Restless Legs Syndrome - Research Paper Example

?Restless Legs Syndrome Introduction Restless leg syndrome (RLS) is a sensorimotor disorder that is most easily recognised by the desire to move a particular part of the body in order to stop an uncomfortable sensation (Earley, 2003). RLS is most often associated with the legs but can also be felt through the arms and torso as well as the phantom limbs (Skidmore, Drago, Foster, & Heilman, 2009). Typically when the patient moves the affected body part, it tends to modulate the uncomfortable sensation that in turn helps to relieve it temporarily. The sensations that are experienced during RLS can be compared to both itching and tickling sensations present within muscles. These sensations tend to initiate and intensify in the patient’s body during the quite wakefulness regime. This could include (but is not limited to) activities such as relaxing, studying, drifting into sleep or reading. Most patients of RLS experience limb jerking as they are sleeping and this is taken as the objective marker for the disorder. In certain cases, the limb jerking during sleeping is so intense that the patient’s sleeping cycle is significantly disturbed. However, this is not true for all patients suffering from RLS. Instead, RLS tends to exhibit itself as a spectrum disease so that certain people experience minor disturbance while others have significant sleep disruption which in turn impairs their quality of life (Earley & Silber, 2010). RLS is still being researched for a number of different perspectives including its causes, treatments and possible genetic disorders that might trigger it. This paper will attempt to discuss the various biological causes and treatments available for RLS. Causes The bulk of research focused on the reasons behind RLS concentrates on the dopamine and the iron system (Allen, 2004) (Clemens, Rye, & Hochman, 2006). The basic contention behind these hypotheses relies on the observation that both iron and levodopa (a pro drug based on dopamine that can cross over the blood brain barrier) could be used to treat RLS. Levodopa is also used to treat hypodopaminergic conditions such as for example Parkinson’s disease. This is confirmed through various functional brain imaging techniques such as positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) (Earley, Bbarker, Horska, & Allen, 2006). Individuals affected by RLS also have differences in dopamine and iron related markers in the composition of their cerebrospinal fluids (Allen, Connor, Hyland, & Earley, 2009). Another connection between these systems can be arrived at from the observation that patients with RLS have low iron levels in their substantia nigra regions. However, this observation need not be limited to the substantia nigra regions as other regions might also experience such low iron levels in their composition. RLS has also been reported in people withdrawing from opiates. This most often occurs at night when these people are trying to rest. The severity of the withdrawal could range from slight uneasiness to a painful or burning sensation in the muscles. This could also occur as lactic acid builds up in muscles. In addition, RLS has a strong connection to genetics. Around 60% of all RLS patients have a family history of RLS. This is inherited through an autosomal dominant fashion though the penetrance is variable. The exact causes behind RLS are still unknown though current research and brain autopsies tend to indicate the involvement of iron deficiency in the substantia nigra and the dopaminergic systems. Treatment The treatment for RLS relies on the removal of the underlying causes that inflict the various symptoms of RLS. The primary technique in use is the reduction of the symptom severity experienced during RLS exposure. The basic contention is the reduction of RLS symptoms so that the patient’s quality of life improves. This is achieved by reducing symptom severity, reducing night time awakenings and reducing the number of nights with RLS symptoms. The pharmalogic perspectives on treatment for RLS include the administration of dopamine antagonists or the administration of gabapentin enacarbil as the first line drugs. The more resistant cases of RLS are dealt with using opioids (Karatas, 2007). The treatment of primary RLS is not possible until and unless the precipitating medical conditions are not removed somehow. This is all the more true keeping venous disorders in mind. Furthermore, RLS drug therapy is not curative by design and can induce various side effects. These could include nausea, hallucinations, hypotension, dizziness as well as day time sleep attacks. On the other hand secondary RLS can be cured if the precipitating medical conditions could be managed effectively enough. These underlying medical conditions could include anemia, venous disorders as well as a host of other such problems. Secondary medical conditions that could trigger RLS might include iron deficiency, thyroid issues as well as varicose veins. In addition, fatigue might actually worsen the symptoms presented by RLS so there is a continuous need to keep the patient relaxed. A number of techniques are available to this effect including massaging the limbs, soaking limbs in warm water etc. The avoidance of caffeine, tobacco and alcohol is also highly advised. The use of a regular exercise regime has also been known to help with RLS based symptoms. It is also advised that patients experiencing RLS in the evenings should take onto activities that stimulate the mind such as video games, crossword puzzles, quizzes and the like (Hayes, Kingsley, Hamby, & Carlow, 2008). Temporary relief from RLS can also be obtained by stimulating the limbs such as by stretching the arms and the legs. This is known to provide a temporary cessation of RLS symptoms. In addition, masturbation and sexual intercourse has also been shown to be effective in relieving RLS symptoms. However, for either masturbation or sexual intercourse the achievement of an orgasm is seen as being necessary (Marin, Felicio, & Prado, 2011). Conclusion RLS is a particular sensorimotor problem associated with uneasy limbs typified by the severity of the symptoms. While some patients might experience slight discomfort, others might suffer from decreased quality of life. RLS is caused by iron deficiency as well as disturbances in the dopamine levels. Successful treatment of RLS includes pharmalogical paths as well as physical stimulation paths. References Allen, R. (2004). Dopamine and iron in the pathophysiology of restless legs syndrome (RLS). Sleep Medicine 5 (4) , 385–391. Allen, R. P., Connor, J. R., Hyland, K., & Earley, C. J. (2009). Abnormally increased CSF 3-Ortho-methyldopa (3-OMD) in untreated restless legs syndrome (RLS) patients indicates more severe disease and possibly abnormally increased dopamine synthesis. Sleep Medicine 10 (1) , 123-128. Clemens, S., Rye, D., & Hochman, S. (2006). Restless legs syndrome: Revisiting the dopamine hypothesis from the spinal cord perspective. Neurology 67 (1) , 125–130. Earley, C. J. (2003). Restless Legs Syndrome. New England Journal of Medicine 348 (21) , 2103–2109. Earley, C. J., & Silber, M. H. (2010). Restless legs syndrome: Understanding its consequences and the need for better treatment. Sleep Medicine 11 (9) , 807–815. Earley, C., Bbarker, P., Horska, A., & Allen, R. (2006). MRI-determined regional brain iron concentrations in early- and late-onset restless legs syndrome. Sleep Medicine 7 (5) , 458–461. Hayes, C. A., Kingsley, J. R., Hamby, K. R., & Carlow, J. (2008). The effect of endovenous laser ablation on restless legs syndrome. Phlebology 23 (3) , 112–117. Karatas, M. (2007). Restless Legs Syndrome and Periodic Limb Movements During Sleep: Diagnosis and Treatment. The Neurologist 13 (5) , 294–301. Marin, L. F., Felicio, A. C., & Prado, G. F. (2011). Sexual intercourse and masturbation: Potential relief factors for restless legs syndrome? Sleep Medicine 12(4) , 422. Skidmore, F. M., Drago, V., Foster, P. S., & Heilman, K. M. (2009). Bilateral restless legs affecting a phantom limb, treated with dopamine agonists. Journal of Neurology, Neurosurgery & Psychiatry 80 (5) , 569–570. Read More