Legs run at night. Causes and treatment of restless legs syndrome at home. Restless legs syndrome causes

Epidemiology

Current population studies indicate that the prevalence of RLS in adults is 5-10%, with symptoms occurring at least once a week in approximately two-thirds of cases and more than twice a week in one-third of cases, significantly affecting quality of life. RLS occurs in all age groups, but is more common in middle and old age (in this age group its prevalence reaches 10-15%). However, at least a third of RLS cases first appear in the second or third decades of life. RLS occurs 1.5 times more often in women than in men, and this disproportion is further exacerbated by the fact that women are more likely to seek medical help for RLS. According to a number of researchers, approximately 15% of cases of chronic insomnia are associated with RLS.

Etiology

In more than half of cases, RLS occurs in the absence of any other neurological or physical disease (primary or idiopathic RLS). Primary RLS usually appears in the first three decades of life (SBP with early onset) and may be hereditary. In various clinical series of RLS, the proportion of familial cases ranged from 30 to 92%. Analysis of family cases indicates a possible autosomal dominant type of transmission with almost complete penetrance, but variable expressivity of the pathological gene. Both polygenic and monogenic nature of the disease are assumed. In some families, an association of RLS with loci on chromosomes 12, 14 and 9 has been identified. It is possible that in a significant proportion of cases the disease is multifactorial in nature, arising as a result of a complex interaction of genetic and external factors.

The three main causes of secondary (symptomatic) RLS are pregnancy, end-stage uremia, and iron deficiency (with or without anemia). RLS is detected in 15-52% of patients with uremia, including almost a third of patients on dialysis, almost 20% of pregnant women (symptoms often appear only in the 2nd-3rd trimester and disappear within a month after delivery, but sometimes persist ). In addition, cases of RLS have been described in diabetes mellitus, amyloidosis, cryoglobulinemia, vitamin B12 deficiency, folic acid, thiamine, magnesium, as well as alcoholism, thyroid diseases, rheumatoid arthritis, Sjögren's syndrome, porphyria, occlusive arterial disease or chronic venous insufficiency of the lower extremities. In many of these conditions, RLS occurs in conjunction with symptoms of axonal polyneuropathy. RLS has also been described in patients with radiculopathies, as well as with lesions of the spinal cord, usually in the cervical or thoracic regions (for example, with trauma, spondylogenic cervical myelopathy, tumors, myelitis, multiple sclerosis). Symptomatic RLS most often begins after age 45 (late-onset RLS) and usually tends to progress more rapidly.

RLS is sometimes detected in patients with Parkinson's disease, essential tremor, Tourette's syndrome, Huntington's disease, amyotrophic lateral sclerosis, post-polio syndrome, but it remains unclear whether this combination is due to chance (due to the high prevalence of RLS), the presence of common pathogenetic mechanisms, or the use of medicines.

Pathogenesis

The effectiveness of dopaminergic drugs and the possibility of worsening symptoms under the influence of antipsychotics indicate that a key element in the pathogenesis of RLS is a defect in dopaminergic systems. However, the nature of this dysfunction remains unclear. IN last years Using positron emission tomography (PET), patients with RLS revealed a moderate decrease in the uptake of [ 18 F]-fluorodopa in the putamen, which indicates dysfunction of dopaminergic neurons in the substantia nigra, but, unlike Parkinson's disease, the number of these neurons does not decrease. According to some authors, the leading role in the pathogenesis of RLS is played by dysfunction not of the nigrostriatal system, but of the descending diencephalic-spinal dopaminergic pathways, the source of which is a group of neurons located in the caudal thalamus and periventricular gray matter of the midbrain. This system regulates the passage of sensory impulses through the spinal cord and, possibly, segmental mechanisms of motor control.

The clear daily rhythm of the clinical manifestations of RLS may reflect the interest of the structures of the hypothalamus, in particular the suprachiasmatic nucleus, which regulates the daily cycles of physiological processes in the body. The increase in RLS symptoms in the evening can also be explained based on the dopaminergic hypothesis: the worsening coincides with a daily decrease in dopamine levels in the brain, as well as with the period of lowest iron levels in the blood (this indicator decreases by almost half at night). The association of RLS with iron deficiency may be determined by the important role of iron in the functioning of the dopaminergic system.

The occurrence of RLS in the setting of peripheral nervous system lesions suggests the importance of peripheral nervous system dysfunction in the generation of symptoms. According to the clinical picture, including the daily rhythm of symptoms and responsiveness to drugs, RLS associated with damage to the peripheral nervous system is not much different from primary RLS, which indicates their pathogenetic relationship. It is possible that in some patients with RLS, polyneuropathy, iron deficiency, coffee abuse or other factors only reveal an existing hereditary predisposition, which partly blurs the line between the primary and secondary variants of RLS.

