Restless legs syndrome how to treat. Restless legs syndrome: when the night turns into torture

Have you ever experienced discomfort in the legs, an irresistible desire to move them and the inability to fall asleep? I think that quite a lot of people will answer this question in the affirmative. And if this is not an accident, but a systematic repetition from day to day? In this case, these may be symptoms of a condition such as restless leg syndrome. What is it?

Restless legs syndrome is a pathological condition of the nervous system in which a person has unpleasant sensations mainly in the lower extremities with an irresistible desire to constantly move them. These symptoms prevent a sick person from sleeping, and sometimes cause depression. In more than half of all cases of restless legs syndrome, the immediate cause of the disease cannot be identified, that is, it occurs independently and spontaneously. The remaining cases are provoked by other diseases and conditions of the body (most often as a result of chronic renal failure, pregnancy and iron deficiency in the body).

A feature of the disease is the absence of any signs during a neurological examination, that is, the diagnosis of this condition is based only on clinical manifestations. Treatment is complex, requires the use of non-drug and medical methods. In this article, you can get acquainted with the causes, the main signs of restless legs syndrome and how to treat it.

Statistics and historical background

Despite the apparent rarity of the disease, it occurs in 5-10% of the world's population. Simply highlighting all the signs in a separate diagnosis is quite rare (unfortunately, due to insufficient awareness of the medical staff).

Restless legs syndrome has been known to mankind for a long time. The first description was given in 1672 by Thomas Willis, but this problem was studied well enough only in the 40s of the 20th century by the Swede Ekbom, so sometimes this disease is used under the names of these scientists - Willis' disease or Ekbom's disease.

The disease is most common among middle-aged and elderly people. The female sex suffers more often by 1.5 times. About 15% of cases of chronic insomnia are due to restless leg syndrome.

The reasons

All episodes of restless legs syndrome are divided into two groups, depending on the cause. Accordingly, they are distinguished:

• primary (idiopathic) restless legs syndrome;
• secondary (symptomatic) restless legs syndrome.

This division is not accidental, because the treatment tactics are somewhat different for idiopathic and symptomatic syndromes.

Primary restless leg syndrome accounts for more than 50% of cases. In this case, the disease occurs spontaneously, against the background of complete well-being. Some hereditary connection is traced (some sections of chromosomes 9, 12 and 14 have been identified, changes in which cause the development of the syndrome), but it cannot be said that the disease is exclusively hereditary. Scientists suggest that in such cases, a hereditary predisposition is realized against the background of the coincidence of a series external factors. As a rule, primary restless legs syndrome occurs in the first 30 years of life (then they talk about early start diseases). The disease accompanies the patient all his life, periodically weakening his grip, periodically intensifying. There may be periods of complete remission for several years.

Secondary restless legs syndrome is a consequence of a number of somatic and neurological diseases, the elimination of which leads to the disappearance of symptoms. The most common of these conditions are:

• chronic renal failure (up to 50% of all its cases are accompanied by restless legs syndrome);
• anemia due to iron deficiency in the body;
• diabetes;
• deficiency of certain vitamins (B1, B12, folic acid) and trace elements (magnesium);
• amyloidosis;
• rheumatoid arthritis;
• cryoglobulinemia;
• thyroid disease;
• alcoholism;
• circulatory disorder lower extremities(both arterial and venous problems);
• radiculopathy;
• tumors and injuries.

Paradoxically, the normal physiological state of the body can also cause secondary restless leg syndrome. It means pregnancy. Up to 20% of all pregnant women in the II and III trimester, and sometimes after childbirth, complain of symptoms characteristic of restless leg syndrome.

Another cause of secondary restless legs syndrome may be the use of certain medicines: neuroleptics, calcium channel blockers, antiemetics based on metoclopramide, lithium preparations, a number of antidepressants, some antihistamines and. Also, excessive consumption of caffeine can serve as an impetus for the appearance of signs of the disease.

Secondary restless legs syndrome occurs later than the primary one, on average, after 45 years (with the exception of cases associated with pregnancy). In this case, we speak of a late onset of the disease. Its course depends entirely on the cause. As a rule, secondary restless legs syndrome does not have remissions and is accompanied by a slow but steady progression (if the disease that caused it is not treated).

By using modern methods studies have found that restless legs syndrome is based on a defect in the dopaminergic system of the brain. Dopamine is one of the brain transmitter substances that carry information from one neuron to another. Dysfunction of neurons that produce dopamine leads to a number of symptoms of restless leg syndrome. In addition, some of the hypothalamic neurons that regulate circadian rhythms (sleep-wakefulness based on the change of night and day) are also related to the appearance of this syndrome. The occurrence of the disease against the background of problems with the peripheral nervous system is associated with the implementation of a hereditary predisposition against the background of the action of provoking factors. A clear mechanism for the formation of restless legs syndrome is not known.

Symptoms

The main signs of the disease are:

• discomfort in the lower extremities. The word "unpleasant" refers to a whole range of phenomena: tingling, burning, crawling, twitching, tingling, stretching, itching, dull braining or cutting pain. Sometimes patients cannot find a word to describe their feelings. Most often, these sensations occur in the legs, but not symmetrically, but with a predominance in one or the other limb. A unilateral onset of the disease is also possible, but then the process will still cover both limbs. After the shins, these signs appear in the feet, knees, and thighs. In severe cases, the arms, torso, and perineum are involved. Then the sensations become simply unbearable;
• the need to constantly move the limbs in which discomfort arose. Why the need? Yes, because otherwise a person simply cannot get rid of these sensations, and movement brings noticeable relief or even the disappearance of symptoms. But as soon as a person stops, obsessive unpleasant sensations appear again;
• sleep disturbance. The fact is that the occurrence of discomfort in the legs is associated with a daily rhythm. As a rule, they appear a few minutes after going to bed, which means they do not let you fall asleep. Also, such sensations arise during the rest period. The maximum severity of symptoms occurs in the first half of the night, in the morning it decreases, and in the first half of the day there may be no symptoms at all. It turns out that the person cannot sleep. He is forced to constantly move his legs, shake and rub his limbs, toss and turn in bed, get up and wander around the house to get rid of sensations. But as soon as he goes back to bed, a new wave rolls in. Lack of sleep at night leads to daytime sleepiness, reduced performance. In severe cases, the daily rhythm is lost, and the symptoms become permanent;
• the appearance of periodic movements of the limbs in a dream. If the patient still manages to fall asleep, then in a dream his leg muscles contract involuntarily. For example, the fingers on the foot are unbent and / or fan-shaped, the knees are bent, and sometimes the hips. Movements are usually stereotyped. In severe cases, the hands are also involved. If the movements are insignificant in their amplitude, then the person does not wake up. But most often, such movements lead to the awakening of the patient, already exhausted by the lack of sleep. Such episodes can be repeated an infinite number of times per night. This time of day becomes torture for the patient;
• occurrence of depression. Prolonged lack of sleep, persistent discomfort in the limbs, loss of working capacity, and even fear of nightfall can provoke the onset of depressive disorders.

