The restless leg syndrome (RLS), also known as Willis-Ekbom disease , is a neurological pathology characterized by the presence of discomfort described as tingling, burning, cramps, restlessness, and / or pain in the legs . These unpleasant sensations usually appear or worsen during rest , occur at dusk or evening and lead the patient to experience the urgent need to move to relieve these sensations . This causes that, in many cases, patients have difficulty falling asleep or awakenings are triggered : interruption and the destructuring of sleep is one of its main consequences. The Spanish Society in Neurology (SEN) estimates that in Spain more than 2 million people suffer from this disease and that close to 20% suffer from a severe form of this syndrome.
Although it is a fairly common disease, since it is estimated that the prevalence of restless legs syndrome reaches 5-10% of the adult population and 2-4% of children and adolescents , is highly underdiagnosed : some studies suggest that only 10% of cases are diagnosed and that this figure is even lower in childhood . And in some cases it may even take periods of 10 years until a correct diagnosis is made.
“The course of this disease is fluctuating, with seasons in which the symptoms are milder or others in which they are more intense and worsen the quality of life. It usually affects the lower extremities, usually the calves and ankles. In some cases the discomfort can be intense and even manifest during the day and can also involve other parts of the body, such as the upper extremities or the abdomen. Therefore, it is common for some patients to confuse it with discomfort due to poor circulation and, in certain cases, it is not until it implies a bad rest, with insomnia or drowsiness during the day when they consult ”, comments Dr. Ana Fernández Arcos, Coordinator of the Study Group on Sleep and Wake Disorders of the Spanish Neurology Society.
In severe cases of this disease it is a very disabling disease . One of the latest studies carried out in Spain among adult patients points out the high prevalence of associated symptoms such as intense pain, insomnia, depression or anxiety among patients, which not only decrease their quality of life, but also produce important limitations in their daily life and in social and work relationships.
Restless legs syndrome is more frequent in women , in a ratio of 2 to 1 with respect to men. In early ages there are no differences regarding the distribution of sexes , but at the end of adolescence it begins to be more frequent in girls.
In addition, in the case of pediatric leg syndrome, the clinic of the disease differs from adults . This, together with the fact that children’s explanations tend to be more imprecise, means that up to 40% of adults who are recently diagnosed indicate that their symptoms began in childhood. In pediatric age, it is common for children to describe their symptoms as itching , having the urge to hit or having too much energy in the limbs .
In addition, the symptoms do not have to appear at night, but rather can do so at any time of the say a, especially when sitting. On the other hand, in children, restless legs syndrome (RLS) has been associated with different mood disorders or with psychiatric disorders . Above all, a bidirectional association has been seen with attention deficit / hyperactivity disorder : 26% of Children with RLS meet criteria for ADHD, and 12-35% of children with ADHD suffer from RLS.
“It is important, therefore, to emphasize the importance that both patients and relatives recognize and go to the doctor in the event of symptoms such as those we have described, as well as the relevance of primary care in recognizing and referring patients who present sleep disturbances, mood disturbances, and limb discomfort. Early diagnosis can improve their quality of life and reduce the associated comorbidity and its impact on school and work ”, points out Dr. Ana Fernández Arcos.
Restless legs syndrome can be primary or secondary . The most common causes of secondary RLS are iron deficiency, kidney failure, neuropathies, pregnancy, spinal cord injuries, certain drugs, or other neurological causes such as Huntington’s disease, amyotrophic lateral sclerosis (ALS), multiple sclerosis, Parkinson’s disease, etc. In contrast, the cause of the primary forms is not entirely clear, although some authors estimate that primary RLS is hereditary in up to 50-92% of the cases.
“When faced with a patient with secondary RLS, we should treat the cause as far as possible by withdrawing possible drugs involved and providing iron supplements in cases where there is a deficit. While in patients with primary RLS, we can offer symptomatic treatments when symptoms interfere with the quality of life of patients. In any case, and especially in children, where pharmacological treatment is only recommended in the most serious cases, it is even more important to establish adequate standards of sleep hygiene as part of the treatment of this disease ”, explains Dr. Ana Fernández Arcos.
“This includes trying to get enough sleep for each age; establish a regular sleep schedule, avoiding large dinners or intense exercise in the hours before going to bed; reduce stimulating activities before bed, such as watching television or video games; exercise moderately, because not only does it improve RLS symptoms, but it also reduces anxiety and depression and promotes sleep; and, in general, avoid anything that could make it difficult to rest. ”
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