Restless legs syndrome (RLS) is a chronic, progressive movement disorder characterized by abnormal sensations that occur with the urge or need to move the legs.
Patients with restless legs syndrome characteristically have difficulty describing their symptoms. They mostly express it as an uncontrollable desire to move their legs, a pain-burning-tingling sensation that is not very painful, but quite disturbing. This disorder occurs during rest, worsens at night, and is often arousing, thus causing chronic sleep disturbance and psychological stress. Patients state that they cannot sleep at night and try to relax by getting up and walking around, sometimes by pouring water on their legs. It can also manifest itself during long journeys and in situations where long sitting is required, such as cinema/theatre. It impairs the quality of life by causing fatigue, weakness, and difficulty concentrating due to the sleep disorder it creates.
It is more common in women and is more common with age. It affects 5-7 people out of every 100.
The cause of Restless Legs Syndrome
Restless legs syndrome is a clinical condition among the "central sensitivity syndromes" characterized by impairment in pain perception. It is reported that it is caused by a disorder in the dopamine system, similar to Parkinson's.
Restless legs syndrome is seen in 2 ways:
Primary type Restless Legs Syndrome for which there is no cause: No problems are found in all examinations, laboratory and imaging methods. While it may be genetically inherited, some patients do not have a genetic origin.
Restless Leg Syndrome, which develops secondary to another disease: Iron deficiency, pregnancy, kidney failure, inflammatory rheumatic diseases, diabetes, multiple sclerosis When the causative factor in Secondary Restless Legs Syndrome is found and treated (such as iron deficiency), it may be possible to completely eliminate the disease.
Diagnosis in Restless Leg Syndrome
The diagnosis of Restless Leg Syndrome is made based on the patient's description and the absence of any other reason to explain the complaints in his legs. Neurological examination It should be carefully investigated whether there is one of the other movement disorder diseases, whether there is neuropathy, whether there is a waist, hip, knee and ankle problem, whether there are symptoms of both veins and arteries, and whether there is a problem with the lymphatic system. It is also uneasy with some metabolic (such as diabetes, obesity, B12 deficiency, iron deficiency) and endocrine (such as thyroid-goiter dysfunctions, hypothalamus, pituitary, adrenal axis problems) and organ failures (kidney failure, dialysis, liver cirrhosis). Since leg syndrome is common, evaluation should be made from these aspects. Pregnancy should also be evaluated in this regard, as the frequency of restless leg syndrome increases in multiple sclerosis and some inflammatory rheumatic diseases (such as rheumatoid arthritis). The medications used by the patient should also be evaluated, because similar problems may be observed in those using neuroleptics.
Differential diagnosis of some clinical conditions that are very similar to restless legs syndrome should also be made. One of these is night cramps. It usually involves the muscles in the back of the lower leg and is relieved by stretching. The other one is “painful leg moving finger syndrome”. It is characterized by severe pain and burning in one or both feet, accompanied by repetitive movements in the big toes. Unlike restless legs syndrome, it does not worsen at night and is not improved by movement.
Diagnostic Criteria in Restless Legs Syndrome:
Basic diagnostic criteria
1. The need to move the legs due to or accompanied by uncomfortable or unpleasant sensations in the legs
2. Need for movement or uncomfortable feelings begin or worsen at rest
3. The need for movement or disturbing feelings are partially or completely relieved by movements such as walking or stretching
4. The need for movement or uncomfortable sensations worsens in the evening or night than during the day, or occurs only in the evening or night
5. The features listed above cannot be considered solely in relation to primary symptoms or other medical or behavioral conditions (e.g. myalgia, venous stasis, leg edema, leg cramps, habitual foot shaking).
Supporting i clinical features
1. Family history
2. Response to dopaminergic treatment
3. Periodic limb movements (while awake or asleep)
4. Absence of expected daytime sleepiness
Markers associated with the clinical course
a Chronic/persistent Restless Leg Syndrome: If no treatment is given, symptoms will occur on average at least weekly in the last year. Appearing twice
b. Intermittent Restless Leg Syndrome: If no treatment is given, symptoms appear on average at least twice a week per year and at least five attacks occur throughout life
Markers associated with clinical significance
Restless Leg Syndrome symptoms cause serious distress and disability in social, educational, work and other important functional areas, with effects on sleep, energy/fitness, daily activities, behavior, cognition and mood.
Treatment for Restless Legs Syndrome
Drug Treatment: The most preferred drug group is dopaminergic (drugs used in Parkinson's) drugs. Apart from this, anticonvulsants (drugs used in epilepsy), opioids, benzodiazepines can also be used.
Complementary medicine methods:
Acupuncture: Acupuncture, which acts by regulating the energy systems in the body, is a method that can be used both in pain control, sleep control and psychological state regulation.
Neural therapy: Neural therapy, which regulates the nervous system using local anesthetic and enables the patient's own healing mechanisms to activate, is successfully used in Restless Leg Syndrome patients. In our clinic, combined treatment with acupuncture is usually performed.
Ozone therapy: It activates the antioxidant mechanism in patients with Restless Legs Syndrome.
Relaxation Methods: Relaxation training for patients, biofeedback. treatment can be applied.
Exercise: Exercise ensures the stability of the legs by preserving joint movements, lengthening and strengthening the shortened muscles.
Aerobic exercises (such as swimming, walking, running, cycling, dancing) improve respiratory and cardiac functions. It is necessary to improve the properties and increase the resistance. In addition, it is possible to increase the release of painkillers and happiness-inducing substances (endorphins, serotonin) with regular aerobic exercises. To achieve this effect, the patient must exercise regularly for at least 8 weeks. It is very important to do all exercises regularly and make it a way of life.
Yoga: Yoga is one of the widely used methods that provides both stretching, strengthening and relaxation with its unique postures, breathing work and relaxation methods.
Massage: It can be recommended to provide muscle relaxation.
Diet: Patients It is recommended that they stay away from alcohol, cigarettes, caffeine and chocolate as they increase their complaints.
Ensuring Sleep Hygiene: It is very difficult for patients to go to bed and wait for sleep, as Restless Leg Syndrome occurs at night. keeps you alive. For this reason, it is recommended to take a warm shower before sleep, go to bed at the same time, not to have electronic devices such as television, telephone, tablet computer in the bedroom, not to drink beverages such as tea or coffee that may prevent sleep after 19:00 in the evening, and instead to drink calming teas such as lemon balm and chamomile tea.
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