One Leg Up
They buzz, they tingle, they irritate, and they’re just downright nasty! When sleep beckons, those “creepy crawlers” intervene, keeping us awake at night, watching old reruns, and making for yawning sprees and fatigue at work or at play, when the sun comes up. Restless leg syndrome (RLS) is the culprit and source of the tingling legions that strike under cover of darkness, perplexing us, and leaving us with questions unanswered. Unfortunately, current medical literature on the subject is wanting, so our illustrious health care providers must run for cover or snag the latest medical journal piece of relevance or the latest edition of the “Bible of internal medicine,” Harrison’s Principles of Internal Medicine (17th Edition, ©2008, McGraw Hill Medical, New York).
What do we know? What answers can we give the 1-5% of young and middle-aged adults and the 10-20% of adults aged 60 years and greater, who suffer from the deep aching of the upper and/or lower extremities inherent in RLS? Let’s first try to corner the pest, and define its modus operandi. It appears in the evening, usually when we are inactive, and it keeps us from falling asleep. The deep muscular aching it provokes can be temporarily relieved with movement, but that is only a stopgap measure that we can’t rely on at night, when we need our sleep. The symptoms of RLS come and go, and, frankly speaking, they can be aggravated not only by our vices, like caffeine and alcohol, but also by sleep deprivation, some antidepressants, and pregnancy. So, we’re damned if we do, and damned if we don’t, especially those of us who suffer from depression. Are we willing to accept a tingling in our toes in exchange for peace of mind and freedom from the debilitating effects of depression? You be the judge, jury, and victim!
Are there any silver linings here? Perhaps for those of us who are not White Caucasians, there may be, as RLS appears more commonly in those of Northern European extraction, a sort of reverse discrimination, if you will, and if you’ll excuse my poor attempt at humor. Multiple family members may be affected, although pinpointing the malady to a specific gene on a particular chromosome is beyond the reach of current medical and genetic research on the heredity of the disorder. So, hapless victims continue to trudge over to their doctors’ offices in search of a magic elixir or cure-all, only to find that their “pillars of medical knowledge” are as clueless as they themselves. Those in the know can assert, with some degree of confidence, that RLS can be caused by iron deficiency and renal failure in some instances. The vast majority of sufferers, however, must consider their condition an enigma, which gives no comfort when restless legs wish to walk right out from under them.
The symptoms are there, including disturbed sleep, musculoskeletal pain, and fatigue; a profound knowledge of the causes is not. That doesn’t mean that relief is not near. Success has been achieved with neurologic drugs such as pramipexole (0.25-0.5 mg, every evening at 8 p.m.) or ropinirole (0.5-4.0 mg, every evening at 8 p.m.). The latter has been marketed consistently on television, under the commercial name Requip®, by pharmaceutical giant GlaxoSmithKline. Nonetheless, while a suitable “leg up” on symptoms can be attained with such medications, until the cause of RLS is individuated and targeted, our legs will continue to run away with us at any given moment. If that were not all, we have also seen the rise of periodic leg movements of sleep (PLMS), consisting of the raising of the big toes and feet, which can accompany its big brother RLS.
Restless legs syndrome has given new life to the concept of Mexican jumping beans. Hopefully, with time, the former will be silenced. That will leave us with only Montezuma’s revenge to quell.
What do we know? What answers can we give the 1-5% of young and middle-aged adults and the 10-20% of adults aged 60 years and greater, who suffer from the deep aching of the upper and/or lower extremities inherent in RLS? Let’s first try to corner the pest, and define its modus operandi. It appears in the evening, usually when we are inactive, and it keeps us from falling asleep. The deep muscular aching it provokes can be temporarily relieved with movement, but that is only a stopgap measure that we can’t rely on at night, when we need our sleep. The symptoms of RLS come and go, and, frankly speaking, they can be aggravated not only by our vices, like caffeine and alcohol, but also by sleep deprivation, some antidepressants, and pregnancy. So, we’re damned if we do, and damned if we don’t, especially those of us who suffer from depression. Are we willing to accept a tingling in our toes in exchange for peace of mind and freedom from the debilitating effects of depression? You be the judge, jury, and victim!
Are there any silver linings here? Perhaps for those of us who are not White Caucasians, there may be, as RLS appears more commonly in those of Northern European extraction, a sort of reverse discrimination, if you will, and if you’ll excuse my poor attempt at humor. Multiple family members may be affected, although pinpointing the malady to a specific gene on a particular chromosome is beyond the reach of current medical and genetic research on the heredity of the disorder. So, hapless victims continue to trudge over to their doctors’ offices in search of a magic elixir or cure-all, only to find that their “pillars of medical knowledge” are as clueless as they themselves. Those in the know can assert, with some degree of confidence, that RLS can be caused by iron deficiency and renal failure in some instances. The vast majority of sufferers, however, must consider their condition an enigma, which gives no comfort when restless legs wish to walk right out from under them.
The symptoms are there, including disturbed sleep, musculoskeletal pain, and fatigue; a profound knowledge of the causes is not. That doesn’t mean that relief is not near. Success has been achieved with neurologic drugs such as pramipexole (0.25-0.5 mg, every evening at 8 p.m.) or ropinirole (0.5-4.0 mg, every evening at 8 p.m.). The latter has been marketed consistently on television, under the commercial name Requip®, by pharmaceutical giant GlaxoSmithKline. Nonetheless, while a suitable “leg up” on symptoms can be attained with such medications, until the cause of RLS is individuated and targeted, our legs will continue to run away with us at any given moment. If that were not all, we have also seen the rise of periodic leg movements of sleep (PLMS), consisting of the raising of the big toes and feet, which can accompany its big brother RLS.
Restless legs syndrome has given new life to the concept of Mexican jumping beans. Hopefully, with time, the former will be silenced. That will leave us with only Montezuma’s revenge to quell.
© 2008, Albert M. Balesh, M.D. All rights reserved.
posted by Dr. Al at
5/26/2008 03:56:00 PM
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