Clinical picture

Clinically, RLS is characterized by two main groups of symptoms: subjective pathological sensations and excessive motor activity, which are closely related. Sensory symptoms of RLS include sensations of itching, scraping, stabbing, bursting or pressing, as well as the illusion of “crawling” sensations. Some patients complain of a dull cerebral or intense cutting pain, but more often these sensations are not painful, although they can be extremely painful and unpleasant. Painful pathological sensations experienced by patients are usually referred to as dysesthesias, non-painful ones - paresthesias, but the boundary between them is arbitrary. Pathological sensations with RLS initially have limited localization and most often occur in the depths of the legs, less often (as a rule, with polyneuropathy) - in the feet. With subsequent progression, they often spread upward, involving the thighs and arms, and occasionally the torso and perineal area. Unpleasant sensations usually occur on both sides, but in more than 40% of cases they are asymmetrical, and sometimes even unilateral.

A characteristic feature of pathological sensations with RLS is depending on motor activity and poses. They usually occur and intensify at rest (sitting and especially lying down), but decrease with movement. To alleviate their condition, patients are forced to stretch and bend their limbs, shake, rub and massage them, toss and turn in bed, get up and walk around the room, or shift from foot to foot. Each patient develops his own “repertoire” of movements that help him reduce discomfort in the limbs. During movement, the unpleasant sensations decrease or disappear, but as soon as the patient lies down, and sometimes just stops, they intensify again.

Symptoms of RLS have a clear circadian rhythm, appearing or intensifying in the evening and night hours. On average, they reach their maximum severity in the period from 0 to 4 am, and their minimum in the period from 6 to 10 am. Initially, most patients experience symptoms about 15 to 30 minutes after they go to bed. But subsequently, the time of their appearance may become earlier and earlier, right up to daytime hours. In severe cases, the characteristic circadian rhythm disappears and symptoms become permanent. They can occur not only in a supine position, but also in a sitting position and can make visiting a movie or theater, flying on an airplane, or a long trip in a vehicle unbearable.

A direct consequence of unpleasant sensations in the limbs and the need to constantly move is sleep disturbance - insomnia. Patients cannot fall asleep for a long time and often wake up at night. The consequence of insomnia is fatigue and decreased attention during the daytime. The complaint of poor sleep is the leading one for most patients, and it is this that most often brings them to the doctor. Many patients have comorbid depression.

Sleep disturbances in RLS are aggravated by periodic limb movements (PLM), which occur during sleep in 80% of patients with RLS. They are rhythmic short-term jerks, most often observed in the legs, are stereotypical and involve dorsiflexion of the big toes, sometimes with fanning of the remaining toes or flexion of the entire foot. In more severe cases, bending of the legs at the knees and hip joints. MPCs last from 0.5 to 5 s and occur in series at intervals of 20-40 s over several minutes or hours. In mild cases, neither the patients themselves nor their close relatives suspect the presence of PDC; they can only be detected using polysomnography. In severe cases, movements continue throughout the night and may cause frequent awakenings. In general, the intensity of MDCs correlates well with the severity of RLS manifestations, so their registration using polysomnography can serve as a reliable objective method for assessing the effectiveness of RLS therapy.

General and neurological examination of patients with primary RLS usually does not reveal any abnormalities. But with symptomatic RLS, signs of a somatic or neurological disease, primarily polyneuropathy, can be detected.

Course of the disease

In primary RLS, symptoms usually persist throughout life, but their intensity can fluctuate significantly - it is temporarily intensified during periods of stress, due to the consumption of caffeine-containing products, after intense physical activity, and during pregnancy. In most cases, there is a tendency for symptoms to slowly worsen over time. But sometimes there are periods of stationary course or remission, which can last from several days to several years. Long-term remissions are observed in 15% of patients. In secondary RLS, the course depends on the underlying disease. Remissions in symptomatic forms are rare.

Diagnostics

RLS refers to frequent illnesses, but is rarely diagnosed - mainly due to the low awareness of practical (practicing) doctors, who are often inclined to explain the complaints of patients with neurosis, psychological stress, diseases of peripheral vessels, joints, and spinal osteochondrosis. However, in most cases, the diagnosis of RLS is simple and is based on the patient’s complaints. The diagnostic criteria for RLS proposed by the International RLS Study Group are presented in the table.

RLS must be differentiated from akathisia, “painful legs - moving toes” syndrome, hypnic twitching, night cramps, meralgia paresthetica, polyneuropathy, fibromyalgia. Having diagnosed RLS, the secondary nature of the syndrome should be excluded by conducting a thorough neurological and somatic examination of the patient. The scope of laboratory and instrumental examination is dictated by the need to exclude polyneuropathy (including using electroneuromyography), anemia, uremia, diabetes mellitus, chronic lung diseases, rheumatic diseases, deficiency of iron, magnesium and vitamins. It should be noted that iron deficiency in the body is more reliably indicated by the level of ferritin, rather than serum iron. If there is a deviation from the typical clinical picture of the syndrome or if standard therapy is ineffective, polysomnography is indicated.

