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She Nearly Kicked Me Out of Bed!Now that I have your attention, let’s talk about “Restless Legs Syndrome (RLS).” The “she” is not my wife fortunately, but the spouse of any number of my patients who experience the misery that RLS can cause. This is a neurological disorder that occurs most frequently at night and stimulates the legs to move and jerk. It is pretty much an urge that cannot be controlled. Sometimes it is described as “a crawling sensation, achyness, or tingling.” One who suffers from this will have to get up from sleep and walk about until the urge subsides. The sensation may be relieved only temporarily by movement, and the will recur again in an hour or so. How Common Is It? About 8% of all U.S. adults experience this syndrome with the frequency increasing to 10% or more after age 65. It is twice as common in women as it is in men. In about one quarter of all cases, it is associated with another condition (e.g., multiple sclerosis, end-stage kidney disease, iron deficiency, Parkinson disease, sleep apnea, nerve damage in the extremities, and the third trimester of pregnancy). Certain medications are known to worsen the disorder and should be avoided if possible (antihistamines, dopamine antagonists, and serotonin reuptakeclass antidepressants). Having Northern European ancestry or a family history of the disorder are also risk factors in about half of those who suffer. How Is It Diagnosed? A thorough history is the basis for a diagnosis. No sleep study nor X-ray studies are needed. A drug history should include prescription and OTC drugs. All patients should have blood testing for serum iron and if low, oral or intravenous iron should be administered. Low brain iron due to blockage from the blood-brain barrier is thought to be causative. Of recent, RLS has been identified as a possible precursor of dementia of the Lewy body type, so a good mental status exam is recommended. Medical Tip from Charles Driscoll, MD Virginia SAR State Surgeon
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