in many patients with restless leg syndrome.  This group of drugs is the most predictably effective family of medications.  Unfortunately, they also have a relatively high side-effect profile that requires the patient to make a trade-off .  These drugs can cause nausea and low blood pressures.  If taken at bedtime, neither side effect may be particularly bothersome, but the patient always has to make a decision on whether or not stopping the restless leg syndrome is worth the side effects that might occur.

            The second family of medications that might help this condition is called benzodiazepines.  A column about these was written recently.  Basically, these drugs are sedatives that induce a deeper sleep and sometimes will turn off the restless leg syndrome symptoms.  The side effect of these drugs is hang-over drowsiness that may carry into the next day.  Adjustment of doses can often overcome this side effect.

            The third family of medications that might help the restless leg syndrome is the opioids.  These basically are the narcotic medications such as codeine, oxycodone, hydrocodone, or morphine.  The major side effect of this family of drugs is the addiction potential, but in my experience that is very slim.  This family of drugs also causes constipation which is probably the most bothersome of the side effects that might occur with this family of medications.

            The last medication that sometimes helps patients with restless leg syndrome is a drug called gabapentin (Neurontin).  The major side effect of this medication is the expense.

              The Parkinsonian drugs are by far the most commonly used family of medications for the treatment of restless leg syndrome because of they are relatively inexpensive and effective.

            Another term that has crept into the medical literature is “periodic limb movement disorder”.  This is a condition in which the person’s legs or arms tend to have a rhythmic movement almost on a timed basis.  These patients will have a particular movement of their toe or their leg or their hand that will come every 5 seconds, every 8 seconds, or every 20 seconds while they are asleep.  When sleep studies are done, this finding is a striking, usually deemed abnormality, however, the clinic importance of this may be insignificant.  This periodic limb movement disorder tends to come on most commonly in patients that have restless leg syndrome.  If the restless leg syndrome is effectively treated, the periodic limb movement disorder also appears to be effectively treated.

            Several reports in the literature have estimated the incidence of restless leg syndrome as 3% in those people who visit a primary care clinic such as those sponsored by Rural Health, Inc.  The same literature reports also indicate that the condition is substantially under diagnosed.  The symptoms of restless leg syndrome are often attributed to other conditions such as diabetic neuropathy, varicose veins, or depression.  It wouldn’t be hard to understand how a person would be depressed if their legs kept moving all night long and kept them awake and prevented sleep.  The healthcare providers at your local clinics are aware of the restless leg syndrome, how to diagnose it and the appropriate medication to alleviate symptoms.