General principles of treatment

For symptomatic RLS, treatment should primarily be aimed at correcting the primary disease or replenishing the identified deficiency (iron, folic acid, magnesium, etc.). Correction of iron deficiency with the administration of iron supplements is indicated when serum ferritin levels are below 45 mcg/ml. Typically, ferrous sulfate (325 mg) is prescribed in combination with vitamin C (250-500 mg) 3 times a day between meals. In primary RLS, the basis of treatment is symptomatic therapy, with the help of which it is possible to achieve complete regression of symptoms in a significant proportion of patients. Symptomatic therapy includes both non-drug measures and the use of drugs.

Non-drug therapy

First of all, it is important to find out what medications the patient is taking and, if possible, discontinue those that may increase the manifestations of RLS (neuroleptics, metoclopramide, antidepressants - both tricyclic and selective serotonin reuptake inhibitors, lithium preparations, terbutaline, antihistamines and antagonists H2 receptors, nifedipine and other calcium antagonists).

All patients are recommended to do moderate physical activity during the day, following a certain bedtime ritual, evening walks, evening shower, balanced diet with refusal to drink coffee, strong tea and other caffeine-containing products (for example, chocolate or Coca-Cola) during the day and evening, limiting alcohol, stopping smoking, normalizing the daily routine.

Even Ekbom (1945) noted that the symptoms of RLS are more pronounced in patients with cold feet, while with an increase in body temperature they are alleviated. In this regard, a warm foot bath or a light warming foot massage before bed can significantly improve the condition. In some cases, transcutaneous electrical stimulation, vibration massage, darsonvalization of the legs, reflexology or magnetic therapy are effective.

Drug therapy

It is customary to prescribe medications for RLS in cases where it significantly disrupts the patient’s vital functions, causing persistent sleep disturbance, and non-drug measures are not effective enough. In mild cases, you can limit yourself to taking sedatives of herbal origin or prescribing a placebo, which can give a good, but sometimes only temporary effect.

In more severe cases, you have to choose a drug from four main groups: benzodiazepines, dopaminergic drugs, anticonvulsants, opioids.

Benzodiazepines accelerate the onset of sleep and reduce the frequency of awakenings associated with PDC, but have relatively little effect on the specific sensory and motor manifestations of RLS, as well as PDC. The most commonly used benzodiazepines are clonazepam (0.5-2 mg at night) or alprazolam (0.25-0.5 mg). With long-term use of benzodiazepines, there is a danger of developing tolerance with a gradual decrease in effect and the formation of drug dependence. The negative aspects of the action of benzodiazepines also include the possibility of developing or increasing drowsiness during the day, decreased libido, increased sleep apnea, episodes of confusion at night, as well as worsening cognitive impairment in the elderly. In this regard, benzodiazepines are currently used sporadically in mild or moderate cases - during periods of deterioration, and in severe cases requiring constant treatment, they are prescribed only when dopaminergic drugs are ineffective.

Dopaminergic drugs (levodopa and dopamine receptor agonists) are the mainstays of treatment for RLS. They affect all the main manifestations of RLS, including the maximum concentration limit. Dopaminergic drugs are so effective in RLS that a positive reaction to them can serve as an additional criterion for diagnosing RLS, and its absence, as, for example, in Parkinson's disease, should be considered a basis for revising the diagnosis. The effect of dopaminergic drugs in RLS occurs in doses that are significantly lower than those used in Parkinson's disease. Dopaminergic agents appear to be equally effective for both primary and symptomatic RLS.

Levodopa has been used for RLS since 1985, when its effectiveness in this category of patients was first shown. Currently, levodopa is prescribed in combination with DOPA decarboxylase inhibitors benserazide (Madopar) or carbidopa (Nakom, Sinemet). Treatment begins with 50 mg of levodopa (approximately 1/4 tablet of Madopar “250”), which the patient should take 1-2 hours before bedtime. If the effectiveness is insufficient, after a week the dose is increased to 100 mg, the maximum dose is 200 mg. Taking levodopa provides an adequate effect in 85% of patients. In many patients it remains effective for many years, and in some patients its effective dose may remain stable or even decrease. Levodopa is generally well tolerated by patients with RLS, and side effects(nausea, muscle spasms, tension headaches, irritability, dizziness, dry mouth) are usually mild and do not require discontinuation of the drug. Given the rapid onset of effect and the lack of need for dose titration, levodopa may be considered the treatment of choice for intermittent worsening symptoms.

However, when long-term use in a significant proportion of patients, the effectiveness of levodopa decreases, while the duration of action of a single dose is reduced to 2-3 hours, which may be followed by a rebound increase in the symptoms of RLS and PDC in the second half of the night. In this case, it is recommended to increase the dose of the drug or add a second dose immediately before bedtime or upon awakening at night. However, with an increase in the dose of levodopa, the rebound increase in symptoms may not be eliminated, but only shift to early morning hours, while its intensity may increase. Experience shows that a more reasonable alternative in this situation is to switch to a sustained-release levodopa preparation (Madopar GSS). A slow-release drug that acts over 4-6 hours and provides good dream throughout the night and prevents morning rebound intensification of symptoms.

