Restless Legs Syndrome

Diabetes is well known, and for good reason too, as one in ten adults have it worldwide. 116

Almost the same proportion of the adult population – some estimates put it at one in twelve or about 8% – has an ailment a lot fewer have heard about. It is the Restless Legs Syndrome (RLS).

One of the reasons it is not as well known as diabetes could be because most of those who suffer from it do not know their ailment precisely by this name – such is the nature of the ailment.

Technically known as the Willis-Ekbom disease from the names of the two doctors who identified and described it (Sir Thomas Willis in 1672 and Karl-Axel Ekbom in 1915, almost 250 years apart!), this complex syndrome results in unpleasant sensations and pain – unbearable on many occasions – while the legs are at rest, and creates a powerful urge to move the legs.

For those suffering from RLS, moving their legs will usually make them feel better at night, at least for a short time. Come morning, most people will have no symptoms.

RLS can be easily confused with leg cramps, but these are distinct conditions. 

Nocturnal leg cramps are typically painful involuntary muscle contractions that are most often felt in the calf. Like RLS, they also often occur at rest. Nocturnal leg cramps are however associated with physical changes, including a muscle hardening.

RLS is a neurological movement disorder. Technically, it is classified as a neurologic sensorimotor disorder – a problem that involves nerves, feeling and movement.

Its symptoms are protracted in seniors (50+ age group), 117 are more prevalent among women, and usually get worse with age. All these mean that women in their 70s and 80s with RLS could go through torture, many times over.

It is not life threatening, but can make lives hell.

RLS likely results from a combination of genetic 118 and environmental factors, many of which are still poorly understood. Studies have suggested a strong correlation between RLS and a deficiency of iron in certain parts of the brain. 119

For those having primary restless legs syndrome (where cause is unknown), there is presently no cure, with the only recourse being treatment to alleviate its pain and discomfort.

In some relatively fortunate cases, RLS could be triggered by medications. 120 Use of caffeine, nicotine, or alcohol can exacerbate mild RLS symptoms. In these cases, categorised as secondary RLS, the symptoms go away or significantly decrease once a person stops using these medications or substances.

Treatments for primary RLS range all the way from grandmother suggestions to sophisticated neurology drugs. Many suffering from RLS need to try out multiple treatments, sometimes on the same day, to get relief.

During some nights, they never get relief and spend the night twitching, turning, walking. That night’s sleep is gone for good.

Unfortunately, the effect of RLS does not end with the one who is suffering from it alone, but extends to anyone sleeping in the same room.

Amma had severe RLS, and it was one her longest life companions, and definitely the most unwelcome.

Pulling up my socks <= Restless legs syndrome => Painful companion

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Notes

116. 9.3% in 2019, according to a diabetes research foundation

117. While studies suggest that about 30% of those with RLS had it before they were 20 years old, my guess is that it starts getting painful for most only much later in their lives.

118. Several genes have been studied as risk factors for restless legs syndrome, with most of them thought to be involved in the development of nerve cells before birth. The role of these genes in brain iron levels or in dopamine signaling is not fully clear; nor is it clear if there are other genes too that are responsible for RLS.

119. Iron plays an important role in brain cells, including production of a chemical messenger (neurotransmitter) called dopamine. Among other functions, dopamine triggers signals within the nervous system that help the section of the brain which controls physical movement, the basal ganglia. Current research indicates that malfunction of the dopamine signaling system may result in restless legs syndrome, though precise correlations between iron deficiency and abnormal dopamine signaling, or between abnormal dopamine signalling and RLS symptoms are not yet fully known.

120. Drugs that have the potential to result in RLS include those used to treat nausea, depression and other mental health disorders. In some cases even medications used for colds, allergies, heart problems, and high blood pressure have been found to be responsible.

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