From the foregoing, it becomes clear that all the main symptoms of restless legs syndrome are associated with subjective sensations. In most cases, a neurological examination of such patients does not reveal any focal neurological symptoms, sensory or reflex impairments. Only if restless legs syndrome develops against the background of an existing pathology of the nervous system (radiculopathy, multiple sclerosis, tumor spinal cord and so on), then changes in the neurological status are detected, confirming these diagnoses. That is, restless legs syndrome itself does not have manifestations that can be detected during examination.

Diagnostics

It is precisely because the main signs of restless legs syndrome are associated with subjective sensations that are presented to patients in the form of complaints that the diagnosis of this disease is based solely on clinical signs.

Additional research methods in this case are carried out in order to find possible cause diseases. After all, some pathological conditions can proceed unnoticed by the patient, manifesting only restless legs syndrome (for example, iron deficiency in the body or the initial stage). Therefore, such patients undergo a general blood test, a blood test for sugar, a general urine test, determine the level of ferritin in the plasma (reflects the saturation of the body with iron), do electroneuromyography (shows the condition of the nerve conductors). This is not the whole list possible surveys, but only those that are carried out in almost every patient with similar complaints. The list of additional research methods is determined individually.

One of the research methods indirectly confirming the presence of restless legs syndrome is polysomnography. it computer research human sleep phases. In this case, a number of parameters are recorded: electrocardiograms, electromyograms, movements of the legs, chest and abdominal walls, video recording of sleep itself, and so on. During polysomnography, periodic movements in the limbs are recorded that accompany restless legs syndrome. Depending on their number, conditionally determine the severity of the syndrome:

• easy flow - up to 20 movements per hour;
• moderate - from 20 to 60 movements per hour;
• severe course - more than 60 movements per hour.

Treatment

Treatment for restless leg syndrome depends primarily on its type.

Secondary restless legs syndrome requires treatment of the underlying disease, since its elimination or reduction in manifestations contributes to the regression of the signs of restless legs syndrome. The elimination of iron deficiency, the normalization of blood glucose levels, the replenishment of the lack of vitamins, magnesium, and similar activities lead to a significant reduction in symptoms. The rest is completed by drug and non-drug treatments for restless leg syndrome itself.

Primary restless legs syndrome is treated symptomatically.

All measures of assistance in this disease are divided into non-drug and drug.

Non-drug methods:

• the abolition of drugs that can exacerbate symptoms (neuroleptics, antidepressants, antiemetics, and so on. The list of drugs was announced above). If possible, they should be replaced by other means;
• avoid caffeine (coffee, strong tea, coca-cola, energetic drinks, chocolate) and alcohol;
• to give up smoking;
• creation comfortable conditions for falling asleep. It implies going to bed at the same time, a comfortable bed, a kind of ritual of going to bed;
• walk before bed
• moderate physical activity during the day. Only non-exciting type: yoga, Pilates, swimming are suitable. But it is better to refrain from basketball, volleyball, Latin American dances and detailed classes;
• a warm foot bath or foot rub before bed
• warm shower;
• transcutaneous electrical stimulation;
• vibration massage;
• acupuncture;
• physiotherapeutic methods: magnetotherapy, darsonvalization, mud therapy.

In cases light flow disease, only these measures may be enough, and the disease will recede. If they do not help, and the disease causes a persistent disruption of sleep and life, then they resort to drugs.

Medical methods:

Feature of the drug treatment restless leg syndrome is that long-term (years) medication may be needed. Therefore, it is necessary to try to achieve the effect of treatment with a minimum dosage. Gradually, it is possible to develop some addiction to the drug, which requires an increase in the dose. Sometimes you have to change one drug for another. In any case, one should strive for monotherapy, that is, to relieve symptoms with a single drug. The combination should be resorted to in the very last case.

There are such cases of the disease when the patient needs to take medicines only during a significant increase in symptoms, and the rest is managed only by non-drug methods.

If restless legs syndrome leads to the development of depression, then it, in this case, is treated with selective monoamine oxidase inhibitors (Moclobemide, Befol and others) and Trazodone. Others may contribute to the worsening of restless leg syndrome.

Usually, the application of all measures in combination gives positive result. The disease manages to be muffled, and the person returns to the normal rhythm of life.

Treatment of pregnant women presents great difficulties, since most drugs are contraindicated in this condition. Therefore, they try to identify the cause (if possible) and eliminate it (for example, compensate for the lack of iron by taking it from the outside), and also get by with non-drug methods. In extreme cases, with a particularly severe course, Clonazepam is prescribed for a while or small doses of Levodopa.

Thus, restless legs syndrome is a fairly common disease, the symptoms of which are sometimes not given importance even by the doctors themselves. They may not be considered as a separate disease, but only as part of the standard complaints of patients with sleep disorders or depression. And the sick continue to suffer. But in vain. After all, restless legs syndrome is quite successfully treated, one has only to correctly recognize it.

Video version of the article

European clinic "Siena-Med", video on the topic "Treatment of restless leg syndrome. Clinic, diagnostics":

A fairly common occurrence, incomprehensible discomfort in the legs, which do not allow you to fall asleep or, conversely, wake up a person. Most people explain such sensations to themselves as banal fatigue, without going into details, but this ailment has a name - restless legs syndrome. However, first things first…

So, restless leg syndrome, what is it? This is a neurological disease that manifests itself at the time when the patient goes to bed. The main complaint of patients is that, supposedly, as soon as you go to bed, incomprehensible burning sensations and itching appear in your legs, all this causes discomfort and does not allow you to fall asleep. This is how this syndrome manifests itself.

The disease was first described in 1672 by Thomas Willis, after which the Swedish neurologist Ekb took up the study of this issue in the 1940s. That is why the disease occurs under the guise of Willis' disease and Ecomb's disease.

The disease is rare and occurs in 10-15% of the world's population. At risk are women who are about 1.5 times more likely than men to suffer from this disease. In addition, the disease is diagnosed in the elderly and middle-aged people.

The reasons

The causes of the formation of the disease are divided into two groups:

1. Of unknown origin (idiopathic).
2. Secondary (resulting from a concomitant disease or disorder).

The idiopathic nature of the development of restless leg syndrome is the most common. Furthermore, given type disease, compared with the secondary begins to develop much earlier. So, the patient begins to feel the first signs of the idiopathic form of the syndrome already at the age of 30.

There is evidence that indicates the relationship of the idiopathic form of the disease with a hereditary factor, however, it is impossible to assert that the disease has a 100% hereditary structure, since there is too little evidence.

As for the secondary type of the disease, in this case the disease begins to manifest itself in a more late age about 40-45 years old. The main reasons for the formation of a secondary type of disease are:

• diabetes;
• anemia;
• renal failure of a chronic nature;
• thyroid disease;
• chronic alcoholism;
• circulatory problems in the legs
• multiple sclerosis;
• spinal cord injury;
• tumor processes in the spine;
• radiculopathy;
• arthritis;
• amyloidosis;

Amyloidosis is a disease associated with disorders of protein metabolism in the body and is characterized by deposits of the amyloidoid substance.

