Also Called Willis-Ekbom Disease
The term "restless legs syndrome" (RLS) can't quite convey how troublesome this neurological disorder can be to the millions of people who have the condition. People with Willis-Ekbom disease, commonly called restless legs syndrome or RLS have likened the tumult in their lower limbs to darting jolts of electrical current, a creepy-crawly feeling or an aching sensation. No wonder Willis-Ekbom disease (WED) sufferers are prone to jump out of bed and pace the floor at night for relief.
Although WED/RLS may sound merely bizarre, it is a serious disorder, affecting an estimated 10 to 19 percent of elderly adults. Because affected individuals feel compelled to move their legs while at rest, the condition hampers their ability to sleep. In fact, Willis-Ekbom disease can cause more severe sleep deprivation than almost any other sleep disorder.
In addition, any activity that requires a period of extended sittingsuch as riding in a car or plane, going to a movie or attending a concertmay be intolerable for someone with restless legs syndrom. Fortunately, various treatments, including a recently approved skin patch drug, are available.
What is Willis-Ekbom disease?
RLS, or Willis-Ekbom disease, is a neurologic disorder marked by uncomfortable feelings in the lower limbs that are heightened by inactivity and relieved by movement. The leg discomfort usually begins in the evening and worsens at night for most people as they attempt to sleep. Though movement promptly relieves the discomfort, symptoms return as soon as the person sits or lies down again.
Some cases of Willis-Ekbom disease can result from conditions that include iron deficiency, kidney failure, peripheral neuropathy or pregnancy. But in most cases the cause is unknown. Often, other family members are affected as well, and more than half of the cases of unknown origin are thought to have a genetic basis.
Low brain levels of dopamine, a chemical that helps transmit nerve impulses, are thought to play a critical role in causing the condition, as are low blood and brain levels of iron. People with restless legs syndrome, or WED, have lower than normal levels of ferritin (an iron-storage protein) in their cerebrospinal fluid and decreased iron levels in regions of the brain rich in dopamine-producing nerve cells. Because iron is required for dopamine synthesis, low brain iron levels may lead to dopamine deficiency and, perhaps, Willis-Ekbom disease.
Therapy for mild-to-moderate Willis-Ekbom disease/RLS is directed primarily at relieving symptoms. Some patients can ease symptoms with lifestyle measures, such as taking a hot bath, exercising on a stationary bike before bedtime and avoiding caffeine, alcohol and nicotine. Most patients, however, eventually require medication and should be managed, at least initially, by a neurologist familiar with WED.
Because Willis-Ekbom disease may be caused or exacerbated by low iron stores, iron supplements (ferrous sulfate) are recommended for all people with restless legs syndrome. Ferrous sulfate is usually combined with vitamin C to aid in absorption. Oral iron supplements should be taken only on the advice of a physician since certain individuals may be at risk for iron overload.
Dopaminergic drugs, which are also used for Parkinson's disease, are effective for many patients. They work by increasing levels of dopamine in the brain. The drugs include ropinirole (Requip), pramipexole (Mirapex) and carbidopa/levodopa (Sinemet). The Food and Drug Administration recently approved another dopamine-related drug, rotigotine (Neuro), in the form of a skin patch to treat moderate-to-severe Willis-Ekbom disease, as well as advanced Parkinson’s disease. The patch provides continuous delivery of the drug for 24 hours.
Unfortunately, extended use of these drugs is associated with symptom augmentationsymptoms worsen and appear earlier and earlier in the day. If augmentation develops while taking one drug, another dopaminergic drug can be substituted.
Other medications that may help include benzodiazepines (temazepam, clonazepam) to aid sleep, anticonvulsant drugs (gabapentin) and, as a last option, opioid pain relievers (oxycodone, codeine, methadone). For many patients, combining drugs offers the best symptom relief.
Source: Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50; Updated by Remedy Health Media