In approximately half of patients, during long-term treatment with levodopa, symptoms gradually begin to appear earlier (sometimes even during the day), becoming more intense and widespread (the so-called “augmentation”). The higher the dose of levodopa, the stronger the augmentation, so increasing the dose of levodopa in this situation only makes the situation worse, completing a vicious circle. When using Madopar GSS as a basic therapy for RLS, rebound enhancement and augmentation are observed less frequently than when taking standard levodopa drugs. In this regard, Madopar GSS is now often used as a means of initial treatment of RLS (1-2 capsules 1-2 hours before bedtime). Sometimes it is reasonable to recommend to the patient 1 hour before bedtime 100 mg of levodopa as part of a standard drug or a soluble fast-acting drug, which provides a relatively rapid onset of effect, and 100 mg of levodopa as part of a slow-release drug (for example, 1 capsule of Madopar GSS). When augmentation develops, it is recommended to either replace levodopa with a dopamine receptor agonist, or add it to it (by reducing the dose of levodopa).

Dopamine receptor agonists (DRAs) have been used for RLS shortly after levodopa was shown to be effective, in 1988. Experience shows that the effectiveness of ADR for RLS is approximately equivalent to that of levodopa. ADRs can be considered as a means of choice if long-term daily medication is required. For RLS, both ergoline drugs (bromocriptine, cabergoline) and non-ergoline drugs (pramipexole, piribedil) are used. Non-ergoline drugs have the advantage of being free from side effects such as vasospastic reactions, pleuropulmonary, retroperitoneal fibrosis, and fibrosis of the heart valves. To avoid nausea, ADRs are taken immediately after meals and the dose is adjusted by slow titration. Pramipexole is initially prescribed at a dose of 0.125 mg, then gradually increased until the effect is achieved (usually no more than 1 mg). The effective dose of piribedil is 50-150 mg. For bromocriptine treatment, the starting dose is 1.25 mg and the effective dose ranges from 2.5 to 7.5 mg. Cabergoline treatment begins with 0.5 mg, and its effective dose is 1-2 mg. The indicated dose is usually prescribed once 1-2 hours before bedtime, but in severe cases, additional administration of the drug may be necessary in the early evening hours. Side effects when taking ADR include nausea, fatigue, headache, dizziness, daytime sleepiness. Domperidone may be prescribed at the beginning of treatment to prevent nausea.

With long-term use of ADR, signs of augmentation are detected in approximately 25-30% of patients, but they are almost never as severe as with levodopa treatment. If one of the ADRs turns out to be ineffective, you can try replacing it with another drug from this group. It is important to note that dopaminergic drugs, while eliminating the symptoms of RLS, do not always lead to normalization of sleep, which requires the addition of a sedative drug (benzodiazepine or trazodone).

It should be noted that, probably due to the absence of denervation and the normal number of dopaminergic neurons, dopaminergic drugs are effective in RLS at doses significantly lower than those used in Parkinson's disease. Moreover, side effects such as dyskinesia, psychosis, impulsivity, and compulsive behavior (common in Parkinson's disease) are extremely rare in RLS.

In those few cases where the patient does not tolerate dopaminergic drugs well, and benzodiazepines are ineffective or cause intolerable side effects, they resort to anticonvulsants or opioids. Of the anticonvulsants, gabapentin is currently most often used - at a dose of 300 to 2700 mg/day. The entire daily dose is usually prescribed once in the evening. Opioid drugs (codeine, 15-60 mg; dihydrocodeine, 60-120 mg, tramadol, 50-400 mg at night, etc.) can significantly reduce the symptoms of RLS and PDC, but the risk of developing drug dependence makes their use justified only in the most severe cases where all other treatment methods are ineffective. The treatment algorithm for RLS is shown in the figure.

For RLS, it is possible to use some other drugs (clonidine, folic acid, magnesium, vitamins E, B, C), but their effectiveness has not been confirmed in controlled studies. In some patients, amantadine, baclofen, zolpidem are effective; beta blockers (for example, propranolol) can reduce symptoms, but sometimes cause them to worsen.

Treatment of RLS has to be carried out over a long period of time over many years, and therefore it is very important to follow a unified treatment strategy. Sometimes it is carried out only during the period of intensification of symptoms, but often patients are forced to take certain drugs for life to maintain drug remission. It is better to start treatment with monotherapy, choosing a drug taking into account its effectiveness in each individual patient and the presence of concomitant diseases. If monotherapy is insufficiently effective or in cases where, due to side effects, it is not possible to achieve a therapeutic dose of one of the drugs, it is possible to use a combination of drugs with different mechanisms of action in relatively small doses. In some cases, it is advisable to rotate several drugs that are effective for a given patient, which allows them to maintain their effectiveness for many years.

Treatment of RLS in pregnant women is particularly challenging. None of the drugs commonly used for RLS are considered safe during pregnancy. Therefore, when RLS develops during pregnancy, they are usually limited to non-drug measures (for example, a walk and a warm shower before bed) and the administration of folic acid (3 mg/day), as well as iron supplements (if there is a deficiency). Only in severe cases is it permissible to use small doses of clonazepam, and if they are ineffective, small doses of levodopa.

