Restless Leg Syndrome

RLS (also commonly referred to as Jimmy Legs) may be described as uncontrollable urges to move the limbs in order to stop uncomfortable, painful or odd sensations in the body, most commonly in the legs. Moving the affected body part eliminates the sensation, providing temporary relief. The sensations and need to move may return immediately after ceasing movement, or at a later time. RLS may start at any age, including early childhood, and is a progressive disease for a certain percentage of sufferers, although it has been known for the symptoms to disappear permanently in some sufferers.

Symptoms

The International Restless Legs Syndrome Study Group (IRLSSG) identified four criteria that must be present for an RLS diagnosis.

• "An urge to move, usually due to uncomfortable sensations that occur primarily in the legs."

The sensations are unusual and unlike other common sensations, and those with RLS have a hard time describing them. People use words such as: uncomfortable, electrical, creeping, painful, itching, pins and needles, pulling, creepy-crawly, ants inside the legs, and many others. The sensation and the urge can occur in any body part; the most cited location is legs, followed by arms. Some people have little or no sensation, yet still have a strong urge to move.

• "Motor restlessness, expressed as activity, that relieves the urge to move."

Movement will usually bring immediate – however often temporary – relief. Walking is most common, however doing stretches, yoga, biking, or other physical activity may relieve the symptoms. Constant and fast up-and-down movement of the leg, coined "sewing machine legs" by at least one RLS sufferer, is often done to keep the sensations at bay without having to walk. Sometimes a specific type of movement will help a person more than another.

• "Worsening of symptoms by relaxation."

Any type of inactivity involving sitting or lying – reading a book, a plane ride, watching TV or a movie, taking a nap - can trigger the sensations and urge to move. This depends on several factors: the severity of the person’s RLS, the degree of restfulness, the duration of the inactivity, etc.

• "Variability over the course of the day-night cycle, with symptoms worse in the evening and early in the night."

While some people only experience RLS at bedtime and others experience it all day and all night, all sufferers notice that the RLS is worst in the evening and the least noticeable sometime in the early to mid morning.

Causes

RLS is either primary or secondary. Primary RLS is considered idiopathic, or with no known cause. However, there is a high incidence of familial cases, suggesting a genetic tendency in primary RLS. Primary RLS starts before age 40 or 45 (can occur as early as the first year of life). In primary RLS, the onset is often slow. The RLS may disappear for months, or even years, however it always returns. It is often progressive and gets worse as the person ages.

Secondary RLS often had a sudden onset and may be daily from the very beginning. It often occurs after the age of 40, however it can occur earlier. It is most associated with specific medical conditions or the use of certain drugs. The conditions include: pregnancy, iron deficiency, folate deficiency, uremia, diabetes, thyroid problems, peripheral neuropathy, and certain auto-immune disorders such as Sjogren's, Celiac Disease, and rheumatoid arthritis. Treatment of the underlying condition often eliminates the RLS.

Both primary and secondary RLS can be worsened by surgery of any kind, however back surgery or injury is often associated with causing RLS.

Certain medications may worsen RLS in those who already have it, or cause it secondarily. These include: anti-nausea drugs, certain antihistamines (often in over-the-counter cold medications), drugs used to treat depression (both older tricyclics and newer SSRIs), antipsychotic drugs, and certain medications used to control seizures.

Train drivers in South Africa operate a vigilance control by clicking a pedal with their right foot every thirty seconds. If it doesn't happen, a stimulus is emitted followed soon by emergency braking, it can contribute to restless legs syndrome which can keep the driver clicking the pedal while sleeping.