FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

RESTLESS LEGS SYNDROME UNCOMFORTABLE FOR VICTIM -- AND SPOUSE!

Question: My husband has a difficult time falling asleep because his legs bother him. Our doctor says he has restless legs syndrome. He has given him some medicine for this, but it hasn't helped very much. What causes this condition, and is there anything besides the Sinemet that could help him?

Answer: As I've reminded the readers of this column before, any time you see the label "syndrome" you should automatically know that your doctor is practicing the "art" of medicine instead of the "science" of medicine. I say this because a syndrome is a grouping of symptoms that are commonly observed together rather than a specific disease condition for which we understand the underlying causes. Consequently, treatment decisions are based less on lab tests than upon the more subjective -- or "artful" - careful observations of those with the syndrome.

Individuals with restless legs syndrome move their legs, just as the name suggests, but they do this in response to discomfort rather than in an effort to get someplace. Typically the legs become uncomfortable late in the day or after going to bed but before falling asleep. Most describe the leg discomfort as a burning, aching, itching or pins-and-needles sensation rather than as a severe pain. Leg movement briefly relieves this discomfort, but it returns in a few moments after the legs come to rest. As a result, those with this syndrome have trouble falling asleep. In addition to troubling the individual with the disorder, it also frequently disturbs his or her spouse.

Most who suffer with restless legs syndrome also experience periods of fidgeting during the day, usually without pain. In addition to the daytime fidgets and nighttime pain, up to 80 percent have twitches, kicks or other leg movements at 20 to 30 second intervals during sleep. Not surprisingly, this often contributes to feelings of fatigue in the morning. It also invariably disturbs the sleep of the bed partner.

Restless leg syndrome strikes men and women with equal frequency. About five percent of the total adult population suffers from its symptoms, but 45 percent of those over 65 complain of these symptoms frequently or occasionally.

The Sinemet your husband has taken is a common treatment choice, but there are a number of other medicines that can help or totally relieve the symptoms of this syndrome. There are no simple tests that help your doctor determine which medicine is going to give relief in a specific case. Consequently, treatment often involves some educated guesses on your doctor's part and some switching of medicines until relief is provided -- once again, the "art" of medical practice.

I'd recommend that you and your husband return to his doctor to discuss other treatment choices. Be patient with both of them -- art often takes some time.

"Family Medicine" is a weekly column.

To submit questions, write to: John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.