Restless legs syndrome (Willis-Ekbom) and solutions to improve

Restless legs syndrome (RLS) is a very common movement disorder in the elderly. This syndrome is not a threat to health but greatly affects sleep and quality of life. Depending on the severity, the patient may need medication or may improve with some home remedies.

Restless Legs Syndrome?

Restless Legs Syndrome (RLS) is also known as Willis-Ekbom disease or restless leg syndrome. This term refers to a movement disorder characterized by uncontrollable impulses that lead to the desire to move the legs, arms, and other body organs. Restless legs syndrome affects mainly the legs but can sometimes occur in other organs as well.

Without movement, the legs, arms and some other parts will appear stinging, crawling, uncomfortable, sad and aching. This feeling urges the patient to move their legs, arms, etc. frequently. When moving, the feeling of discomfort and paresthesia will be significantly reduced. Symptoms of Willis-Ekbom disease usually occur at night, especially when sitting or lying down.

Restless legs syndrome is a very common disease with a prevalence of about 5% of the Asian population and 8-10% of the European population. This syndrome is more common in the elderly but can also occur in some young and middle-aged people.

The feeling of “restless” legs makes many people have to walk and move their legs constantly, affecting the quality of sleep. So, although not life-threatening, this syndrome needs to be treated to reduce the impact on quality of life.

Symptoms of Restless Legs Syndrome

Restless legs syndrome is characterized by a need to move one part of the body, usually a leg, arm, or other organ. The patient cannot resist this need. If left alone, the organs will feel aching, stinging, crawling, etc. Meanwhile, movement will help the patient reduce the discomfort significantly.

Restless legs syndrome is characterized by an irresistible need to move the legs along with a crawling sensation, paresthesias, etc.

Restless legs syndrome has quite obvious symptoms. Here are some signs to recognize this syndrome:

• The need to move the legs, arms,…: The most typical symptom of restless legs syndrome is the need to move the legs and arms all the time. The patient has impulses, from which the urge to move the limbs continuously and cannot resist this need. The feeling of wanting to move the legs and arms often occurs at night, especially when lying down or sitting.
• There is discomfort in the legs and hands: If you do not move your legs, arms, etc., these organs will appear uncomfortable sensations such as burning, pain, crawling, itching. In addition, the patient himself will also feel uncomfortable and sad.
• Reduce discomfort when moving: When walking or moving legs, arms, … such as stretching limbs, massaging, muscle contraction, discomfort will be significantly reduced. This condition causes many patients to have to walk continuously at night to reduce discomfort. This affects the quality of sleep and weakens the body.
• Symptoms are more severe in the evening and at night: Symptoms of Willis-Ekbom disease will usually appear at night, but there are cases when they appear during the day. At night, symptoms will become more severe, disrupting and profoundly affecting sleep.

Discomfort in the legs, arms and some other organs causes the patient to constantly move even during sleep. This causes cyclic leg movement syndrome (PLMD). Statistics show that about 80% of people with Willis-Ekbom disease develop this syndrome.

Cyclic limb movement syndrome is characterized by convulsions, movements of the lower extremities that cycle every 20 to 40 seconds. During sleep, the patient is completely unaware of the movement of the lower extremities and has no abnormal sensations in the extremities.

Causes of Restless Legs Syndrome

Restless legs syndrome can occur at any age, but affects more adults. The risk is higher in women – especially those with peripheral neuropathy.

Depending on the cause, Willis-Ekbom disease is divided into two groups: primary and secondary. Primary refers to cases of inherited, congenital diseases. Whereas, secondary refers to those acquired due to lack of substance or the effect of some other health problem.

