What will help ease the symptoms of RLS

Restless Legs: Help against restless legs

As of: 02/11/2021 9:35 a.m.

The legs twitch, fidget or burn - especially in the evening and at night when the body comes to rest. Restless Legs Syndrome (RLS) means something like disease of the restless or restless legs.

RLS sufferers can hardly sit still, let alone sleep soundly. Whenever they are looking for rest and relaxation, for example while reading or watching TV, in the cinema or in the theater, the symptoms arise.

Symptoms decrease with exercise

Those affected usually describe their symptoms and abnormal sensations very differently:

  • They can occur on one side, on both sides or alternately on one side or the other.
  • In addition to the legs, the arms or, rarely, the chest wall can also be affected.
  • It is typical that the complaints are reduced by movement.
  • Because of their increased leg movements, those affected sleep very poorly at night and are therefore very exhausted, tired and poor in concentration during the day.
  • Often there are also problems in the partnership, depressive symptoms and social isolation. It is not uncommon for doctors to consider sleep disorders, daytime sleepiness and exhaustion to be signs of depression and prescribe antidepressants. But they do not help those affected, they actually strengthen the RLS.

The cause of Restless Legs Syndrome is a mystery

Although restless legs syndrome is the second most common neurological disease after migraines, with almost eight million people affected in Germany, the exact causes are still unknown. No one can conclusively answer where the impulses in the legs ultimately come from.

It is still unclear whether RLS is a systemic disease in which the brain interacts with the spinal cord and legs, or whether the cause lies in the brain alone.

It is currently assumed that it is a disorder of the messenger metabolism. Either the neurotransmitter dopamine is not sufficiently produced in the brain or it is not used properly by the nervous system. If the dopamine metabolism is disturbed, movement impulses during sleep or at rest are no longer sufficiently suppressed and passed on to the muscles without being filtered.

Iron metabolism is also likely to play a role, as many people with RLS have iron deficiency anemia (anemia) and iron tablets can help relieve symptoms.

According to a Finnish study, the RLS is caused by a local circulatory disorder in the legs.

Anyone who already has kidney weakness or polyneuropathy has an increased risk of developing RLS at the same time.

The RLS can progress in bouts, in which the symptoms worsen, sometimes even with the arms twitching.

RLS diagnosis is difficult

An RLS is often overlooked for a long time and only recognized late because it cannot be seen or measured. There are also no clear laboratory values ​​or X-ray findings that secure the diagnosis. When sufferers complain of abnormal sensations and pain, this often leads doctors on the wrong track. You then do not think of an RLS, but of a circulatory disorder in the legs (intermittent claudication) or a herniated disc.

Five criteria indicate an RLS:

  • Urge to move
  • Paresthesia
  • Deterioration in resting position
  • Improvement through exercise
  • Circadian rhythm (symptoms are more pronounced in the evening than during the day)

L-dopa test can detect disease

With the so-called L-Dopa test, the doctor can determine whether an RLS is actually present:

  • Performs a 100 milligrams dose of L-dopa Discomfort disappears, the disease is secured.
  • If there is only one relief, In addition to the RLS, there may be a second disease, for example a polyneuropathy.

Secure diagnosis in the sleep laboratory

If the previous history is unclear and the L-Dopa test is unsuccessful (often in children and adolescents), an examination in the sleep laboratory makes sense. The twitching leg movements can be recorded here. To do this, those affected are completely wired: their brain waves, every leg movement and also their breathing - everything is recorded during sleep and evaluated the next day.

Typical of RLS are periodic leg movements that occur in a certain rhythm and lead to a rash in the brain waves. This shows that the spontaneous leg movements wake the brain out of sleep and prevent the important REM phases of deep sleep. Although people do not wake up with every twitch, sleep is not restful.

Therapy with drugs

These drugs are used in RLS therapy:

  • L-dopa
  • Dopamine agonists
  • Dopamine patch
  • Iron supplements
  • Anti-epileptic drugs
  • opiate

In most RLS patients, the dopamine deficiency can be compensated for for a certain period of time with low-dose Parkinson's medication such as L-dopa and dopamine agonists. But the body often gets used to the medication over time, and the fidgeting gets worse again. In some cases, the dose has to be increased more and more (augmentation) and the preparation has to be changed every now and then. This is especially true for the L-Dopa preparations, which is why experts are now recommending treatment with dopamine agonists. However, these preparations have unusual side effects: It is not uncommon for patients to fall into a buying frenzy or gambling addiction under this therapy, which they must consciously counter.

Iron deficiency is a common side effect

An iron deficiency (ferritin level in the blood below 75 milligrams per liter) often occurs parallel to the RLS, which promotes augmentation and must therefore be monitored and treated, as well as any kidney dysfunction. Those who cannot tolerate the tablets or cannot cope with them can also switch to dopamine patches. If these drugs are no longer effective, opiates or anti-epileptic drugs can also help.

Treatment in the cold chamber is being tested

Treatment in the cold chamber is still in the trial phase: the patients are exposed to an extreme temperature of minus 60 degrees Celsius for three minutes. Study data show that ten applications still bring relief two weeks afterwards. In many cases, the twitching subsides and patients sleep more calmly. There are suitable cold chambers in many rheumatism centers.

These measures can support the therapy:

  • cold
  • Leg massages
  • Brush massage to improve blood circulation (starting with a dry brush under the foot, brushing over the lower leg and thigh towards the heart. This brings oxygen to the muscles and is supposed to relieve the urge to move)
  • deflection
  • Preoccupation with the hands
  • Exercise (but not in the evening)
  • Avoid coffee, alcohol and sweets

Chat Log: Restless Legs Syndrome

What helps against restless legs and what treatment options are there? The neurologist Dr. Heike Beneš answered questions about Restless Legs Syndrome. more

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The Nutritional Docs | 02/15/2021 | 9:00 p.m.