Trazodone and monoamine oxidase inhibitors (MAOIs) can be used to treat depression in patients with RLS. Data on the effect of selective serotonin reuptake inhibitors in patients with RLS and PDC are contradictory. However, in some patients they can nevertheless improve the condition, which is explained by the suppression of the activity of dopaminergic neurons. Tricyclic antidepressants, like antipsychotics, are contraindicated.

Conclusion

RLS is one of the most common neurological diseases. Modern methods Treatments make it possible to achieve almost complete elimination of symptoms and a significant improvement in the quality of life in the vast majority of patients. In this regard, timely diagnosis of the syndrome is of key importance - doctors must learn to recognize, behind the seemingly “banal” complaints of patients about insomnia or discomfort in the legs, this is a very unique and, most importantly, curable disease.

Literature

Averyanov Yu. N., Podchufarova E. V. Restless legs syndrome // Neurological Journal, 1997. No. 3. P. 12-16.

Levin O. S. Restless legs syndrome // Diagnosis and treatment of extrapyramidal disorders / ed. V. N. Shtoka. M., 2000. pp. 124-138.

Levin O. S. Restless legs syndrome // Extrapyramidal disorders. Guide to diagnosis and treatment / ed. V.N.Shtoka, I.A.Ivanova-Smolenskaya, O.S.Levin. M.: Medpress-inform, 2002. P. 425-434.

Allen R. P., Walters A. S., Monplaisir J. et al. Restless legs syndrome // Slep. Med., 2003. V.4. P. 101-119.

Allen R.P. Contraversies and challenges in defining etiology and pathophysiology of restless legs syndrome // Am. J. Med., 2007. V.120. S. 13-21.

Becker P. M., Jamieson A. O., Brown W. D.. Dopaminergic agents in restless legs syndrome and periodic limb movements of sleep: response and complications of extended treatment in 49 cases // Sleep, 1993. V.16. P. 713-716.

Ekbom K. A. Restless legs // Acta Med. Scand., 1945. V. 158. P. 5-123.

Earley C. J. Restless legs syndrome // N. Engl. J. Med., 2003. V. 348. P. 2103-2109.

Happe S., Klosch G., Saletu B.. et al. Treatment of idiopathic restless legs syndrome (RLS) with gabapentin // Neurology, 2001. V.57. P. 1717-1719.

Kaplan P.W. Levodopa in restless legs syndrome // Ann Pharmacotherapy, 1992. V. 26. P. 244-245.

Montplaisir J., Godbout R., Poirier G.. et al. Restless legs syndrome and periodic movements in sleep: physiopathology and treatment with l-dopa // Clin. Neuropharmacol., 1986. V. 9. P. 456-463.

Montplaisir J., Nicolas A., Denesle R. et al. Restless legs syndrome improved by pramipexole // Neurology, 1999. V.52. P. 938-943.

Ondo W., Jankovic J. Restless legs syndrome. Clinicoetiologic correlates // Neurology, 1996. V. 47. P. 1435-1441.

Paulus W., Trenkwalder C. Pathophysiology of dopaminergic therapy - related augmentation in rextless leg syndrome // Lancet Neurology, 2006. V. 5. P. 878-886.

Phillips B., Young T., Finn L. et al. Epidemiology of restless legs symptoms in adults//Arch. Int. Med., 2000. V.160. P. 2137-2141.

Saletu M., Anderer P., Saletu-Zyhlarz G.. et al. Restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) acute placebo-controlled sleep laboratory studies with clonazepam // Eur. Neuropsychopharmacol., 2001. V. 11. P. 153-161.

Silber M. H., Ehrenberg B. L., Allen R. P.. et al. An algorithm for the management of restless legs syndrome // Mayo Clin Proc., 2004. V. 79. P. 916-922.

Steiner J.C.. Clonidine helps restless legs syndrome // Neurology, 1987. V. 37(Suppl. 1). P. 278.

Trenkwalder C., Henning W. A., Walters A. S.. et al. Circadian rhythm of periodic limb movements and sensory symptoms of restless legs syndrome // Mov. Disord., 1999. V.14. P. 102-110.

Turjanski N., Lees A. J., Brooks D. J.. Striatal dopaminergic function in restless legs syndrome: 18F-dopa and 11C-raclopride PET studies // Neurology, 1999. V.52. P. 932-937.

Ulfberg J., Nystrom B., Carter N. et al. Prevalence of restless legs syndrome among men aged 18 to 64 years: anassociation with somatic disease and neuropsychiatric symptoms // Mov. Disord., 2001. V. 16. P. 1159-1163.

Walker S. L., Fine A., Kryger M. H.. L-DOPA/carbidopa for nocturnal movement disorders in uremia // Sleep, 1996. V.19.
P. 214-218.

