Restless Legs Syndrome: Causes, Symptoms And Therapy
What is necessary to be able to fall asleep? A sine qua non condition is maintaining good sleep hygiene. Take care of routines so that we encourage drowsiness, avoid lights or physical exercise, an adequate temperature, as much silence as we can get, etc. We also need to feel relaxed and without physical discomfort, something that people with restless legs syndrome do not achieve.
These people, as soon as their body rests, begin to feel a series of sensations from the trunk down that prevent them from sleeping and force them to move their legs to try to relieve the discomfort. The discomfort goes away only to return the moment the person is at rest again.
Patients with restless legs syndrome, when they feel discomfort or tingling in their legs, They have the urgent need to move them to end the itching that interferes with rest. The type of sensations that someone with restless legs can feel is wide, from itching, very mild pain, vibrating tactile sensations, small pricks that move, etc.
Rarely it also occurs on the arms, chest or even the face. Furthermore, the sensations tend to be bilateral indistinctly, that is, they can occur on both sides of the body without any type of criteria. Some patients describe a certain alternation, as if when the sensations on one side disappear they move to the other side of the body.
These sensations produce a lot of discomfort, and the longer the individual waits for them to go away, the more irritated they become. This is why these people, whenever they are at rest sitting or lying down, keep their legs moving. In this way the discomfort disappears during the time they are in motion. However, the symptoms return when one wants to rest completely, entering a circle that is difficult to break.
Course of the disorder
One of the characteristics of restless legs syndrome is that it fluctuates. The discomfort does not occur the same throughout the day, but often disappears in the morning and reappears in the afternoon and evening. For this reason, people without restless legs syndrome have many problems both falling and maintaining sleep.
They are not present every day either. In most cases, which are mild, they appear once or twice a week, which is enough to disturb sleep and seek professional help. In the most severe cases, it occurs more than twice a week. Sometimes certain periods of remission occur in which symptoms disappear completely for weeks or months. However this is a characteristic of the earliest stages of the disease; The tendency of symptoms is to worsen as time passes.
Causes
The first link in the causal chain is usually unknown. Most cases have an uncertain origin, although there are instances of genetically transmitted restless legs syndrome. The current hypothesis considers the possibility that the dopamine circuits of the basal ganglia are not functioning properly. It seems that those people who already have a dopaminergic alteration in this place, as in the case of Parkinson’s disease, have a significantly higher risk of suffering from restless legs.
There are some medical factors that have been related to the appearance of restless legs, but they do not explain all cases. These factors include:
Possible treatments
The management of the disease is symptomatic, there is no definitive cure. However, symptomatic treatment is already very successful on its own. For most cases, changes in daily routine can already be very beneficial. Having a regular sleep schedule, exercising continuously in the morning or bathing your legs in hot or very cold water at night may be enough to prevent the appearance of those annoying tickles.
There are also effective drugs such as anticonvulsants, which are almost the first line of pharmacological treatment due to their dopaminergic effects, or dopaminergic agents themselves that are administered in diseases where these circuits are dysfunctional, such as Parkinson’s disease. However, long-term use of this medication appears to worsen symptoms. This phenomenon stops as soon as the dopaminergic drug is withdrawn.
Other drugs such as opioids or benzodiazepines can be useful as they help you fall asleep, but they really have no effect on the presence of discomfort and tingling in the legs. Furthermore, the use of benzodiazepines is not recommended beyond the first two or three weeks, as they have great addictive potential. So perhaps they would only serve as a rescue on those days when, despite following all the advice and taking the appropriate medication, the discomfort remains.