The risk of restless legs syndrome increases significantly if there is a family member with this syndrome

Currently, scientists have not found the exact cause of restless legs syndrome. However, the following factors have been identified to be involved in the pathogenesis:

• Genetics: Heredity has been identified as a risk factor for restless legs syndrome. The risk is significantly increased if there is a family history of this syndrome or cyclic leg syndrome. If the biological parents have the disease, the risk in the children is up to 92%. Currently, scientists have found four genes that are associated with Willis-Ekbom disease.
• Dopamine deficiency: Dopamine deficiency in certain areas of the brain has been identified to increase the risk of Willis-Ekbom disease. Although the mechanism is unknown, the majority of patients have a dopamine deficiency. Experts believe that a lack of dopamine causes disturbances in neurotransmitters in the brain and inadvertently prompts the feeling of wanting to move legs and arms continuously.
• Effects of health problems: Restless legs syndrome can be the result of a number of health problems such as anemia, hypothyroidism, weakness, diabetes, rheumatoid arthritis, Parkinson’s disease, pain fibromyalgia, peripheral neuropathy, kidney disease, etc.
• Pregnancy: Pregnancy is a favorable condition for developing restless legs syndrome. Hormonal changes and pressure from the expanding uterus are factors that can increase discomfort, prompting the need to move limbs and other organs.
• Side effects of certain medications: Certain medications can increase the risk of restless legs syndrome, such as antidepressants, sedatives, etc.

Although not the cause, but unhealthy habits such as drinking alcohol, using tobacco, caffeine, etc. can aggravate the symptoms of restless legs syndrome.

Is Restless Leg Syndrome Dangerous?

Restless legs syndrome is a common movement disorder and is not life-threatening. However, this syndrome greatly affects quality of life and can increase physical and psychological health problems.

As mentioned, Willis-Ekbom disease often causes discomfort in the legs and arms at night. This feeling urges the patient to walk and move continuously, which affects the quality of sleep. Disrupted sleep causes feelings of fatigue, lack of concentration, and daytime lethargy.

Lack of sleep also increases physical health problems such as headaches, anemia, weakness, vestibular disorders, high blood pressure, etc. The troubles of restless legs syndrome cause some patients to develop depression.

Although not life-threatening, restless legs syndrome needs to be treated early to avoid affecting health and life. Early treatment will also limit the impact on those around because the habit of moving your legs while sleeping will disturb the sleep of the person next to you.

Diagnosis of restless legs syndrome

Restless leg syndrome (RLS) is diagnosed primarily by clinical presentation. Through the collection of symptoms, the doctor can localize the possibilities. Several laboratory tests may be done to rule out other health problems with similar symptoms.

The diagnosis of restless legs syndrome is mainly based on clinical manifestations

Techniques used to diagnose restless legs syndrome:

• Exploiting personal and family medical history
• Collect patient symptoms
• Comprehensive health check
• Blood tests
• Sleep polysomnography

Restless leg syndrome is diagnosed when the following criteria are met:

• There is discomfort inside the muscles in the legs, arms and some other organs. This feeling prompts the need to move the legs and arms continuously.
• Symptoms often appear or become worse at rest (lying or sitting).
• Discomfort is significantly reduced when walking, stretching arms and legs, tensing muscles, etc.
• Symptoms tend to be more severe at night
• Symptoms are not due to other health problems

Treatments for Restless Legs Syndrome

Treatment of restless legs syndrome depends on the severity of the symptoms. Basically, this syndrome does not affect health, but only causes discomfort and interferes with sleep. Therefore, if not necessary, the doctor will prescribe non-drug improvement methods. Drug treatment will be considered in case of severe disease.

In general, the treatments give positive results and patients can improve their quality of life after only a short time. The following methods are applied in the treatment of Willis-Ekbom disease:

1. Non-drug measures

Non-pharmacological measures are applied to mild cases. In addition, severe cases will also be prescribed these measures first. After considering the level of improvement, the new doctor considers taking medication to minimize unnecessary interventions.

Non-drug methods have the advantage of being benign and inexpensive. If you persist in doing it, the discomfort in your legs, hands and some other organs will be significantly reduced.