O. S. Levin, Doctor of Medical Sciences, Professor
RMAPO, Moscow

One of the most distressing sensorimotor disorders known to neurology is restless legs syndrome. The disease is one of the main factors provoking chronic insomnia. The disorder affects all age groups, but is more common in older people. Women over 60 years of age are most prone to its occurrence. Differential diagnosis, despite the prevalence of the syndrome, is significantly difficult, and the correct diagnosis is established only in 8% of all patients.

Classification of the syndrome by type of manifestation

Traditionally, the disorder affects middle-aged and elderly people, but restless legs syndrome is also observed in children in some cases.

The disorder often accompanies pregnancy, causing the woman to develop severe and psychological disorders that are incompatible with healthy pregnancy.

• Childhood restless legs syndrome. The disorder in children is often mistakenly classified as so-called “growing pains.” Some clinical studies have found that restless legs syndrome in childhood is associated with lack of attention from parents, and as a result, psychological disorders.

  Other doctors believe that the disorder occurs in response to children's motor hyperactivity during the day. The true unambiguous causes of childhood and adolescent deviation have not yet been established, however, it has been proven that this syndrome tends to progress over the years and does not disappear on its own.

• Syndrome in pregnant women. The disorder occurs during pregnancy in 15-30% of cases. Often its onset occurs in the third trimester, and then the syndrome disappears on its own during the first month of motherhood. However, it is necessary to understand that the disorder can be directly related to problems in the body, including iron deficiency anemia.

If the syndrome is caused by pathological factors, it can be transmitted genetically from mother to child. To dispel doubts about the physiological causes of the disease, you need to seek help from doctors.

• Idiopathic restless legs syndrome. This form refers to the primary manifestation of the disorder. In this case, the syndrome manifests itself in the first 30 years of life and has a hereditary etiology of the autosomal dominant type.

  Clinical signs are no different from the symptomatic (secondary) syndrome, however, the idiopathic form is characterized by the absence of concomitant somatic and neurological diseases.

Do you know the feeling of numbness and “running” goosebumps in your legs? If these are isolated cases that are associated, for example, with an uncomfortable position of the legs, there is no need to worry. When this happens constantly, and the attacks are repeated, then, most likely, we can talk about the first

The concept of synkinesis is widespread not only in neurology, but is also quite often used in speech therapy. On the website you can find out more about this pathology.

Causes and provoking factors of the disorder

The symptomatic syndrome is observed mainly in the middle and older age categories, arising for the following reasons:

• Iron-deficiency anemia;
• Insulin-dependent diabetes mellitus type 2;
• Chronic hypovitaminosis of folic acid and cyanocobalamin;
• Uremia;
• Kidney and heart failure;
• Discogenic radiculopathy;
• Complications resulting from gastrectomy;
• Hormonal imbalance;
• Thyroid dysfunction: hypothyroidism, hyperthyroidism or thyrotoxicosis;
• Sjögren's syndrome;
• Obstructive diseases of the lung tissue;
• Venous insufficiency of the legs;
• Rheumatoid arthritis;
• Diseases of the blood vessels;
• Porphyrin disease;
• Cryoglobulinemia;
• Severe spinal cord injuries.

Pregnancy also contributes to the development of the disorder, but if no other pathological factor has provoked the syndrome, it is eliminated after the woman gives birth.

Polyneuropathic causes:

• Porphyritic polyneuropathy;
• Amyloidosis.

Symptoms of the syndrome

Symptoms of the disorder are distinguished by a clearly limited time frame.

The disorder manifests itself in a certain daily rhythm, and the peak of symptoms occurs between 00.00 and 04.00 at night.

A person suffering from restless legs syndrome experiences a combination of the following symptoms:

• Intense pain in the lower extremities;
• The pain is often associated with a feeling of strong tingling, burning, a feeling of fullness and tightness, itching, pain in the legs;
• Unpleasant sensations are localized in the area of ​​the ankle joint and calf muscles;
• Occurs mainly at night;
• Signs begin to progress in a state of complete rest;
• Discomfort and pain tend to decrease with physical activity;
• Rhythmic movements in the legs of a neuropathic nature.

The clinical consequence of the development of restless legs syndrome in the vast majority of cases is severe insomnia. The patient cannot sleep for a long time due to increased motor activity and pain in the lower extremities.

If this is still possible, the patient wakes up after a short time from increasing symptoms, and falling back into sleep becomes almost impossible for him.

Differential diagnosis

Like any neurological disease, restless legs syndrome undergoes careful medical analysis before an accurate diagnosis is made.

Diagnostics consists of several main stages:

• A thorough study of the patient’s symptoms and an objective assessment of his family history;
• Somatic and neurological face-to-face examination;
• Blood chemistry;
• Study of ferritin content in blood serum based on tests;
• Electroneuromyography;

For additional data on the presence of concomitant diseases, you may need to consult a therapist and endocrinologist.

General computerization has led to the widespread spread of a disease that manifests itself as pain and discomfort in the hands. To eliminate it, various techniques are used, including surgery.