• lack of vitamins in the body (B vitamins, folic acid, thiamine);
• uremia;
• excess weight;
• lack of dopamine in the body;

Dopamine is a hormone that is responsible for motor activity

• polyneuropathy.

AT special group pregnancy should be distinguished, since it is precisely given state the female body can cause Willis disease. In about 20% of cases, a pregnant girl may feel discomfort associated with her legs (more often in the 2nd and 3rd trimester of pregnancy). All symptoms disappear within 1–1.5 months after childbirth.

In addition, the intake of certain drugs, neurological focus and excessive consumption of foods and drinks with excess caffeine can serve as an impetus for the development of the disease.

Symptoms

The symptoms of Ecomb's syndrome can be divided into two groups:

1. Touch.
2. Psychosomatic.

To sensory symptoms refer directly to the manifestations of the disease, and to psychosomatic its consequences.

So, the main sensory symptoms are:

• itching in the legs;
• feeling of "goosebumps";
• burning in the legs;
• numbness;
• pressure on the legs;
• involuntary motor manifestations (twitching, flexion or extension);
• tingling (the condition resembles when the leg or arm was lying down).

All of the above symptoms do not have a pronounced pain effect, however, their intensity causes discomfort and leads to the gradual development of psychosomatic symptoms.

Psychosomatics of restless legs syndrome manifests itself in the form of development in humans depression, against the background of regular sleep deprivation. Perhaps aggravating the picture with frequent stress at work or in other places.

Restless legs syndrome manifests itself most clearly in the first half of the night. At the earliest stage, immediately after putting a person to sleep, after 15–30 minutes, he begins to feel attacks of this disease. The time interval from 12 am to 4 am is the most dangerous, in terms of the manifestation of the syndrome. From 4 a.m. to 10 a.m., the likelihood of the manifestation of the disease remains, but its intensity is much lower than in the first half of the night.

The discomfort caused by this disease does not allow a person to fully fall asleep, he is forced to knead his lower limbs, stretch them, change his sleeping position and even get up to “stretch” his legs.

The peculiarity of the disease lies in the fact that during exercises that relieve symptoms, the disease recedes, but as soon as the patient stops manipulating the legs, the sensations return.

Willis disease gradually begins to manifest itself not only in the supine position. There is evidence when the patient felt symptoms while walking.

Localization of unpleasant sensations is as follows:

1. About 50/% - lower leg.
2. About 30% are feet.
3. About 20% are thighs.

The most common place is the lower leg, less often the foot. There have been reports of symptoms of the syndrome on the hips, and even the torso with the arms.

Despite the age restrictions that have been described above, there is some evidence that this disease can also develop in children. In this situation, the symptoms of the disease in a child are no different from adults.

Diagnostics

Absence visible reasons syndrome formation, the basis diagnostic measures I am compiling a collection of data on the patient's condition as a result of a survey by a doctor. The study of the anamnesis allows the specialist to draw a conclusion about the presence or absence of this disease.

In addition, since the secondary type of the disease is associated with the presence of any disorders or abnormalities in the body, the patient's complaints about discomfort in the lower extremities are an indicator for diagnosing the body in order to detect such abnormalities. Such activities include:

• general blood analysis;
• analysis of blood sugar levels;
• Analysis of urine;
• analysis of the level of iron in the blood;
• electroneuromyography (ENMG);

Electroneuromyography - a study aimed at establishing the state of nerve conductors in the human body

• polysomnography (study of the patient's sleep);
• Ultrasound of the lower extremities.

One of the main tasks of a neurologist is not just to determine the presence of a problem, but also to be able to differentiate the disease from such ailments as anxiety disorder, akathisia, fibromyalgia, arthritis, vascular diseases etc.

Treatment

Treatment for restless leg syndrome depends on the nature of the condition.

It is possible to cure and completely get rid of this disease. Usually therapy is as follows:

1. Medical treatment.
2. Treatment with folk remedies.

Treatment of the primary syndrome

How to treat the idiopathic form of the disease? Usually when it's not bright expressed cause The basis of treatment is the elimination of symptoms and alleviation of the patient's condition.

• refusal to drink alcohol (maximum restriction of its intake) and smoking;
• compliance with sleep and wakefulness (going to bed and waking up should be done at about the same time);
• contrast baths for legs before going to bed, will be an excellent prevention of Ekobma's disease.

In addition, for the treatment of the idiopathic form of the disease, the doctor prescribes a drug - mirapex.

Mirapex is designed specifically for the treatment of restless legs syndrome, in addition, it can be used for other diseases, such as Parkinson's disease.

About application this medicine during pregnancy, it is not said, since studies on pregnant women have not been conducted.

Treatment of the secondary syndrome

What to do if the cause of the disease is any internal or external violations? First of all, it is necessary to eliminate the cause that causes this syndrome. This will require either a change in lifestyle, or the doctor will prescribe medications to support the body.

What pills can be prescribed:

• benzodiazepines - sleeping pills (cause dependence with long-term use);
• dopamine receptor agonists - designed to produce dopamine in the body;
• vitamin complex (depending on which vitamin is required by the body);
• opioids - with severe sleep disorders;
• anticonvulsants - a symptomatic medicine to eliminate convulsive manifestations;
• drugs to treat depression.

ethnoscience

Treatment of this disease is carried out not only by medical methods, but also by folk remedies. So, for treatment at home, the following recommendations apply:

How else can you help your body during exacerbations:

• regular walks before going to bed in the fresh air;
• you can use a pillow as a roller, which must be placed between the legs before going to bed;
• the preferred sleeping position is on the side;
• during an attack, you need to rub your legs well with your hands.

Some tips for replacing drug therapy

Sex

Regular release of endorphins will improve the patient's quality of life, relaxation after intercourse will reduce the intensity of discomfort from Ekobm's disease or completely eliminate them for a while.

Massage

The relaxing effect of massage has long been well known to everyone. It is desirable that this be a relaxing foot massage, since a strong intense load on the legs can play a negative role in the fight against the disease.

Regular stretching

Stretching, oddly enough, has a positive effect on the body and soothes restless legs, and doing it on a regular basis will help in the fight against the disease.

Forecast

The prognosis for this disease is quite favorable, with proper and proper treatment and compliance with all the recommendations voiced by the doctor, the symptoms completely disappear and no longer bother the person.

It is worth remembering that the drugs that are practiced in the treatment of Willis' disease can be addictive, so you need to periodically replace them with others.

So, restless legs syndrome is an unpleasant disease that reduces the quality of sleep. healthy person and causes depression. You should not run this ailment, but it is better to consult a specialist if its primary symptoms occur. Take care of your sleep and do not let any illness disturb it.

