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Night Walker: Restless Legs Syndrome

Do creepy-crawly feelings in your legs have you walking the night away? You may have restless legs syndrome.
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Restless Legs Syndrome: Sometimes, Sneaky Symptoms continued...

"People with moderate-to-severe restless legs syndrome can become totally disabled," says Buchfuhrer. In the most severe cases, he adds, "They can't sit down to work. They eat breakfast walking around the room." Many avoid movies, car trips, or plane rides, knowing their symptoms might make the activity intolerable.

Fortunately, restless legs syndrome does not lead to other neurological conditions, such as Parkinson's disease or neuropathy. However, "this is a progressive disorder that -- in most people -- gets worse over time," says Buchfuhrer.

Most people with restless legs syndrome also have periodic limb movement disorder. In this condition, involuntary twitching of the arms and legs disrupts sleep. Periodic limb movement disorder can contribute to the chronic fatigue of RLS.

Restless Legs Syndrome: What Causes It?

Experts aren't sure what causes restless legs syndrome. According to James Connor, PhD, distinguished professor and vice chairman in the Department of Neurosurgery at Penn State University, however, new research shows that iron plays a key role.

Magnetic resonance imaging (MRI) scans and brain tissue studies from deceased restless legs syndrome patients demonstrate reduced amounts of iron in their brains compared with non-RLS patients' brains. This occurs even when the level of iron in the blood is okay.

"Many people with restless legs syndrome are 'brain-iron-deficient,' even if their whole-body iron levels are normal," says Connor.

Researchers also know that dopamine is a key player in restless legs syndrome. Dopamine, a neurotransmitter, relays messages between nerve cells in the brain.

In those with RLS, "there appears to be compromised uptake of iron into the [nerve] cells in the brain that make dopamine," says Connor. This could lead to decreased function of these nerve cells, including the ability to make dopamine, he adds.

The disorder runs in families, with about half of restless legs syndrome sufferers having family members affected as well.

Most cases of restless legs syndrome are unexplained, or "idiopathic." Sometimes RLS is associated with other medical conditions:

  • Iron deficiency
  • Kidney disease requiring dialysis
  • Diabetes
  • Parkinson's disease
  • Pregnancy

Treating these conditions, if present, can improve restless legs syndrome symptoms.

Restless Legs Syndrome: New Treatments Bring Relief

In 2005, the FDA approved Requip (ropinirole) for the treatment of moderate-to-severe restless legs syndrome. Requip is the first FDA-approved medication for RLS. In 2006, Mirapex (pramipexole) was also approved. Neupro (rotigotine) was approved in 2012.

These drugs act like dopamine. They attach to nerves and change the way they "talk" to each other. In clinical trials, these medicines relieved symptoms of restless legs syndrome in about 75% of people. Both drugs also prevented relapses during long-term use.

Many other medicines have been shown to help people with restless legs syndrome. Physicians often use combinations of medicines to get RLS under control.

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