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By Lisa Cunningham -APRN
Restless leg syndrome is thought to be a neurological disorder associated with unpleasant sensations in the extremities...It is usually described as burning, crawling, creeping, tugging, electrical shocks , and crazy limbs.
RLS is thought to be a neurological disorder associated with unpleasant sensations in the extremities. It was first identified over 300 years ago. The NIH (National Institute of Health) identifies it as a primary disorder with no apparent cause. The epidemiological risk factors for RLS -female sex, pregnancy, multiparty, old age, and family history are the same risk factors for CVD (chronic venous disorders).
The prevalence of RLS in the adult population is as high as 15%. RLS is associated with constant desire to move the limbs that occurs at rest and is relieved by limb movement. It is usually described as burning, crawling, creeping, tugging, electric shocks, and crazy legs.
It is poorly understood, often under diagnosed or misdiagnosed. Treatment is often inadequate. It is a quality of life issue. Often causes insomnia for the affected and many times for the sleep partners of the affected.
Clinically there are 4 basic criteria: URGE Urge to move legs because of unpleasant sensation, Rest induced, Gets better with activity, Evening and night accentuations. It appears to increase in in prevalence as age increases. It also affects women two-fold over men.
Diagnosis is made using the International RLS study group (IRLSSG) criteria (above). Symptoms rating scale is
Mild: 1-10 points
Moderate; 11-20 points
Severe: 21-40 points
Many theories as to causes including genetic, familial, anemia, pregnancy, Parkinson's, thyroid disease, kidney failure, varicose veins and idiopathic.
Current and relative research:
McDonagh, King, Guptan Phlebolgy 2007 studied 174 consecutive patients and 174 matched healthy controls. They found that 36% of patients presenting to Phlebology practice had RLS symptoms compared to control of 19%. Of the 36% that had RLS symptoms 98% had chronic venous disease. Of the 19% control that had RLS symptoms 91% had chronic venous disease. Only 9% of control group that had RLS symptoms had no CVD. It appears that higher RLS scores were associated with higher CEAP score.
Kanter Dermatological Surgery 1995 had 113 patients with the dual diagnosis of RLS and varicose veins. They were treated with sclerotherapy only. 57% had type 1 CVD (telangiectasia). Of those treated 98% reported rapid relief.
Hayes et al Phlebology 2008 studied 35 patients with moderate to severe RLS with CVD. They were divided into operative (EVLT/UGS) and non-operative (no treatment). 80% of those with treatment had improvement in their symptoms. 53% had a follow up score less than 5 indicating their symptoms had been largely alleviated. 31% had a score of 0 indicating complete relief of their symptoms.
McDonagh et al COMPASS study Phlebology 2002 studies 186 with GSV reflux, 17%with RLS. They were treated with sclerotherapy. 100% reported RLS relief.
Two hypotheses on why CVD causes RLS:
Venous congestion hypothesis: Venous congestion causes pooling of blood in the extremities which then stimulates movement of the extremities to increase venous return.