Subsequently, the Finnish doctor and scientist Karl Alex Ekbom again drew attention to this symptom complex in 1943. Ekbom, from the standpoint of modern medical science, developed criteria for diagnosing a disease, and shifted the focus from the motor component to the sensory (sensitive). Sensory disorders are the main symptom of the disease and, at the same time, the main complaint presented by patients. Ekbom grouped all observed forms of the disorder under the general term "restless legs", and subsequently added the term syndrome. In relation to this pathology - restless legs syndrome - the term syndrome is used to refer to a stable symptom complex, but is not a reflection of a specific and uniform pathogenesis of the disease. In modern medical practice Two terms are used - restless legs syndrome and Ekbom's syndrome.

Definition of Restless Leg Syndrome

Classification of restless leg syndrome
depending on origin

Characteristics of Primary Restless Leg Syndrome

Secondary Restless Leg Syndrome
common causes

• iron deficiency in the body.

Uremia (increased concentration of urea in the blood) mainly develops in patients with renal pathology. Therefore, 15 to 80% of patients with chronic renal failure undergoing hemodialysis also suffer from secondary restless leg syndrome.

Pathologies associated with the development of restless leg syndrome

• cryoglobulinemia;
• deficiency of vitamins B 12, B 9 (folic acid), B 6 (thiamine);
• magnesium deficiency;
• thyroid pathology;
• rheumatoid arthritis ;
• Sjögren's syndrome;
• obliterating endoarteritis;
• venous insufficiency of the lower extremities;
• diseases of the spinal cord (trauma, myelopathy, tumors, myelitis, multiple sclerosis);
• chorea of ​​Hettington;
• amyotrophic lateral sclerosis;
• post-poliomyelitis syndrome;

Some patients with restless legs syndrome have a hereditary predisposition to the development of this pathology, which manifests itself in the form of a disease due to exposure to adverse environmental factors, such as excessive coffee consumption, iron deficiency, or polyneuropathy. Therefore, in this situation, the difference between primary and secondary restless leg syndrome is rather arbitrary.

Obesity increases the risk of developing this symptom complex by almost 50%. The risk group primarily includes young people under the age of 20 who are obese.

Restless legs syndrome in neurological patients (chorea, parkinsonism, etc.) may be due to the coincidence of two pathologies, the effects of medication, or the presence of common links in the development of diseases.

Data from a general and special neurological examination usually do not reveal any disease in people with primary restless leg syndrome, and in people with a secondary one, somatic or neurological pathologies are almost always detected, most often polyneuropathy.

Restless legs syndrome pathogenesis

Primary Restless Leg Syndrome

Secondary Restless Leg Syndrome

Prevalence of Restless Leg Syndrome

As can be seen from the above data, restless legs syndrome is quite common, but it is practically not diagnosed. This state of affairs is connected with the fact that most practitioners do not know enough about this syndrome, and its individual symptoms are explained by neurological or psychological disorders, vascular disease or other pathologies. Therefore, in relation to the problems of diagnosing this disease, the magnificent statement of A.M. Wayne "To establish the diagnosis of any disease, it is necessary, at least, to know about its existence."

Restless Leg Syndrome Diagnosis

R. Allen and colleagues in 2003 developed four universal criteria for diagnosing restless leg syndrome. It is noteworthy that these criteria are essential, that is, necessary and sufficient for making a diagnosis.

So, here are the four diagnostic criteria:
1. An irresistible desire to move the legs or other parts of the body, which is caused by the presence of unpleasant sensations in the lower limbs.
2. Unpleasant sensations intensify or begin to manifest at rest.
3. With physical activity, discomfort decreases or disappears.
4. Unpleasant sensations intensify in the evening and at night.

These diagnostic criteria are simple and universal. If a person answers yes to all four questions, then most likely he suffers from restless legs syndrome. These questions can be addressed to the patient in a form convenient for him - orally or in writing.

Characterization of diagnostic criteria for restless leg syndrome

Irresistible desire to move the legs, which occurs in response to extremely unpleasant sensations in the lower extremities
The main characterological sign of restless legs syndrome is an unpleasant sensation in the legs, which is very difficult to fit into any framework. This feeling is difficult to explain to a doctor or just another person. The main descriptive sign of an unpleasant sensation is the desire to make certain movements. Instinctively, some people resist this urge by trying to change position, but in general, patients find that it is better and easier to move their legs to get rid of the unpleasant stress-like feeling. Pathological sensation develops in any part of the lower limb, but most often covers the shins and feet. In cases of severe disease, the hands, neck or torso may be involved in the pathological process. When there is such a strong severity of symptoms, a person cannot fall asleep in any way, taking a variety of postures, but without success. Consideration should be given to the fact that the patient considers the sleep disorder to be the cause. uncomfortable posture rather than constant motor acts.

The desire to move the limbs is often associated with other neurogenic symptoms, such as:

• "crawling" - the impression of something crawling under the skin or in the vessels;
• local temperature - a feeling of hot, rolling of burning waves;
• tingling, tingling, rubbing, punching - a feeling of bubbles under the skin or in the vessels, current discharges in the legs, itching, etc.

Increase or appearance of discomfort at rest
This means that the intensity of discomfort is directly proportional to the amount of time spent at rest. So than longer man does not move, the more unpleasant sensations appear in him, and the more irresistible the desire to move. Volitional suppression of this sensation, and the continuation of being at rest, as a rule, leads to an even greater progression of the symptom, and even to the appearance of pain. If you start moving, then on the contrary, the symptoms are greatly relieved or disappear altogether.

A long sitting position in such people leads to an irresistible desire to walk around, stretch their legs. Therefore, in the behavior of patients with restless legs syndrome, avoidance of prolonged sitting is often found - they instinctively stand in public transport if there are free places, they try not to go to theaters, cinemas, not to drive a car or fly on an airplane. If a person with this pathology drives for a long time, then he is forced to periodically stop, get out of the car and make movements (walk, jump, etc.) in order to eliminate discomfort.

Reduction or disappearance of painful symptoms during movement
The symptom has a pronounced temporal aspect. That is, unpleasant sensations recede immediately after the start of movement. Jumping, walking, shifting from foot to foot, stretching a limb - any motor action reduces the intensity of unpleasant sensations. The improvement effect continues as long as the person is moving. However, no continuation normal state after the end of the movement does not occur. That is, this symptom can be described by the following formula: there is movement - there are no unpleasant sensations, stop movements - the return of unpleasant sensations. That's why this sign is very specific, and helps to distinguish restless legs syndrome from other pathologies associated with the presence of discomfort in the lower extremities.

Increased discomfort at night or in the evening

People with restless leg syndrome have a distinct circadian rhythm of symptom intensity. That is, the maximum severity of discomfort occurs in the evening and at night with a peak between 00.00 and 04.00 hours, and relief is observed in the morning - from 06.00 to 10.00. A similar circadian rhythm corresponds to the daily fluctuations in human body temperature. This means that the highest daily body temperature corresponds to the period of relief of symptoms, and the lowest - on the contrary, the maximum severity of discomfort. If the pathology is running, then the person constantly feels symptoms of the same intensity, not related to the time of day. However, the main time when people are especially tormented is the time of falling asleep, since two factors are combined here - evening and a relaxed state of rest. 15-30 minutes after a person goes to bed, discomfort in the legs begins to bother him.

