Restless legs syndrome- susceptibility t- 1


Restless legs syndrome (RLS) is a neurlgic sleep/wake disrder characterized by uncmfrtable and unpleasant sensatins in the legs that appear at rest, usually at night, inducing an irresistible desire tmve the legs. The disrder results in ncturnal insmnia and chrnic sleep deprivatin


Affected persns experience paresthesias in the legs when first ging tbed r sitting still fr a time and cannt resist fidgeting with their feet. Huizinga (1957) described a family with affected persns in 5 generatins. The cnditin, which began in adlescence, was relieved by cld.


Mst research n the disease mechanism f restless legs syndrme has fcused n the dpamine and irn system.[2] [3] These hyptheses are based n the bservatin that levdpa and irn can be used t treat RLS, but als n findings frm functinal brain imaging (such as psitrn emissin tmgraphy and functinal magnetic resnance imaging), autpsy series and animal experiments.[4] Differences in dpamine- and irn-related markers have als been demnstrated in the cerebrspinal fluid f individuals with RLS.[5] A cnnectin between these tw systems is demnstrated by the finding f lw irn levels in the substantia nigra f RLS patients, althugh ther areas may als be invlved.[6]


The diagnsis f RLS relies essentially n a gd medical histry and physical examinatin. Sleep registratin in a labratry (plysmngraphy) is nt necessary fr the diagnsis. Peripheral neurpathy, radiculpathy and leg cramps shuld be cnsidered in the differential diagnsis; in these cnditins, pain is ften mre prnunced than the urge t mve. Akathisia, a side effect f several antipsychtics r antidepressants, is a mre cnstant frm f leg restlessness withut discmfrt. Dppler ultrasund evaluatin f the vascular system is essential in all cases t rule ut venus disrders which is cmmn etilgy f RLS. A rare syndrme f painful legs and mving tes has been described, with n knwn cause.


An algrithm fr treating primary RLS (i.e., RLS that is nt the result f anther medical cnditin) was created by leading researchers at the May Clinic and is endrsed by the Restless Legs Syndrme Fundatin. This dcument prvides guidance t bth the treating physician and the patient, and includes bth nnpharmaclgical and pharmaclgical treatments.[32] Treatment f primary RLS shuld nt be cnsidered until pssible precipitating medical cnditins are ruled ut, especially venus disrders. Drug therapy in RLS is nt curative and is knwn t have significant side effects. In additin, it can be expensive (abut $100-150 per mnth fr life), and thus it needs t be cnsidered with cautin. Secndary RLS has the ptential fr cure if the precipitating medical cnditins, anaemia, venus disrder, etc., are managed effectively. In many instances the alleged secndary cnditins might be the nly cnditins causing the RLS; these include irn deficiency, varicse veins, and thyrid prblems. Karl Ekbm in his riginal thesis n RLS in 1945 had suspected f venus disease in abut 12.5% f the cases he studied. But due t the unavailability f Dppler ultrasund imaging technlgy (the diagnstic tl that detects the abnrmal bld flw in the veins, "Venus Reflux", the pathlgical basis fr varicse veins) at that time, Ekbm may have underestimated the rle f venus disease. In uncntrlled prspective series, imprvement f RLS was achieved in a high percentage f patients wh had presented with a cmbinatin f RLS and venus disease and had sclertherapy r ther treatment fr the crrectin f venus insufficiency