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Doctors call cerebral edema a fairly common complication after a stroke. You can find out why it develops by following the link.

Treatment for restless legs syndrome

Therapeutic measures

After an adequate diagnosis has been made and the underlying cause of the disease has been identified, comprehensive treatment is prescribed.

First of all, it may be associated with correcting a deficiency in the blood of certain substances and taking multivitamin complexes containing folic acid, magnesium and iron. In any case, the attending physician decides how to treat this syndrome.

Drug treatment

Includes various drugs:

• Tranquilizers and sleeping pills (Restoril, Ambien, Halcion, Klonopin). Used when mild form diseases;
• Antiparkinsonian drugs. To date, Mirapex treatment has proven itself to be excellent. The drug stimulates the synthesis and metabolism of dopamine, activates its receptors in the striatum.

  It is completely absorbed 1-2 hours after administration and has a rapid effect. Indicated for the symptomatic treatment of idiopathic restless legs syndrome and Parkinson's disease. It must be prescribed by a doctor, as it has a number of contraindications and side effects;

• Anticonvulsants (Neurontin, Tegretol);
• Opiates. Injections of potent opiate-containing injections are used in particularly severe cases of the syndrome. The following drugs are used: Codeine, Methadone, Oxycodone, Propoxyphene;
• Creams and ointments for pain relief and general relaxation (Nise, Relax, Menovazin, Nicoflex).

Physiotherapy

The following are used as incentive measures:

• Endodermal electrical stimulation;
• Darsonvalization of limbs;
• Magnetotherapy;
• Vibromassage;
• Acupuncture;
• Therapeutic applications with sea mud;
• Lymphopress;
• Manual acupressure;
• Cryotherapy.

Psychotherapy

Consultations and work with a psychotherapist. May be necessary if no other common causes of the disorder have been identified.

Some patients require correction of comorbid mental disorders by taking antidepressants, sedatives and benzodiazepine receptor agonists (Zolpidem, Trazodone).

Homeopathic remedies

• Zincum Metallicum;
• Zincum C6;
• Zincum Valerianicum;
• Sodium Bromatum.

Folk remedies

• Massage using bay oil. You can prepare the product by infusing 30 g bay leaf in 100 g vegetable oil. Treat your feet daily before bed;
• Rubbing with concentrated tincture of golden mustache;
• Phytotherapeutic foot baths with the addition of nettle, sage, valerian and oregano;
• Rub your shins with apple cider vinegar;
• Taking tea with linden and lemon balm;
• Drinking hawthorn infusion;
• Cold and hot shower.

Physiotherapy

Includes a number of exercises:

• Mandatory load on the legs during the day. Ideally, classic squats without a load;
• Stretching gymnastics - basic exercises to stretch the calf muscles;
• Long jogging or long-distance walking before bed;
• Exercising with an exercise bike or cycling;
• Leg flexion and extension;
• Walking on toes with high knees.

Treatment at home

• Increased intellectual stress;
• Self-massage of the calf muscles and legs;
• Alternating cold and hot foot baths;
• Correction of nutrition and giving up bad habits;
• Compliance with sleep hygiene rules.

Everything about causes of inflammation of the sciatic nerve, as well as about the methods of its treatment and preventive measures.

It happens that the acoustic neuroma does not respond to conservative treatment, then surgery is resorted to. How the patient’s postoperative period progresses, you will find in

Restless legs syndrome causes and treatment (RLS) is today's hot topic for study and is of interest to those who are bothered by it.

What is this restless leg syndrome, and why does it keep us from sleeping peacefully until the morning? Is it possible to get rid of this syndrome forever?

Restless legs syndrome causes and treatment, what kind of disease it is:

Medicine has determined that this syndrome is a neurological disorder. The older you get, the higher the risks. Women are more susceptible to this disease than men.

A person simply needs to move his legs, he has such an alarming need. This sensation is not very painful, but occurs deep inside the legs. They are described as a kind of tension inside the muscles. Sometimes the arms and the entire torso are involved in this process.

As soon as the patient moves, all symptoms disappear. The movement of the legs stops, and everything starts again. Unfortunately, these symptoms only worsen at night, weaken a little during the day, but do not disappear completely.

Restless legs syndrome, symptoms:

Patients describe their sensations in their legs or arms, especially at rest before bed:

1. They start to get sick.
2. It's as if someone is crawling on them.
3. They start to burn.
4. It pierces like an electric current.
5. They begin to itch and tingle.
6. Feeling of tingling, bursting, squeezing.
7. Worms crawling under the skin.
8. Coldness in the legs or, conversely, the feeling of boiling water pouring into the legs.

There is a desire to move your legs, and not only at night, but also during the day, when a person is simply resting. Occurs every ten to fifteen seconds at rest.

Sometimes leg symptoms are very difficult to describe. It is good if the doctor knows enough about this disease. No changes were found on MRI or other examinations. Blood is normal.

Almost a person cannot sleep peacefully. Even if the patient has fallen asleep, the legs continue to twitch, which means the brain’s reaction does not stop. The person does not rest normally.

