Restless Legs Syndrome / Periodic Limb Movements
Restless Legs Syndrome (RLS) is a condition described as the urge to move, usually accompanied or caused by uncomfortable and unpleasant sensations in the legs while awake. Reports of RLS have been around for centuries, but it wasn't until 1945 that Swedish neurologist, Dr. Carl Ekbom termed this condition as Restless Legs Syndrome.
The majority of patients with symptoms of RLS experience this discomfort while sitting or lying down and are often compelled to stretch their legs, walk, or move in order to alleviate the discomfort.
One of the main characteristics of RLS is the worsening of symptoms in the evening and even more so during the night. Studies show that the severity of leg discomfort due to unpleasant sensation follows a circadian rhythm, with the maximum occurring after midnight.
The reason RLS worsens during these times may be contributed to by several factors; circadian rhythm, increased somnolence (sleepiness) during the evening hours, and typically decreased motor activity in the evening hours. Patients with RLS often say that their symptoms are worse when they are overly tired or sleep deprived.
Many people with symptoms of RLS report difficulty falling asleep, or waking shortly after falling asleep due to leg discomfort. This disruption of sleep is believed to be the cause of excessive daytime fatigue and somnolence.
Similar to RLS, periodic movements of sleep or periodic limb movements (PLM) are repetitive movements of the lower extremities, usually a flexing of the ankle, during sleep. These movements have also been known to occur in the arms and axial muscles (trunk or abdomen). If these limb movements disrupt sleep to a certain level, a person may be diagnosed with Periodic Limb Movement Disorder (PLMD)
Patients with these limb movements, or perhaps their bed partner, may experience leg kicking or arm movements at night. These movements may either occur as repetitive periodic movements or may appear to be random. People with RLS usually have the limb movements that characterize PLMD during the night.
Studies show that PLMD is associated with uremia, anemia, arthritis, peripheral vascular disease, peripheral neuropathy, spinal cord lesions, antidepressants, and caffeine use.
Treatment of RLS/PLMD often requires medications such as narcotics (oxycodone, Propozyphene, Methadone, Morphine), or more common medications such as dopamine agonists (Requip, Sinemet, Bromocriptine, Permax, Mirapex), or benzodiazepines (Temazepam, Clonazepam).