Periodic leg movements during sleep

Severity of Restless Leg Syndrome

Sleep disturbances in people with restless leg syndrome

PDNS are the cause of changes in the structure of sleep, imbalance of its phases and constant awakenings. After waking up, a person, as a rule, can no longer fall asleep. To improve their well-being and reduce the intensity of symptoms, patients begin to walk around the apartment. Such forced night "walks" are called night walker symptom . By 4.00 in the morning, the severity of discomfort decreases, and the person falls asleep for a short period of time. Naturally, after such an inadequate night's rest, people wake up with difficulty, and all day they feel tired, inattentive, forgetful, etc.

Differences between restless legs syndrome and other diseases
with similar symptoms

Treatment Principles for Secondary Restless Leg Syndrome

If a we are talking about secondary restless legs syndrome, then the underlying disease should be identified and adequate therapy should be started for the latter. It is recommended, first of all, to investigate the concentrations of vitamins and microelements - iron, folic acid and magnesium, and in case of a deficiency, to correct the deficiency state. Restless legs syndrome is often associated with iron deficiency . In this case, treatment with iron preparations in the form of tablets or intravenous and intramuscular injections is carried out under the control of the level of ferritin in the blood serum. Treatment with iron preparations should be continued until a ferritin concentration of 50 μg / l is reached.

The use of the following medications leads to an increase in the symptoms of restless legs syndrome:

• neuroleptics;
• lithium preparations;
• adrenomimetics;
• calcium antagonists;
• blockers.

Treatment Principles for Primary Restless Leg Syndrome

Non-drug methods include moderate physical activity during the day, the correct sequence of actions when falling asleep, and a walk in the evenings. It will also help relieve the intensity of the symptoms of a shower before bedtime and proper nutrition. Proper nutrition Restless legs syndrome patient means avoiding caffeine in any products (coffee, chocolate, Coca-Cola, etc.) and limiting alcoholic beverages. It is recommended to stop smoking and observe the daily routine. Effectively helps to deal with painful symptoms hot tub foot massage or foot massage. You can also use physiotherapy - transcutaneous electrical stimulation, vibration massage, darsonvalization of the legs, reflexology and magnetotherapy.

The use of drugs for the treatment of restless legs syndrome is resorted to only in case of ineffectiveness of non-drug methods and a serious deterioration in the quality of life. The following groups of drugs are used: benzodiazepines, dopaminergics, anticonvulsants and opiates. All of these drugs act on the central nervous system therefore, treatment should be carried out only under the supervision of a physician.

So, we examined the main manifestations, diagnosis, differences from other diseases and the principles of treatment of such a fairly common ailment as restless legs syndrome. Without a doubt, the effectiveness of treatment is due, first of all, to the most accurate diagnosis of pathology. Unfortunately, today no more than 30% of cases of this symptom complex are correctly diagnosed. Therefore, if you notice any signs of the disease, consult a doctor and describe all your feelings in as much detail as possible. At the same time, focus on the main signs of restless leg syndrome, because when early detection pathology, it is possible to begin adequate treatment, which will lead to a stable remission.

Restless legs syndrome (RLS) - sensorimotor neurological disorder, manifested by increased motor activity of the lower extremities, mainly at rest. Usually, characteristic symptoms have a pronounced circadian rhythm with onset or intensification in the evening and at night. The most frequent complaints of patients are disturbance and deterioration of sleep quality, affective and anxiety disorders, deterioration in the quality of life associated with a state of health and a decrease in working capacity. This disease is common among all age groups, but the number of patients increases with age. So, in old age, 9-20% of people suffer from it. At least one third of cases of RLS first occur in their 20s and 30s. In women, this disease occurs 1.5 times more often than in men, and this disproportion increases due to the fact that women are more likely to apply for medical care. It can sometimes be difficult for clinicians to diagnose RLS, or to determine the extent and severity of the disorder, and to assess the benefits and drawbacks of treatment. It should be noted that for general practitioners, these problems are more acute than for narrow specialists.

According to statistics, restless legs syndrome affects 5-10% of the adult population of the Earth. At the same time, a third of those suffering from the disease are worried about 1 time per week, and two-thirds - from two times or more. Most often, this disease is found in adults in middle and old age, and women suffer from restless legs syndrome 1.5 times more often than men.

Restless legs syndrome, depending on the cause, can be primary or secondary. However, the exact cause of the development of primary RLS has not yet been clarified, but it is assumed that it lies in wrong work some brain structures. Primary RLS occurs in close relatives. It usually appears in the first 30 years of life and is thought to be associated with defects in chromosomes 9, 12, and 14.

Secondary RLS occurs during pregnancy (more often in the second or third trimesters), with iron deficiency in the body and with terminal renal failure. There are also cases of the development of restless legs syndrome in diabetes mellitus, amyloidosis, rheumatoid arthritis, thyroid diseases, alcoholism, radiculopathy, multiple sclerosis, as well as insufficiency of vitamin B12, thiamine, folic acid, magnesium. In this case, most often the disease develops after 45 years. Also, sometimes restless legs syndrome develops in those suffering from Parkinson's disease, Huntington's chorea, Tourette's syndrome.

Unpleasant sensations in the legs can be various diseases. But if they occur at rest, disappear with movement, intensify in the evening or at night, without appearing during the day, accompanied by leg movements and problems with sleep, be sure to contact a neurologist with suspicion of Eckbott's syndrome.

Who is affected by the syndrome?

And although this disease is often confused with other diseases, for example, varicose veins of the legs, nevertheless, groups of people who fall into the so-called risk group have been identified. Often, restless leg syndrome makes itself felt in parallel with the development of other diseases, for example, kidney failure or diabetes.

People with a lack of iron and folic acid in the blood also suffer. Symptoms of such anxiety often occur in pregnant women in the II and III semesters of the term, but after childbirth, most often, all discomfort quickly disappears.

Also, people with obesity are more susceptible to the syndrome, especially at a young age.

Oddly enough, the desire to constantly go somewhere, most often, does not arise among those who are in real life moves a lot, but, on the contrary, those who lead sedentary image life.

However, in most cases, the disease is not at all associated with any additional diseases; in such cases, patients develop serious metabolic disorders. Unfortunately, what is the reason for such failures - doctors are still not able to answer this question.

Causes and consequences of RLS

Not so long ago, doctors called the cause of restless leg syndrome disorders in the work of nerve endings and blood vessels. But recent studies have shown that the disease is a mental disorder. It is all to blame for the failure of chemical processes in the parts of the brain responsible for the motor processes of the limbs. This made it possible to single out Ekbom's syndrome as a separate section of diseases.

Observations of patients suffering from symptoms of the disease showed that it mainly begins as a concomitant to more serious problems organism.

