Restless legs (RLS). Is it a new thing or an old disorder that no one ever mentioned before?

RLS or Ekbom syndrome was first noted in medical journals in 1672, however it wasn’t really till 1945 that it was properly organised as a stand-alone disorder. We can say that RLS was probably always around, however to know if there was always a 10% population effect is impossible due to the modern availability of medical information and ‘doctor google’.

RLS effects around 10% of the American and European population, generally in women over 50, however it has been noticed by up to 45% of sufferers before the age of 20. Women are twice more likely to be effected than men and Caucasians more likely to be effected than other races.

Diagnosis:

Generally 4 symptoms are present to confirm the diagnosis:

• The symptoms are more severe at night and do not occur, or are negligible, in the morning (although in extreme cases, symptoms may occur in the daytime)
• An irresistible urge to move the legs and/or arms, often associated with a sensation of pain, burning, pricking, tingling, numbness, or other unpleasant or unusual sensations
• The sensations begin following relaxation or a period of staying still, and during sleep
• Temporary relief from these sensations during movement of the affected legs and/or arms

Testing:

There is no single test to diagnose RLS, however, a standard blood test will be performed to rule out the most obvious causes such as iron deficiency (20-30% of the cause). Further investigations may include and should be ruled out: deficiency of folate or magnesium, thyroid disease, fibromyalgia, sleep apnoea, diabetes, Parkinson’s disease, MS, uraemia, diabetes, Sjogrens, celiac or rheumatoid arthritis. ‘Growing pains’ or ‘shin splints’ in children and adolescents is not considered part of the same diagnosis.

Genetics:

Three genes, MEIS1, BTBD9 and MAP2K5, were found to be associated to RLS.

Western Treatment:

Some drugs such as dopamine antagonists (usually used for Parkinson’s disease) have shown some good results, but not enough to warrant a frontline, safe and long term health plan.

Chinese Medical & Acupuncture Approach

Chinese journals have commented on restless leg syndrome in their own language and frame work over the years. Here is an
extract from a medical journal from 1529 AD.

“夜间少寐, 足内酸热, 若再良久不寐, 腿内亦然, 且兼腿内筋似有抽缩意, 致两腿左右频移, 展转不安, 必至倦极方寐, 此劳伤元气, 阴火乘虚下注。”薛己《内科摘要》1529

“The patient has trouble sleeping at night and a feeling of soreness and hotness in the legs. This kind of feeling will continue if the patient does not fall asleep when he lies on the bed. In addition, the leg muscles could have spasms, leading to frequent leg movements which are from left to right or from right to left, until the patient falls asleep from exhaustion. The cause of these symptoms is debilitation and Yin Fire from deficiency moving downwards.” Ji Xue 1529

But what does that really mean to someone not familiar to Chinese medical concepts?

Not much besides the fact that the Chinese doctors noted this as a disease some time ago, and if fact had around 10 differentiation’s of disease mechanism and related treatments, mainly centered around an initial deficiency of a bodily resource (perhaps iron, folate, or some aspect of the “richness” of blood) and inability of the transport mechanism of that substance (poor circulation), and in some cases a worsening of the condition in the presence of heat (possible inflammation of the blood vessels of the legs).

So what do I do in the clinic?

Of course the most important thing to do is take a full history of the patient. This includes pulse taking, palpation, observation of changes in the body such as varicose veins, changes in temperature around the body such as cold hands in the day but hot feet at night, or reversed. Everything we can ask and observe gives us a clue.

I have to say I believe there is a genetic component involved, and this will dictate how hard the condition may be to treat.

The main point of the treatment is to diagnose the dysfunction and return homeostasis (balance/regularity) and normal functioning of the body.

This usually involves acupuncture and herbal medicine.

I also find certain changes in diet to be effective. Some patients drink large amounts of coffee, sometimes they tell me 8-12 cups a day! The problem with this is that not only does it create heat in the body, coffee is a strong diuretic. This means you are urinating a lot of nutrients and minerals out the more you urinate. Not great for calcium, potassium, sodium and magnesium stores.

If you are on medication it is not a problem, thus we would like you to disclose full medication information to avoid interactions.

Treatments of RLS can take months, however you should notice symptomatic easing within 2-3 treatments and we expect those results.

Studies:

Using acupuncture and specific heat-lamp radiation, there was a 90% reduction if symptoms. http://europepmc.org/abstract/med/18257184 unfortunately they used the word ‘cured’ which makes me obviously suspicious, however, at least warrants further investigation.

Post-apoplectic RLS treated effectively with acupuncture, 76% reduction http://link.springer.com/article/10.1007/BF02850995

Treating RLS on patients previously on medication http://aim.bmj.com/content/29/3/240.short

Treatment review Chinese herbal medicine for RLS: http://www.sciencedirect.com.ezproxy.lib.rmit.edu.au/science/article/pii/S1087079212000056?np=y#