Symptoms
People affected by Restless Legs Syndrome (RLS), suffer from fidgety or restless legs. They often find it difficult to classify and describe the condition. Typical symptoms mainly include an urge to move the legs, often in conjunction with paresthesiae such as tingling, pulling, tearing, itching, burning, muscle cramps or pain. The symptoms can be temporarily relieved or eliminated by movement. They mainly occur in resting situations and are especially severe in the evening before falling asleep or at night. As a result of these problems, sufferers often also suffer from distressing sleep disturbances, resulting in daytime fatigue, irritability or a reduction in performance. In some patients, the symptoms do not occur every day at the beginning of the disease, but often worsen with advancing age.
Symptoms
Causes
There are many indications that a disturbance of the dopamine metabolism in the brain (similar to Parkinson’s disease, although RLS otherwise has nothing to do with Parkinson’s disease) is responsible for the development of RLS. Familial clustering can be observed in some patients. Since other diseases such as polyneuropathy can cause similar symptoms, other causes should be excluded. Iron deficiency, disturbances of the kidney metabolism, a vitamin deficiency, pregnancy or various medications (including neuroleptics, certain antidepressants, etc.) can also trigger RLS. These treatable causes should be sought and treated before starting purely symptomatic treatment.
Treatment/progression
Many patients can alleviate their symptoms – if they are not too burdensome – through a range of measures such as exercise, massage or general lifestyle changes. If the symptoms are severe and troublesome, your neurologist will consider drug therapy. This cannot cure the disease, but it is possible to alleviate it. Graduated drug therapy is used based on the severity of the symptoms. In recent years, the three dopamine agonists (pramipexole, ropinirole and rotigotine) have become established as the first choice. Due to the high risk of augmentation (paradoxical worsening of RLS), the use of levodopa is now discouraged. In recent years, good efficacy has also been demonstrated with pregabalin and gabapentin, which are not associated with augmentation problems. All these drugs have side effects that influence the selection of the first-choice agent. Treatment should be monitored and adjusted as necessary by an experienced neurologist.
