Restless legs syndrome- susceptibility t- 4
Restless legs syndrome (RLS, Wittmaack-Ekbm's syndrome, r smetimes, but inaccurately, referred t as Ncturnal myclnus) is a cnditin that is characterized by an irresistible urge t mve ne's bdy t stp uncmfrtable r dd sensatins. It mst cmmnly affects the legs, but can als affect the arms r trs. Mving the affected bdy part mdulates the sensatins, prviding temprary relief. RLS causes a sensatin in the legs r arms that can mst clsely be cmpared t a burning, itching, r tickling sensatin in the muscles. Sme cntrversy surrunds the marketing f drug treatments fr RLS.
Mtr restlessness, expressed as activity, that relieves the urge t mve."[citatin needed] Mvement will usually bring immediate relief; hwever, this relief will ften be nly temprary and partial. Walking is mst cmmn; hwever, ding stretches, yga, biking, r ther physical activity may relieve the symptms. Cnstant and fast up-and-dwn mvement f the leg, cined "sewing machine legs" by at least ne RLS sufferer, is ften dne t keep the sensatins at bay withut having t walk. Smetimes a specific type f mvement will help a persn mre than anther. "Wrsening f symptms by relaxatin."[citatin needed] Any type f inactivity invlving sitting r lying—reading a bk, a plane ride, watching TV r a mvie, taking a nap—can trigger the sensatins and urge t mve. This depends n several factrs: the severity f the persn’s RLS, the degree f restfulness, the duratin f the inactivity, etc. "Variability ver the curse f the day-night cycle, with symptms wrse in the evening and early in the night."[citatin needed] While sme nly experience RLS at bedtime and thers experience it thrughut the day and night, mst sufferers experience the wrst symptms in the evening and the least in the mrning.
Mst research n the disease mechanism f restless legs syndrme has fcused n the dpamine and irn system.  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. Differences in dpamine- and irn-related markers have als been demnstrated in the cerebrspinal fluid f individuals with RLS. 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.
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. 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