In addition to brain disorders, it can accompany a lack of vitamins and minerals, and it can also be caused by:

• Anemia due to lack of iron, indicated by low hemoglobin levels
• Damage to nerve endings in the background diabetes(neuropathy)
• Deficiency of B vitamins, magnesium and calcium
• Taking or avoiding sedatives, vasodilators, and antidepressants
• kidney disease
• Spinal nerve injury
• Arthritis of various etiologies
• Lyme disease
• Parkinson's disease
• Smoking, alcohol and caffeine abuse
• Stress and nervous disorders
• hereditary predisposition
• Pregnancy

The disease develops very slowly. On the early stages it may not cause much concern. Timely diagnosis and treatment cope with it easily. But the apparent frivolity of the symptoms is misleading for most restless leg syndrome sufferers. People don't go to medical institutions until it leads to severe sleep disturbance and stress, and sometimes to mental disorders which are not easy to get rid of.

Restless legs syndrome symptoms

The main symptoms of restless legs syndrome are sensory disturbances, which are expressed in paresthesias and movement disorders.

Violations affect both legs, and the movements of the limbs are most often asymmetrical.

Sensory disturbances occur when a person is sitting or lying down. The maximum strength of the symptoms is gaining in the period from 12 to 4 o'clock in the morning. To a lesser extent, symptoms appear between 6 and 10 am.

Complaints that patients may present:

• Feeling of tingling in the legs.
• Feeling of numbness in the lower extremities.
• Feeling of pressure on the legs.
• Skin itching of the lower extremities.
• Feeling of goosebumps running down the legs.

These symptoms are not accompanied severe pain, but they are very annoying to a person and cause him serious physical discomfort. Some patients report dull, aching pain or mild but sharp pain.

Unpleasant sensations are localized mainly in the lower leg, less often affect the feet. As the pathology progresses, the hips, arms, perineal region and even the torso are involved in the process.

On the early stages development of RLS, a person begins to experience discomfort 15-30 minutes after he went to bed. In the future, discomfort begins to disturb almost immediately after the cessation of physical activity, and then during the daytime, when the legs are at rest. It is very difficult for such people to drive a car, travel by air, visit the theater and cinema, etc.

In general, a clear symptom of restless leg syndrome is that the person only feels uncomfortable when they are not moving. To eliminate discomfort, he is forced to move them: shake, wiggle, bend and unbend. Sometimes patients get up and stomp on the spot, massage their feet, walk around the room at night. However, after they go to bed, the discomfort returns. When a person suffers from RLS for a long time, he determines for himself a specific ritual of movements that bring him maximum relief.

At night, people experience excessive motor activity of the legs. The movements are stereotyped and constantly repeated. A person bends either the big toe or all the toes, can move the foot. In severe cases of the syndrome, people bend their legs at the hip and knee joints. Each episode of physical activity does not take more than 5 seconds. This is followed by a 30 second break. Such episodes are repeated for several minutes or several hours.

If the pathology has a mild course, then the person himself may not even be aware of such a violation. It can only be diagnosed during polysomnography. When RLS is severe, the patient wakes up several times a night and cannot fall asleep for a long time.

Such pathological behavior during sleep cannot go unnoticed. In the daytime, a person feels tired and weak. His mental functions worsen, attention suffers, which affects his working capacity. Therefore, restless legs syndrome can be attributed to risk factors for the development of depression, neurasthenia, increased irritability and mental instability.

As a rule, with primary restless leg syndrome, pathological symptoms persist throughout life, but their intensity varies. Stronger than a man the disease begins to disturb during an emotional shock, after the consumption of drinks containing caffeine, after playing sports.

The vast majority of people indicate that the pathological symptoms, although slowly, still progress. Sometimes there are periods of calm, which are replaced by periods of exacerbation. Long-term remissions, which stretch over several years, occur in about 15% of patients.

If a person has secondary restless legs syndrome, then its course is determined by the underlying pathology. However, remissions are rare.

Diagnostics

During polysomnography, periodic movements in the limbs are recorded.

It is precisely because the main signs of restless legs syndrome are associated with subjective sensations that are presented to patients in the form of complaints that the diagnosis of this disease is based solely on clinical signs.

Additional research methods in this case are carried out in order to find a possible cause of the disease. Indeed, some pathological conditions can proceed unnoticed by the patient, manifesting only restless legs syndrome (for example, iron deficiency in the body or the initial stage of a spinal cord tumor). Therefore, such patients undergo a general blood test, a blood test for sugar, a general urine test, determine the level of ferritin in the plasma (reflects the saturation of the body with iron), do electroneuromyography (shows the condition of the nerve conductors). This is not the whole list of possible examinations, but only those that are carried out for almost every patient with similar complaints. The list of additional research methods is determined individually.

One of the research methods indirectly confirming the presence of restless legs syndrome is polysomnography. This is a computer study of the phase of human sleep. In this case, a number of parameters are recorded: electrocardiograms, electromyograms, movements of the legs, chest and abdominal walls, video recording of sleep itself, and so on. During polysomnography, periodic movements in the limbs are recorded that accompany restless legs syndrome. Depending on their number, conditionally determine the severity of the syndrome:

• easy flow - up to 20 movements per hour;
• moderate - from 20 to 60 movements per hour;
• severe course - more than 60 movements per hour.

Restless legs syndrome: complex therapy

To alleviate the patient's condition, it is necessary to use the following treatment:

1. Sleeping pills (with the addition of tranquilizers). If the case of the disease is mild, then it is quite possible to achieve a visible effect if the doctor prescribes Clonazepam, Temazepam, Triozalam, Zolpidem, but only in small quantities (the lowest indicator). The only downside to these drugs is that they are addictive.
2. Dopamine. Drugs that give dopaminergic effects allow you to get almost instant results. The most effective drug is Sinemet, the effect of it is almost instantaneous, moreover, even when using the minimum dose. Relief comes in half an hour and lasts more than three hours. If the symptoms of the disease do not appear regularly, then it is necessary to take it from time to time - when necessary. In the event that the pill was taken, and the symptoms returned at night, another dose is allowed - right in the middle of the night. You can also take Sinemet as a preventive measure, for example, if you need to be without active movement for a long time: driving a car or flying in an airplane. Unfortunately, this drug has side effects - the "amplification effect" - over time, the symptoms will become more and more pronounced, and the body, getting used to the medicine, will stop responding to it. At the same time, as a complication, the symptoms will intensify in the daytime or morning time. To avoid this, it is necessary to take Sinemet in small doses, as recommended by the doctor and not to increase the amount of the drug individually. Sometimes this medicine can cause complications such as upset stomach, nausea and vomiting, and severe headache. If suddenly addiction to Sinamet has occurred, it is necessary to switch to another dopaminergic drug. Permax (Pergolid) has proven itself well. Some experts note that it is even more effective than Sinamet, besides, this drug does not have such side effects like the first drug. Of course, Permax is not harmless, it causes constipation, runny nose, hypotension, and in very rare cases - hallucinations. But there is no "addictive effect". With RLS, Parlodel (Bromocriptine) has proven itself well. There are positive aspects when restless legs syndrome is treated with Mirapex, but the effectiveness of the drug has not yet been fully studied.
3. Anticonvulsants. Another aspect of complex treatment, which cannot be dispensed with. In the treatment of RLS, Gabpentin and Carbamazepine (as part of Nerontin and Tagretol) have shown their effectiveness. It is strictly necessary to follow the dosage prescribed by the doctor.
4. Opiates. If Willis disease is heavy character, that is, all the grounds for prescribing opiates. Basically, these are Codeine, Propoxyphene, Oxycodone, Pentazocine or Methadone - in various dosages. Of the side effects of these drugs: nausea, dizziness, impaired consciousness. It is strictly necessary to adhere to the dose prescribed by the doctor, then there is a chance for many years to be saved by a small amount of opiates without an acute dependence on them. If you do not follow the dosage, then you can make yourself even worse, since opium addiction will also be added to the RLS.
5. other medicines. It also happens that doctors prescribe drugs containing beta-blockers - these are non-narcotic analgesics, which are similar in composition to antidepressants. But, often drugs that belong to this category of drugs increase the symptoms of the disease, so they are not suitable for treatment for all patients. These medicines are prescribed only when other medicines do not help at all.

