Massachusetts General Hospital, Tredwell Library
http://www.massgeneral.org/library/w...e=000095_2.htm

Table of Contents

• Highlights
• Introduction
• Causes
• Risk Factors
• Complications
• Diagnosis
• Treatment
• Medications
• Resources
• References

Excerpt:
"Deficiencies in Iron Metabolism

Iron deficiency, even at a level too mild to cause anemia, has been linked to RLS in some people. Studies suggest, in fact, that RLS in some people may be due to impaired iron acquisition in cells that regulate dopamine in the brain. (Dopamine abnormalities are known to play a role in RLS.) Some studies have reported RLS in between 25% and 30% of people with low iron levels. (In fact, the common connection between RLS and Parkinson's disease may derive from iron deficiencies in these patients.) "

National Institute of Neurological Disorders and Stroke (NINDS)
http://www.ninds.nih.gov/disorders/r...tless_legs.htm

Table of Contents

• What is restless legs?
• What are common signs and symptoms of restless legs?
• What causes restless legs syndrome?
• How is restless legs syndrome diagnosed?
• How is restless legs syndrome treated?
• What is the prognosis of people with restless legs?
• What research is being done?
• Where can I get more information?

Excerpt:
What research is being done?
Within the Federal Government, the National Institute of Neurological Disorders and Stroke (NINDS), one of the National Institutes of Health, has primary responsibility for conducting and supporting research on RLS. The goal of this research is to increase scientific understanding of RLS, find improved methods of diagnosing and treating the syndrome, and discover ways to prevent it.

NINDS-supported researchers are investigating the possible role of dopamine function in RLS. Dopamine is a chemical messenger responsible for transmitting signals between one area of the brain, the substantia nigra, and the next relay station of the brain, the corpus striatum, to produce smooth, purposeful muscle activity. Researchers suspect that impaired transmission of dopamine signals may play a role in RLS. Additional research should provide new information about how RLS occurs and may help investigators identify more successful treatment options.

The NINDS sponsored a workshop on dopamine in 1999 to help plan a course for future research on disorders such as RLS and recommend ways to advance and encourage research in this field. Participants' recommendations for further research included the development of an animal model of RLS; additional genetic, epidemiologic, and pathophysiologic investigations of RLS; efforts to define genetic and non-genetic forms of RLS; establishment of a brain tissue bank to aid investigators; continuing investigations on dopamine and RLS; and studies of PLMD as it relates to RLS.

Research on pallidotomy, a surgical procedure in which a portion of the brain called the globus pallidus is lesioned, may contribute to a greater understanding of the pathophysiology of RLS and may lead to a possible treatment. A recent study by NINDS-funded researchers showed that a patient with RLS and Parkinson's disease benefited from a pallidotomy and obtained relief from the limb discomfort caused by RLS. Additional research must be conducted to duplicate these results in other patients and to learn whether pallidotomy would be effective in RLS patients who do not also have Parkinson's disease.

In other related research, NINDS scientists are conducting studies with patients to better understand the physiological mechanisms of PLMD associated with RLS


WebMD Medical Reference in collaboration with The Cleveland Clinic


Restless Legs Syndrome

Restless legs syndrome (RLS) is a sleep disorder that causes tingling, pulling, creeping or painful sensations in the legs at night. This sensation is brought on by lying down in bed or sitting for prolonged periods, such as while driving or at a theatre. RLS typically occurs in the evening, making it difficult to fall asleep. Often, people with RLS want to walk around and shake their legs to help relieve the uncomfortable sensation.
What Are the Symptoms of RLS?

RLS symptoms include uncomfortable leg sensations like cramping or tingling generally in the calf region of the leg. When RLS is advanced, a person may feel these symptoms in the hands and arms. Unusual sensations typically surface at nighttime and at rest. Often, sensations can be reduced or eliminated by stretching, walking, or exercising the affected muscles. As a result of these symptoms, people with RLS often have difficulty falling asleep and staying asleep.

What Causes RLS?

The exact cause of RLS is unknown; however, stress appears to make the condition worse. Pregnancy can also bring on the syndrome, as can anemia (particularly due to low iron levels), kidney problems, diabetes and rheumatoid arthritis. Caffeine and some prescription medications contribute to the development of RLS in some cases. In addition, RLS has been found to be a genetic syndrome, as parents with RLS can pass it down to their children.

There is evidence that RLS, like Parkinson's disease, has been found to be accompanied by a selective destruction of dopamine neurons (nerve cells) in the substantia nigra of the midbrain. The destruction of these neurons affects motor control in the body and can contribute to leg discomfort at night in cases of RLS. Other studies showed that there may be a deficiency in specific receptors in the brain that regulate iron in those that suffer from RLS. Research is actively being conducted to further investigate these relationships.

How Is RLS Diagnosed?

Your doctor may ask you questions about your family health history (for example, if you have any family members with RLS) and will take note of symptoms like sleepiness or insomniainsomnia. Additionally, your doctor will conduct a full physical and neurological exam to check for nerve damage or blood vessel problems and may order a series or blood tests to rule out medical disorders associated with RLS. However, there are no tests designed specifically for diagnosing RLS.
Who Gets RLS?

People of any age, including children, can get RLS. It may affect women slightly more than men and typically strikes older adults with an increased severity. Young people who have RLS or who show the symptoms of RLS are usually dismissed as having growing pains or are considered to be overexerting themselves during physical activity. About 5% to 10% of the U.S. population suffers from RLS.

How Is RLS Treated?

RLS is treated in different ways, depending on the intensity of the symptoms. Using an ice pack or heating pad, taking a warm bath, exercising, or lowering caffeine intake will sometimes alleviate the problem. For more severe symptoms, medications are often prescribed. These medications may include dopamine drugs, which often are prescribed to help Parkinson's disease patients. Dopamine drugs stimulate dopamine activity and have been found very helpful in easing RLS pain. Other medications that may be helpful to control the symptoms of RLS are sleeping pills, pain medication or medicines commonly used to treat epilepsy (recurrent seizures).
Tips to Control RLS Symptoms

• Avoid caffeine, alcohol and tobacco.
• Massage the calf and legs regularly.
• Stretch your legs at the beginning and end of each day.
• Exercise. Some people with RLS find that running in place for a short period of time alleviates the symptoms of RLS
• Maintain a regular sleep schedule since fatigue may worsen symptoms.

If your symptoms are so severe that exercising or stretching the legs becomes painful, it is best for you to consult your doctor for alternative methods to control your symptoms.