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Wednesday, August 31, 2005
Iron deficiency can cause restless leg syndrome
By Zosimo T. Literatus, R.M.T.
Breakthroughs
Leg discomforts could be more than what they seem. It begins with sensations of discomfort in the legs, especially when the person is sitting or lying down, and it is accompanied by an irresistible urge to move about.
Some people describe the sensation as burning, creeping, tugging, or like insects crawling inside the legs. These sensations usually occur deep inside the leg, between the knee and ankle. More rarely, they occur in the feet, thighs, arms, and hands.
Although the sensations can occur on just one side of the body, they most often affect both sides. Its name is restless leg syndrome (RLS).
In a report by the National Institute of Neurological Disorders and Stroke (Ninds), some researchers estimate that RLS affects as many as 12 million Americans. Others estimate a much higher occurrence because, as the report says, “RLS is thought to be underdiagnosed and, in some cases, misdiagnosed.
Some people with RLS will not seek medical attention, believing that they will not be taken seriously, that their symptoms are too mild, or that their condition is not treatable. Some physicians wrongly attribute the symptoms to nervousness, insomnia, stress, arthritis, muscle cramps, or aging.”
Because moving the legs (or other affected parts of the body) relieves the discomfort, people with RLS often keep their legs in motion to minimize or prevent the sensations. They may pace the floor, constantly move their legs while sitting, and toss and turn in bed.
Most people find the symptoms to be less noticeable during the day and more pronounced in the evening or at night, especially during the onset of sleep. For many people, the symptoms disappear by early morning, allowing for more refreshing sleep at that time. Other triggering situations are periods of inactivity, such as long car trips, sitting in a movie theater, long-distance flights, immobilization in a cast, or relaxation exercises.
Although RLS has been observed in 50 percent of cases with RLS family history, the Ninds report says low iron levels or anemia can make people prone to developing RLS. Once iron levels or anemia is corrected, studies have shown that patients see a reduction in symptoms.
RLS has also been observed in patients with chronic diseases, such as kidney failure, diabetes, Parkinson’s disease, and peripheral neuropathy; they are associated with RLS. Treating the underlying condition often provides relief from RLS symptoms. Some pregnant women experience RLS, especially in their last trimester. For most of these women, symptoms usually disappear within four weeks after delivery.
The Ninds report says that anti-nausea drugs (prochlorperazine or metoclopramide), anti-seizure drugs (phenytoin or droperidol), anti-psychotic drugs (haloperidol or phenothiazine derivatives), and some cold and allergy medications may aggravate symptoms. So patients, the report recommends, talking with their physicians about the possibility of changing medications would be helpful.
Researchers also have found that caffeine, alcohol, and tobacco may aggravate or trigger symptoms in patients who are predisposed to develop RLS. Some studies have shown that a reduction or complete elimination of such substances may relieve symptoms. It remains unclear, however, whether elimination of such substances can prevent RLS symptoms from occurring at all.
In 1995, the International Restless Legs Syndrome Study Group identified four basic criteria for diagnosing RLS: a desire to move the limbs, symptoms that are worse or present only during rest and are partially or temporarily relieved by activity, restlessness while moving, and worsening of the symptoms at night.
For those with mild to moderate symptoms, “Prevention,” says the NINDS report, “is key.” Many physicians suggest certain lifestyle changes and activities to reduce or eliminate symptoms. Decreased use of caffeine, alcohol, and tobacco has reportedly provided some relief. Taking supplements can correct deficiencies in iron, folate, and magnesium.
Studies also have shown that maintaining a regular sleep pattern can reduce symptoms. Some individuals, finding that RLS symptoms are minimized in the early morning, change their sleep patterns. Others have found that a program of regular and moderate exercise helps them sleep better. But excessive exercise has been reported by some patients to aggravate RLS symptoms.
Taking a hot bath, massaging the legs, or using a heating pad or ice pack has been reportedly helpful in relieving symptoms in some patients. These measures, though, rarely completely eliminate symptoms.
A more recent study, funded by NINDS, shows that a surgical procedure called pallidotomy, involving a portion of the brain called as the globus pallidus, showed that a patient with RLS and Parkinson’s disease benefited from it and obtained relief from the limb discomfort caused by RLS. Additional research, however. 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.
While much leg-work remains to be done in the search for restless leg syndrome, common sense and a dose of faith can become handy under the present level of therapeutic knowledge on the condition. That means staying alert for breakthroughs in the field and believing that the best option, where options are not available, is to accept and enjoy a life of limited options.
Syndrome or none at all, life moves every second of the day!
(August 31, 2005 issue)
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