It is very important to understand that if you have restless legs syndrome, then you are sick, and the disease must be treated. You should not let everything take its course and hope for "maybe". Only the timely assistance of highly qualified specialists can, if not cure, then significantly weaken the attacks.

Restless legs syndrome: treatment at home

Non-drug treatment can also bring noticeable relief. It is necessary to strictly follow the rules recommended by doctors:

1. Physical activity on the legs, especially before bedtime. But this does not mean at all that it is necessary to sit in the gym for days or do weightlifting, since the loads should be moderate. Yoga or Pilates, as well as regular stretching exercises, are great. It is worth noting that even the patients themselves claimed that the physical activity that was given to the legs at the beginning of the disease stopped the symptoms, and the disease simply receded. But if you let everything take its course, then soon the restless legs syndrome will develop, and the loads will not bring relief, but new pain and symptoms.
2. Arbitrary massage and rubbing of the legs.
3. Contrast foot baths: alternation of cold and hot water.
4. Mental training: concentration of attention will not only train the brain, but also help to cope with neuropsychiatric stress. Start painting, weaving bead figurines, debating or playing video strategy games.
5. Physiotherapy procedures do not benefit everyone, but sometimes it is magnetotherapy, mud, paraffin and lymphopress that work wonders. All this is purely individual.
6. Refusal of coffee, tea and chocolate, as well as any caffeinated products.
7. Compliance with the daily routine: you need to go to bed at the same time. It is better to fall asleep and wake up late, then during the day you will not want to fall asleep. Make your sleeping conditions as comfortable as possible.
8. Do not use drugs that cause RLS.

Additional techniques

As an addition to drug therapy and the right lifestyle in the treatment of Ekbom's syndrome, physiotherapy procedures are used, which include:

• Vibromassage.
• Magnetotherapy is the use of magnetic fields that have anti-inflammatory, analgesic and anti-edematous effects.
• Mud applications - a method using therapeutic mud. When it is used, blood circulation improves, the movement of red blood cells improves, and metabolism is normalized.
• Limfopress - creating pressure on lymphatic system in order to normalize metabolic processes in the body and increase the tone of the veins of the lower extremities.
• Reflexology is a method in which special needles are inserted into specific points on the body.
• Darsonvalization of the legs - with the help of special device impact on certain part bodies with high-frequency fast-damping current.

Prevention

• Rejection bad habits(smoking, alcohol).
• Compliance healthy lifestyle life:
  • regular walks in the fresh air;
  • physical education;
  • observance of the regime of day and night ( night sleep at least 8 hours).
• Balanced and balanced diet: eating food with high content fiber (vegetables, fruits, greens), the rejection of canned, fried, spicy, hot foods.
• Timely contacting a doctor in case of health problems.
• Control of arterial (blood) pressure.
• Resolving conflicts at home and at work.
• Refusal or restriction of the use of coffee, strong tea.
• Refusal to drink caffeinated drinks (Coca-Cola).
• Limiting the use of chocolate, cheese, red fish (the tyramine contained in it increases the manifestations of restless leg syndrome).

More often the syndrome occurs in people over 40 years old, but young people also get sick. The disease is more common in women than in men. It is explained by the fact that in men the nervous system is considered to be stronger. The causes of the onset of the disease vary.

What it is?

Restless legs syndrome (RLS) is a condition characterized by unpleasant sensations in the lower extremities that appear at rest (more often in the evening and at night), force the patient to make movements that facilitate them and often lead to sleep disturbance.

Current population studies show that the prevalence of RLS is 2-10%. RLS occurs in all age groups, but is more common in middle and old age. RLS is the cause of approximately 15% of cases of chronic insomnia - insomnia.

Causes

The primary syndrome is little studied, young people under 30 are sick. Not associated with major diseases, it accounts for up to 50%. It accompanies a person all his life, alternating periods of progression and remission. It occurs suddenly, the reasons are not clarified, it can be:

• heredity in 20-70% of cases;
• disturbances in the work of the central nervous system;
• psychological circumstances (stress, depression, fatigue).

Secondary syndrome - manifests itself against the background of the main (neurological or somatic) disease, disappears after their elimination. Frequently occurring:

• disruption in the blood supply;
• kidney disease,;
• beriberi (group B) and lack of magnesium;
• diabetes mellitus, thyroid disease;
• abuse of alcohol, tobacco, caffeine;
• treatment with certain drugs.

The secondary syndrome occurs after 40 years or later. The exception is pregnancy. More than 16% of pregnant women suffer from this disease, 3 times more than non-pregnant women. There is a possibility of genetic transmission of RLS from mother to fetus, which poses a threat to the bearing of the baby.

Pathogenesis

The effectiveness of dopaminergic drugs and the possibility of worsening symptoms under the influence of antipsychotics indicate that a key link in the pathogenesis of RLS is the defectiveness of dopaminergic systems. clear circadian rhythm clinical manifestations of RLS may reflect the involvement of the structures of the hypothalamus, in particular the suprachiasmatic nucleus, which regulates the daily cycles of physiological processes in the body.

It is possible that in some patients with RLS, polyneuropathy, iron deficiency, coffee abuse, or other factors only reveal an existing hereditary predisposition, which partly blurs the line between idiopathic and symptomatic variants of RLS.

RLS symptoms

A symptom is characterized in the form of unpleasant sensations of a stabbing, scraping, itching, pressing or bursting character in the lower extremities. The manifestation of symptoms mainly occurs at rest, with physical activity they are significantly reduced.

To alleviate the condition, patients resort to various manipulations - stretching and bending, massaging, shaking and rubbing the limbs, during sleep they often toss and turn, get out of bed and walk from side to side, or shift from foot to foot. Such activities help to stop the symptoms of restless legs syndrome, but as soon as the patient goes to bed again, or simply stops, they come back. A characteristic feature of the syndrome is the manifestation of symptoms at the same time, on average, it reaches its maximum severity in the period from 12 am to 4 am, the minimum falls on the time from 6 to 10 am.

