Restless legs syndrome keeps you going (even if you want to
The symptoms of restless legs syndrome sound so bizarre —
creepy-crawly feelings and an uncontrollable urge to move the legs, especially
at bedtime — that until recently, many people who experienced it simply weren’t
believed when they described it to others.
Betsy Dunn, an 85-year-old Cambridge businesswoman who has had
restless legs for nearly 30 years, remembers a doctor saying she must be
depressed. “I walked out and never went back,” she says. “All I needed him to
say was, ‘I don’t know what this is, but together we will find out.’ ”
In severe cases, like that of Donald Loveland, 75, a retired Duke
University computer scientist now living in Dennis, the urge to move the legs
overwhelms everything else, including pain. Right after back surgery, he
recalls, “it was actually painful to be up but I had to get up anyway.”
Ron Blum, 38, a Jamaica Plain e-mail marketer who first noticed
his symptoms as a 7-year-old, recalls that the minute he lay down and tried to
sleep, “my left leg felt like it had to go for a walk.” Though he never told
his parents, he’d get up and walk for hours in circles. It wasn’t until years
later that a friend heard about RLS. “He called me up and said, ‘Ron, I know
what you have. It has a name.’ ”
It also has growing recognition. RLS may affect some 12 million Americans, according to the National Institute of Neurological Disorders and Stroke, as reported on the
National Institutes of Health website (www.ninds.nih.gov/disorders).
The NIH supports research into the condition at major medical institutions
across the country, as well as within its own labs.
The NIH report notes that the number of RLS sufferers may be even
higher than estimated. Some people with the condition don’t 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.
“You can think of RLS today as where sleep apnea was 10 to 15
years ago,” says Dr. John Winkelman, a psychiatrist, RLS expert, and medical
director of Sleep Health Centers, which is affiliated with Brigham and Women’s
“We used to think of sleep apnea as a bunch of fat guys snoring,”
says Winkelman, who consults for drug companies that make RLS medications. “We
are also just beginning to recognize the potential negative medical
consequences of RLS.” A number of studies have hinted that the syndrome might
be associated with more serious conditions.
Not to mention the toll RLS takes on the quality of life.
“There were many, many nights when I would sleep for only two and
a half or three hours,” recalls Roberta Kittredge, a 65-year old retired
teacher in Hampton, N.H., who first got RLS when she was pregnant. (Some
studies suggest a link between RLS and high estrogen levels.) “Every night I
went to bed positive I would sleep, and two or three minutes later, I was out
of bed and walking the floor for hours and hours.”
There is currently no single diagnostic test for RLS.
“We know what’s wrong,” says Richard Allen, an associate
professor of neurology at Johns Hopkins University. “The neurobiology of RLS is
Levels of iron fall too low in parts of the brain, resulting in
reduced availability of dopamine, a neurotransmitter that carries information
between the body’s cells involved with movement that is also deficient in such
disorders as Parkinson’s disease. In addition, four genes have been linked to
RLS, which often appears in families.
The dopamine connection helps explain why RLS has such a distinct
circadian rhythm, says Allen, who also consults for companies that make RLS
drugs. Dopamine levels follow a clear 24-hour pattern, with levels lowest in
the evening. Moreover, presumably because both RLS and Parkinson’s involve low
dopamine, some of the dopamine-enhancing drugs used to treat Parkinson’s — like
Mirapex and Requip — also can reduce or eliminate RLS symptoms in some
patients. Side effects may include nausea and headache. Taking iron supplements
has been helpful in decreasing or halting RLS symptoms for some patients.
“I would probably be dead by now because of exhaustion,” says
retired Newton architect Paul Dudek, 70, whose life improved dramatically when
he was finally diagnosed and treated with medication.
Dopamine also plays an important role in erectile function, and
epidemiologist Xiang Gao of the Harvard School of Public Health has shown that
men with relatively severe RLS have nearly double the normal risk of erectile
dysfunction. (Xiang Gao has no ties to RLS drug companies.)
But dopamine isn’t the only neurotransmitter that plays into the
RLS picture. Histamine, for one, is a powerful brain stimulant, so drugs that
block histamine — antihistamines such as Benadryl — can significantly
exacerbate RLS symptoms.
One of the frustrations with RLS is that symptoms are usually
triggered just when a person needs to sit or lie still, such as on long plane
trips or when sitting in the audience at concerts and other presentations.
Symptoms tend to be most severe at night.
Once asleep, 80 percent of people with RLS also exhibit another
condition: periodic limb movement during sleep (PLMS), in which the legs jerk
as often as every 20 or 30 seconds. Researchers from the University of Montreal
and elsewhere have shown that each involuntary PLMS leg movement is associated
with a dramatic increase in blood pressure.
Studies suggest RLS might be associated with more serious medical
problems, such as increased risk of heart disease and stroke.
If a link between RLS and high blood pressure is confirmed, the impact
would be dramatic. “Hypertension is a powerful predictor of premature death,”
says Dr. David Rye, a neurologist at Emory University who studies the genetics
of RLS and PLMS and has the conditions himself. Rye also consults with
companies that make RLS drugs.
So far, though a number of researchers have noted associations
between RLS and other diseases, no one has established causality between RLS
and the other conditions. RLS is not an established risk factor for
cardiovascular disease in the way that cholesterol is, for example.
While understanding the condition is a complicated task, RLS
patient Kittredge can offer some hard-won advice to people who might be
suffering in silence and shame: “Find an educated doctor . . . who understands
RLS,” she says. “There is hope out there. I am living proof.”