Non-pharmacological measures to improve restless legs syndrome include:

• Exercise regularly: Regular exercise is the most effective measure for restless legs syndrome. Sports such as cycling, walking, yoga, etc. can reduce discomfort in the legs/hands. In addition, exercise also helps improve sleep quality and increase the flexibility of bones and joints. However, it should be noted to avoid heavy exercise and limit high-intensity subjects.
• Limiting stimulants: Avoiding alcohol, tobacco, and caffeine can reduce some of the discomfort caused by restless legs syndrome. In addition, abstaining from these habits also ensures sleep quality, limiting sleep problems and insomnia.
• Hot/cold compress: When there is discomfort in the leg/hand, the patient can apply hot or cold compress to soothe. This method is quite effective and can be done many times without worrying about side effects.
• Relaxation techniques: Stress can worsen symptoms of Willis-Ekbom disease. Therefore, patients should practice yoga, meditate, listen to high-frequency music, drink herbal tea, etc. to relieve stress in life. In addition, relaxation measures have been shown to reduce anxiety and depression in people with restless legs syndrome.
• Diet: Iron and magnesium deficiency can worsen restless legs syndrome. Therefore, patients can improve the disease by adding foods rich in magnesium, iron, etc. At the same time, they should increase green vegetables, fruits, white meats and limit fat and spices to improve health. holistic health.
• Sleep hygiene: Restless legs syndrome greatly affects the quality of sleep. Therefore, patients should take sleep hygiene measures such as avoiding stimulants, not using phones when lying in bed, limiting noise, strong light at night, etc. to ensure adequate sleep.
• Some other measures: In addition to the above measures, patients can try some other measures such as massage, acupressure, soaking in a warm bath, etc. to reduce discomfort caused by Willis-Ekbom disease. .

In the case of restless legs syndrome due to a side effect of the drug, the patient will be prescribed an alternative medicine. In addition, changing the time of medication according to the doctor’s instructions can also limit the feeling of “restlessness”, “restlessness” in the lower extremities at night.

2. Taking medicine for treatment

Drug use is considered when symptoms of Willis-Ekbom disease are frequent and have a significant impact on quality of life. Most of the drugs used to treat this condition carry many risks. Therefore, patients need to combine with non-pharmacological measures for effective symptom control.

Medications are used when restless legs syndrome interferes with sleep and does not improve completely with home remedies.

Medications used to treat restless legs syndrome:

• Dopamine agonists: Dopamine agonists are highly effective in treating restless legs syndrome. In particular, Levodopa is a drug that brings good effects but many side effects, so it is rarely used. Doctors often give priority to using Rotigotine, Pramipexole, Ropinirole, etc. In our country, the Ministry of Health only allows the use of Pramipexole in the treatment of this syndrome.
• Antiepileptic drugs: Antiepileptic drugs can slow or completely block “pain” signals in peripheral nerves. Therefore, this group of drugs can be used to reduce pain and discomfort caused by restless legs syndrome. Commonly used antiepileptic drugs include Gabapentin, Carbamazepine, etc.
• Benzodiazepines: This group of drugs is often used for cases of severe symptoms and persistent, long-lasting insomnia. In addition, benzodiazepines also help ease feelings of anxiety and stress in some patients. The most commonly used drug is Clonazepam.
• Narcotic analgesics (opioids): Narcotic pain relievers (Methadone, Propoxyphene, Oxycodone, etc.) may also be used to relieve symptoms of Willis-Ekbom disease. However, because the drug has the potential to cause addiction, it should only be used when the other classes of drugs are not effective.
• Iron tablets: In the case of low blood ferritin levels, the doctor will prescribe additional iron tablets. Iron is well absorbed on an empty stomach and especially early in the morning. Therefore, it is necessary to pay attention to taking iron at the right time to achieve the best results.

Restless legs syndrome (Willis-Ekbom disease) is a common movement disorder. Although not dangerous to health, this syndrome greatly affects the quality of life. Therefore, patients should not be subjective when experiencing unusual manifestations. Early treatment intervention will help limit the risk of drug use and can control the disease with some simple and safe measures.