What happens and what forms it comes in
Dopamine, which transmits signals in the motor systems of the brain, and iron, which is necessary for its functioning, play an important role in the development of the syndrome. Even with normal hemoglobin, iron stores in the brain may be insufficient. The primary form often begins before age 45, affects multiple family members, and progresses slowly. Secondary is associated with another condition and may weaken after its elimination. Many patients experience periodic limb movements during sleep that interrupt sleep.
- Primary, hereditary form
- Secondary - with iron deficiency, kidney disease, pregnancy
- Intermittent - symptoms are episodic
- Chronic - symptoms several times a week
- Periodic limb movements during sleep
Causes and risk factors
The most common treatable cause is iron deficiency, even without anemia. In pregnant women, symptoms often begin or worsen during the third trimester and usually resolve after delivery. The syndrome is common in people on dialysis. Symptoms can be aggravated by caffeine, alcohol, nicotine, lack of sleep, as well as some medications: antihistamines with a sedative effect, some antidepressants, antiemetics and antipsychotics.
- Heredity
- Iron deficiency
- Pregnancy
- Chronic kidney disease
- Polyneuropathy, diabetes mellitus
- Caffeine, alcohol, nicotine, some medications
Symptoms
The diagnosis is based on four key signs: a desire to move the legs with discomfort, onset or worsening at rest, relief with movement, and worsening in the evening and at night. The sensations are usually deep, in the legs, sometimes in the thighs and arms. Because of them, a person cannot fall asleep for a long time, often wakes up, gets up and walks around the room. During the day, fatigue, drowsiness, and irritability appear.
- An irresistible urge to move your legs
- Feelings of “crawling”, pulling, tingling in the legs
- Increased at rest, with prolonged sitting
- Relief when walking and rubbing
- Worse in the evening and at night
- Difficulty falling asleep, daytime sleepiness
Diagnostics
A neurologist makes a diagnosis based on complaints and excludes similar conditions: calf muscle cramps, polyneuropathy, diseases of the veins and arteries of the legs, uncomfortable posture, side effects of medications. All patients have their ferritin and iron levels checked: for restless legs syndrome, iron replacement is recommended when ferritin is 75 mcg/L or lower, that is, at a higher threshold than usual. Blood tests, creatinine, and glucose help screen for anemia, kidney disease, and diabetes. Polysomnography is needed when there is doubt about the diagnosis and suspicion of other sleep disorders.
- Interview and neurological examination
- Ferritin, serum iron, transferrin
- General blood test
- Creatinine, blood glucose
- ENMG for suspected polyneuropathy
- Polysomnography according to indications
Treatment
For mild symptoms, changes in habits are often enough: going to bed at the same time, avoiding caffeine and alcohol in the evening, not smoking, doing moderate exercise during the day, and getting a foot massage or a warm bath before bed. If ferritin is low, your doctor will prescribe iron supplements orally or intravenously. You need to reconsider your medications. For severe symptoms, the neurologist prescribes drugs from the groups of alpha-2-delta ligands or dopamine agonists; the latter may increase symptoms over time, so their dose is not increased independently. For pregnant women, treatment is selected especially carefully.
- Regular sleep schedule
- Quitting caffeine, alcohol and smoking
- Moderate physical activity during the day
- Massage, warm bath or stretching before bed
- Iron supplements for low ferritin
- Medicines only as prescribed by a neurologist