Restless legs syndrome
Restless legs syndrome is a syndrome where the leg is “restlessness”. This is characterized by sensation of crawling, itching or stretching in the calves which followed by irresistible urge to move the legs, especially during relaxation period. The sensation usually will relieved by movement. Symptoms are worse when patient is sitting at rest or during lying down at night. In some cases, sleep is disturbed.
This disorder can occurs primarily without any other cause. It can also be related to pregnancy, iron deficiency anemia, peripheral neuropathy or periodic leg movements of sleep. The periodic limb movement disorder is characterized by involuntary leg twitching or jerking in every 10-60 seconds, which can be quite disturbing. Some cases has hereditary basis. Several genetic loci have been recognized to be associated with this symptom. There are 12q12-q21, 14q13-q31, 9p24-p24, 2q33 and 20p13.
Diagnosis is made at clinical ground. In certain cases, we need to check for pregnancy status, iron deficiency anemia or peripheral neuropathy. The affected person often gives positive family history. Some differential diagnosis need to be considered, for example akathisia, periodic movement and peripheral neuropathy.
As many others, treating the underlying cause will be the mainstay of treatment. However, some medications can be given to relief symptom. Drugs like ropinirole, pramipexole, clonazepam, propoxyphene and clonidine are widely used. Levodopa is also useful. However, in view of it may lead to the augmentation of the symptoms, the use of this drug is reserved if other measures have failed to control the symptom. Rarely, opiate is required.
Some cases may be severe enough to cause complication like daytime somnolence. Some may be develop tolerance to the treatment.
Reference:
1. Tao Le et al. First aid for the family medicine boards. 2008. McGraw Hill Lange.
2. Stephen J McPhee et al. Current Medical Diagnosis and Treatment 2009. McGraw Hill Lange.
Tags: akithisia, diagnosis, restless legs syndrome, treatment
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