By Jordan Wilson
As soon as you lie down to rest or go to bed, that’s when it hits. What starts as a sometimes creepy and irritating pain in your legs can keep you awake for hours. You may think the only relief is to stand up and walk the pain off. The aforementioned condition isn’t insects crawling around in your legs, although that may be what it feels like. This condition is called Restless Legs Syndrome.
The medical community is still searching for a safe and effective way to treat the condition, as the current method isn’t as effective as it could be. However, knowing you have RLS can at least prepare you to seek proper medication and maybe even provide a little peace of mind knowing what keeps you up at night.
Merrill Mitler describes RLS as a creepy, crawling feeling running through your legs. Mitler is the program director for systems and cognitive neuroscience at the National Institute of Neurological Disorders and Stroke. Mitler said it’s important not to try to self-diagnose RLS.
Restless Legs Syndrome doesn’t always have the same symptoms, as people perceive pain in different ways. However, the condition can usually be identified if you have uncomfortable and odd feelings in your legs that make you want to move in order to stop the sensations. Sometimes the tugging feelings are severely painful while other times they are simply uncomfortable, Mitler said.
Putting the sensation of RLS into words is difficult, but the bottom line is it’s an uncomfortable feeling, said Dr. Dimitry Fornin, a neurologist with Mercy Medical Specialties in Rogers.
“RLS is truly no laughing matter,” he said. “It could be very severe and it could make a person’s life just total misery, a living hell.”
What makes RLS unique is that the symptoms are triggered at rest or during sleep. Sleeping usually brings relief to many conditions or diseases, but not RLS. People with this condition may go an entire day without experiencing any of the crawling sensations, only to be haunted by the feelings when trying to fall asleep. As a result, people with RLS often find themselves exhausted throughout the day because they lack quality sleep.
Difficulty sleeping and uncomfortable legs isn’t necessarily RLS, Mitler said. Instead, you need to approach your doctor and tell him or her the symptoms you’ve been experiencing. Unfortunately, Mitler said many doctors aren’t well-versed in treating RLS.
“There’s no set protocol,” Mitler said. “It depends on what the physician knows.”
Mitler said the best route to take is to write down detailed descriptions of the pains in your legs, how long they lasted and the amount of pain associated with them. Then, you can better describe the pains and inquire with your doctor if you have RLS.
There are two forms of this syndrome. Secondary RLS means there is an underlying condition causing the RLS symptoms. For example, a pregnant woman might develop secondary RLS because of an iron deficiency, Fomin said. If a physician examines a patient and can find no other reason for the crawling sensation, then they will be diagnosed with primary RLS.
The main type of drug used to treat RLS is dopamine agonists, which are best known as drugs that are used to treat Parkinson’s disease.
Eric Farbman, a neurologist at University Medical Center of Southern Nevada in Las Vegas and University of Nevada School of medicine, specializes in movement disorders. Farbman said the dopamine agonists are very effective in treating RLS.
“Agonists are the first-line treatment,” he said. “In my experience, most people do respond to some degree. Oftentimes, on the first or second day.” Farbman added that dopamine agonists are safe and easy to take.
Farbman said many internists are now aware of and prescribing dopamine agonists, relieving many patients of the need to see a neurologist.
Narcotics such as OxyContin and codeine are sometimes prescribed for patients who can’t tolerate the agonists, Farbman said.
The Mayo Clinic suggests avoiding alcohol and tobacco, as those products can worsen symptoms. Mayo also suggests that taking pain relievers may provide relief of mild symptoms. Aside from that, relaxation is key. The more relaxed you are, the more likely you are to sleep and avoid the crawling pains. Yoga, massages, applying heat and warm baths are all techniques that can only help your chances of living a better life with RLS.
And ,of course, there are the drugs. Because the same type of drug is used to treat both RLS and Parkinson’s disease, many people believe the two conditions go hand-in-hand. In fact, many people who have RLS go on to develop Parkinson’s. However, not everyone with the crawly feeling in the legs or torso will develop Parkinson’s, despite popular belief.
“It’s very true that the medications used in RLS are also used in Parkinson’s disease,” Mitler said. “But they’re very common.”
In severe cases, patients will have to take a variety of medications. Fomin said the body sometimes becomes used to one type of drug and he will have to cycle the medications, in which case, there is no set protocol.
“It’s very much flying by the seat of your pants and trying different approaches,” he said. “The goal is to make sure we relieve the symptoms, at the same time not causing any problems from treatment.”
Mitler said there is no known cause of the syndrome, although research has indicated genetics definitely plays into the equation. Iron deficiency also plays a role in the development of RLS, Mitler said.
According to the Mayo Clinic, stress and pregnancy can also contribute. And although the condition is often seen in older people and worsens with age, even younger people can develop the syndrome.

Fomin noted the condition can also be called Restless Limbs Syndrome because some patients experience the restlessness in their arms as well.

Antoinette Grajeda contributed to this report.

Breakout:

Restless Legs Syndrome
Cause Unknown
According to the National Institute of Neurological Disorders and Stroke, no cause can be identified in most cases of RLS. There may be a genetic form of the disorder, however; in about 50 percent of cases there is a family history of the condition. Researchers have identified some related conditions and factors, but still don’t know if any of them actually cause RLS.
Low iron levels: Anemia and low levels of iron may increase the likelihood of developing RLS, and restoring iron to normal blood levels may reduce RLS symptoms.
Pregnancy: Some women develop symptoms during pregnancy, especially during the last trimester. Symptoms usually disappear within four weeks after delivery.
Some drugs: Anti-nausea drugs such as prochlorperazine or metoclopramide, anti-seizure drugs such as phenytoin and droperidol, anti-psychotic drugs such as haloperidol or phenothiazine derivatives may aggravate symptoms. Some cold and allergy medications may also aggravate symptoms.

More Information
National Institute of Neurological Disorders and Stroke
www.ninds.nih.gov
(800) 352-9424
Restless Legs Syndrome Foundation
www.rls.org
rlsfoundation@rls.org
(507) 287-6465
National Sleep Foundation
www.sleepfoundation.org
nsf@sleepfoundation.org
(202) 347-3472
WE MOVE (Worldwide Education and Awareness for Movement Disorders)
www.wemove.org
wemove@wemove.org
(212) 875-8312
National Organization for Rare Disorders
www.rarediseases.org
orphan@rarediseases.org