Restless Leg Syndrome

Q:  I have a big problem with restless leg syndrome, actually not only legs but in the shoulder and elbows too. I understand that there is not a great deal that can be done for it. The pharmacist in our drug store has the problem and he is at a loss as to what to do for it.

While taking Roxicet for some discomfort for cracked ribs, I discovered that it helps the spasms considerably. I only take it at night. Hot baths help too, but it is annoying when I have to take hot baths at 2 or 3 o'clock in the morning.

Do you have any information on this condition?

A:  Restless leg syndrome, (RLS), is one of those very annoying problems that is not life threatening but drives a person crazy. (It seems like many of the questions I get for the column fall under that category!) Although fairly common, affecting about 10-15% of people, RLS is poorly understood. Patients describe very unpleasant sensations as being creepy-crawly, jittery, tingly, or burning pain. These feelings occur mainly in the legs, especially the calves, but occasionally the arms may also be involved.

Lying in bed or sitting in a car or theater can bring the symptoms on, and moving around, such as stretching, pacing the floor, or cycling seems to provide some relief. Massaging the legs or hot baths also may be soothing.

Circadian rhythms may play a role, since the problem seems to be worse at night and better in the morning. People with RLS often have trouble getting to sleep or are awakened by leg discomfort.

In most cases no underlying cause can be found, but RLS has been associated with iron deficiency anemia, pregnancy, Parkinson's disease, and chronic kidney failure, to name a few factors. There may be a hereditary pattern since it appears to run in some families. Although it can develop at any age, about 40% of patients recall the symptoms beginning before the age of 20. RLS tends to get worse with age, but may fluctuate over the years.

That's the gist of the information about RLS, and now I'll mention some of the practical approaches used at the Mayo Clinic Sleep Disorders Center. It is important to eliminate caffeine, alcohol and tobacco and get adequate daytime exercise. When you feel the symptoms come on, get out of bed and do some leg stretching or walking. If you are still plagued with the problem every night, it would be worth trying medication.

There are several medications that have been shown to be effective, but they all have side effects. For mild cases, benzodiazepines, which are used as sleeping pills and have some muscle relaxant properties, can be used. Clonidine is primarily a blood pressure medicine that was recently shown to work well for RLS, but patients did complain of dry mouth and lightheadedness. Sinemet and Pergolide, drugs used for treating Parkinson's disease, also provide relief, but should be reserved for more resistant cases. Finally for severe cases, narcotics, such as Roxicet, which you are taking, can be given. The caution for both the benzodiazepines (Valium falls in this category) and narcotics is the potential for addiction.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.