During the day he is lethargic, tired, and sometimes the patient walks around with suicidal thoughts. Treatment in this condition is urgent.

It is not at all uncommon for symptoms to suddenly disappear without a trace. Apparently the cause of the trigger for restless legs syndrome disappears.

It often torments women during pregnancy, especially in the second or third trimester.

The following are believed to be guilty:

• Deficiency of vitamins and of course minerals (folic acid, iron).
• Insomnia.
• Modified hormonal background pregnant woman.
• Increased sensitivity of the body.

Simple exercises, walks, a calm environment, and proper nutrition can help.

• A complex of vitamins and minerals is prescribed.
• Warm baths at night.

Primary or idiopathic:

The beginning of its development is usually considered before the age of 40 or from childhood. The reason is genetics. Continues for the rest of your life. Not associated with any disease.

Secondary or symptomatic:

The cause of restless legs syndrome is another, underlying disease in a person. Starts after 45 years, suddenly.

Symptoms of the disease progress.

Restless legs syndrome causes:

The following diseases are considered to be the causes of restless legs syndrome in humans:

1. Diabetes mellitus (peripheral polyneuropathy).
2. Acute lack of iron in the body.
3. Failure of the kidneys and heart.
4. Joint disease: rheumatoid arthritis.
5. Pregnancy.
6. Neuropathy.
7. Abuse of drinks containing caffeine.
8. Taking certain medications.
9. Long and intense physical activity.
10. Spinal cord damage.
11. Disturbance of the thyroid gland in a patient.
12. State of chronic stress.
13. Chronic lung diseases.
14. Use of nicotine and alcohol.

Antidepressants (serotonin reuptake inhibitors) can also provoke restless legs syndrome.

To confirm the diagnosis:

• Neurography.
• Polysomography.
• Artography (using sensors on the lower leg and foot).
• Encephalogram.
• Rectromyography.

Restless legs syndrome treatment:

• Healthy lifestyle: nutrition with big amount vitamins, fiber, greens.
• Play sports (any), but in moderation.
• At night, massage or warm baths for relaxation.
• Contrasting foot baths are good.
• A pillow between your legs helps.
• Classes (asanas for relaxation).
• When doing physical education, do more exercises for the leg muscles.
• Eliminate extreme fatigue for a better night's rest.
• Fight in a well-ventilated bedroom.
• Try to go to bed in the evening and get up in the morning at the same time.
• Less light before main sleep.
• Eat foods rich in magnesium (nuts, leafy vegetables, whole grains).
• After lunch, do not drink coffee, tea, or sugar.
• Give up the habit of smoking and drinking alcohol.
• Drink enough clean water.

Medicines:

Dopaminergic drugs:

1. Bromocriptine.
2. Levodopa: about an hour before bedtime, two capsules of Madopar.
3. Pramipexole: one hour before bedtime 0.25 mg to 1 mg.
4. Pergolide.
5. Rotigotine.
6. Carbidopa.
7. Mirapex: at a dose of 0.25 mg in the evening.

Well relieves symptoms of anxious leg movements during sleep. But they have side effects: insomnia, swelling of the limbs, bloating, nausea, chest pain.

Usually these medications are not prescribed for a long time. During treatment, you cannot abruptly stop taking medications, only gradually reduce the dose. Drug withdrawal syndrome is observed.

Iron and folic acid, magnesium supplements:

1. At night, two Magnerot tablets.
2. Ibuprofen for mild symptoms.

Anticonvulsants:

1. Neurontin.
2. Gabapentin: from 300 to 2700 mg at night.

Benzodiazepines:

1. Restoril.
2. Clonazepam.
3. Temazepam.
4. Klonopin.

Opiates in severe cases:

1. Codeine.
2. Propoxyphene.

For neurological causes and symptoms of restless legs syndrome, antidepressants and tranquilizers are prescribed.

It’s better to buy 50 grams of the following herbs at the pharmacy:

1. Valerian root.
2. Horsetail grass.
3. Meadowsweet leaves and flowers.
4. Hawthorn: fruits.
5. Rose hips: fruits.
6. Motherwort grass.
7. Melissa herb.
8. Peppermint.

Take two tablespoons (without top) of the mixed mixture. Brew with 600 grams of boiling water. Wrap up and leave for up to one hour. We drink 300 grams before lunch and before bed.

At exactly 7 pm, take a Mirapex 0.25 mg tablet.

Too many patients simply forget about the symptoms of restless legs. They sleep peacefully and their quality of life improves.

In conclusion, I would like to add that restless legs syndrome causes and treatment depend on the person’s attitude to the underlying disease of the body.

If you have diabetes, you need to actively treat it, following all the doctor’s instructions, starting with diet and ending with physical exercise.

Only then can you avoid negative consequences, and therefore restless legs syndrome. Everyone needs to sleep at night and get enough sleep.

Get treatment and get well.

I always look forward to seeing you on my site. Come back often.

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