Restless Leg Syndrome

 

Restless Leg Syndrome (RLS) is an aggravating condition that many people suffer with. It typically causes restless symptoms in one or both legs that is most bothersome once the affected person is off their legs, usually in the evening or at night after retiring to bed. It typically results in restless sleep for the person affected, or if sharing a bed, for the partner too. The legs feel “restless” (hence the name) and the person typically will move the affected leg(s), either pacing the floor voluntarily overnight, or with nocturnal involuntary major twitching or constant movement or kicking of the legs in bed. Movement of the legs tends to reduce the symptoms, that vary from the noted “restless” feeling, to “itching” or “creepy/crawly”, and/or a vaguely described discomfort.

In the medical papers, there are two types of RLS—primary and secondary. The primary form is suggested to be due to central nervous system problem (i.e. originating in the brain and affecting the legs). The secondary form is due to either blatant or occult venous disease of the legs.

The primary form, per the medical papers, is best treated with pharmaceutical medication. Requip® is a good example of common popular medication that usually meets with so/so results; or side effects of the medication outweigh any benefit. Further, many patient diagnosed with primary RLS have never had a screening evaluation to rule out venous disease of the legs. (Venous disease of the legs is not always obvious, and in such cases, a screening standing venous duplex sonogram is required).

In patients with secondary RLS, when the venous disease of the legs is successfully eradicated with minor surgical modern treatments, in up to 80% of patients, RLS either completely resolves, or at minimum gets markedly better.

Another theory of the cause of RLS involves lymphedema as the reason for symptoms. Besides venous drainage, the lymphatic system also drains the legs of impurities. The lymphatic vessels are much thinner and smaller than the veins, and therefore their outflow can be restricted easily with too much surrounding tissue pressure, especially in the lower legs. As such, patients who suffer with venous insufficiency of the legs, also have a component of lymphedema (lymphatic vessel overload) as the leg swelling appears and worsens. If not due to vein problems, lymphedema can be an inherited trait (just like vein disease) and such affected people have chronic swollen legs solely due to inherited faulty lymphatic system.

The increased pressure and resulting lymphedema in the tissues of the legs can irritate nerves in the legs, leading to faulty function of the nerves. The nerve irritation may well be the underlying problem in RLS since these affected nerves misfire, leading to the the aggravating sensory and movement symptoms noted above.

Alleviating or improving the lymphedema problem can help RLS sufferers improve. Correcting lower extremity venous problems helps RLS, and even in cases of primary lymphedema (standalone inherited trait) improve with lymphedema therapy. Lymphedema therapy rendered by certified therapists with specialized training is very helpful for such patients.

Any patient suffering with RLS should have a formal vein evaluation by a vein specialist. Even if no vein disease is detected, a trial of lymphedema therapy is a better alternative than committing a patient to a lifetime of a pharmaceutical medication.

© 2017 Vein Specialists of Alaska