By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

MOST RESTLESS LEGS SYNDROME IS TREATED WITH “ART” NOT “SCIENCE”

Question: My doctor recently told me that I have restless leg syndrome and to take iron supplements. He didn’t do any lab work, just examined me and said that was what I had. I have been having trouble sleeping from this because my legs only bother me at night. Is there anything else I can do about this? What is restless leg syndrome?

Answer: Restless leg syndrome, or RLS, is a movement disorder. The primary symptoms are an uncomfortable feeling, usually in the upper legs, that causes an irresistible urge to move the legs or walk to relieve the sensation. These symptoms frequently occur during the early stages of sleep. Moving the legs seems to make the sensation go away. Episodes can last for up to an hour or longer. A similar syndrome can affect the arms, but this is rare.

Generally, the person with RLS comes to his or her physician’s office complaining about an inability to sleep. The fourth leading cause of insomnia, RLS is seen in about 6 percent of the adult population, with a higher incidence in people over 65. There is a strong tendency for this disorder to run in families, and most cases are idiopathic -- no cause is ever found.

In some cases, though, certain medical conditions can be pinpointed as the cause. Iron deficiency anemia, for example, is a common, treatable cause of RLS. This may be why you were told to take iron. It would be best to have some lab work done to confirm the diagnosis of anemia, however, before beginning treatment. Women who are pregnant are also more prone to RLS, as are people of both genders who have low thyroid hormone levels, diabetes, low folic aid and magnesium levels, or varicose veins.

The treatment for RLS depends on the cause. If you have an underlying causative condition, then adequate treatment of that condition will usually cure your RLS. However, as I said, most people with RLS have no identifiable cause, so the treatment is much less specific and more problematic.

Discontinuing coffee, alcohol and tobacco can be helpful. Avoid exercise for at least two hours before bedtime. Massaging the legs and using cold compresses can give some relief. There are medications that can help to still the restless legs, but some may have undesirable side effects.

Finally, remember that any time you see the label “syndrome” it means we are in the realm of the “art” of medicine rather than 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 more on subjective -- or "artful" –-observations than on hard, scientific data. This is certainly the case with idiopathic restless legs syndrome.

If you suffer from restless legs syndrome and are one of the majority of sufferers who don’t have an underlying disorder, I'd still recommend that you talk to your family doctor about treatment choices. But be patient -- remember that "art" often takes time.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via email to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnosis and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.