In advanced cases, with prolonged lack of treatment, the circadian rhythm of restless legs syndrome disappears, symptoms appear at any time, even while sitting. This situation greatly complicates the life of the patient - it is difficult for him to withstand long trips in transport, work at a computer, visit cinema, theaters, etc.

Due to the need to constantly move during sleep, over time, the patient develops insomnia, which leads to fatigue and daytime sleepiness.

Diagnostics

Basic diagnostic methods:

1. Blood test for iron, magnesium and folic acid. It helps to determine the deficiency of the listed elements, which can be provocative factors of pathology.
2. Electroneuromyography is a method of studying nerves and muscles using special equipment. In this case, sensitive sensors are connected to different areas body and diagnose the degree of electrical excitability of a particular muscle group.
3. Polysmonography is an integrated approach that allows diagnosing motor activity during sleep. Special sensors register awakenings and muscle activity. Unlike electroneuromyography, a person is in a sleeping state.

How to Treat Restless Leg Syndrome?

A certain algorithm for the treatment of restless legs syndrome has been developed, which includes a number of procedures. This includes:

• help of a psychotherapist;
• folk remedies and homeopathy;
• drug therapy;
• physiotherapy and physiotherapy exercises;
• self-help, bedtime ceremony.

Once a diagnosis has been made, you can start complex treatment Ekbom's disease.

Medical treatment

In cases of a mild course of the disease, only these measures may be enough, and the disease will recede. If they do not help, and the disease causes a persistent disruption of sleep and life, then they resort to drugs.

Drugs used in the disease:

1. Dopaminergic drugs (drugs containing L-DOPA - Nakom, Madopar, Sinemet; dopamine receptor agonists - Pramipexole Pronoran, Bromocriptine). These are first-line drugs of choice, they begin treatment. For drugs containing L-DOPA, the initial dosage is 50 mg of levodopa 1-2 hours before bedtime. If this is not enough, then after about a week the dose is increased by another 50 mg. The maximum dose is 200 mg. Dopamine receptor agonists have an effect comparable in effect to L-DOPA preparations. Pramipexole is prescribed starting from 0.125 mg, the dosage can be increased to 1 mg, Bromocriptine - from 1.25 mg (up to 7.5 mg), Pronoran - from 50 mg (up to 150 mg). If one dopamine receptor agonist is ineffective, it is advisable to replace it with another.
2. Benzodiazepines. Among this chemical group, Clonazepam (starting at 0.5 mg at night and up to 2 mg) and Alprazolam (from 0.25 mg to 0.5 mg at night) are more commonly used. Benzodiazepines affect sleep more than discomfort and periodic movement in the legs, so they are considered "reserve" drugs for the treatment of restless leg syndrome.
3. Anticonvulsants (Gabapentin, Neurontin, Carbamazepine) and opioids (Tramadol, Codeine, Dihydrocodeine, Oxycodone). To these medicines resorted to as a last resort, only if dopaminergic and benzodiazepine drugs were ineffective or gave severe side effects. Gabapentin is prescribed in increasing dosages, starting with 300 mg and reaching a maximum dose of 2700 mg (stop at the dose that works). The entire dose is taken at night in one dose. Tramadol is taken at 50-400 mg at night, Codeine - 15-60 mg each, Dihydrocodeine - 60-120 mg each, Oxycodone - 2.5-20 mg each. These narcotic drugs are used only in particularly severe cases of restless legs syndrome, as they can be addictive.

Willis disease is insidious in that patients often require long-term medication, so the doctor tries to select the minimum dosage of drugs to relieve symptoms and have a gentle toxic effect on the body.

It is especially difficult to treat pregnant women. In such cases, the specialist tries to identify and eliminate the cause of the disease. In most cases, the fault is the lack of trace elements, especially iron. This condition is normalized after the course iron-containing preparations. If more serious disorders are found in the body, doctors advise to eliminate the symptoms of restless legs syndrome in pregnant women by non-drug methods, and small doses of drugs (usually Clonazepam or Levodopa) are prescribed for a short time and only in extreme cases.

Additional techniques

As an addition to drug therapy and proper lifestyle in the treatment of Ekbom's syndrome, physiotherapy procedures are used, which include:

1. Vibromassage.
2. Reflexology is a method in which special needles are inserted into specific points on the body.
3. Magnetotherapy is the use of magnetic fields that have anti-inflammatory, analgesic and anti-edematous effects.
4. Darsonvalization of the legs - with the help of a special device, a certain part of the body is exposed to a high-frequency rapidly decaying current.
5. Lymphopress - creating pressure on the lymphatic system in order to normalize metabolic processes in the body and increase the tone of the veins of the lower extremities.
6. Mud applications - a method using therapeutic mud. When it is used, blood circulation improves, the movement of red blood cells improves, and metabolism is normalized.

Folk remedies in the fight against RLS

To alleviate the condition of restless legs, a lot of tips are described. traditional medicine that can be used together with complex treatment:

1. Laurel oil. Add to 100 ml of olive oil 30 g bay leaf and let the liquid brew in a dark place for about 2 weeks. With the resulting tincture, you should do a foot massage every night before going to bed.
2. Relaxing tea. Such a drink will help improve sleep, soothe and relax the muscles. You will need a mixture of valerian roots, herb oregano and mint. Additionally, you need to rinse 10 rose hips. You can use both dried and fresh versions. Next, you need to place rose hips and 1 tsp in the kettle. mixtures of herbs. Then pour all 400 ml of boiling water and let stand for at least 40 minutes. You need to take this tea 2 hours before bedtime for a month, 1 glass.
3. Fuck tincture. Pour the crushed roots and leaves of horseradish with alcohol or vodka and keep for 4-5 days in a dark place. Rub your feet regularly with this remedy.
4. Healing bath. It is necessary to prepare a decoction of wormwood, rosemary and linden. All herbs need to be mixed and 3 tbsp. l. pour 1 liter of boiling water. Boil for 15 minutes. Then sue, filter and add the liquid to the foot bath. For 3 liters of water, 1 liter of decoction is needed. The temperature must be at least 38 degrees. The exposure time is 15 minutes. Such baths should be done every other day for a month.
5. Golden mustache tincture. rub pharmacy tincture lower limbs at bedtime.
6. Infusion of hawthorn. Brew 1 tbsp. l. hawthorn berries with a glass of boiling water and drink a drink shortly before bedtime. This will calm the nervous system and help relieve discomfort in the legs.

Do not self-medicate, especially if you are not sure of your diagnosis! See a doctor who can confirm or refute your suspicions of restless legs syndrome, as well as recommend how to cope with the pain.

Treatment at home

At home, you can completely follow all the measures that will reduce the symptoms of the disease to a minimum.

1. It is necessary to form your own sleep schedule - fall asleep and wake up at the same time. If the patient suffers from neuropsychiatric disorders, then the doctor definitely advises to train the mind.
2. Physical exercises. Moderate physical activity has a positive effect on the condition of the legs. During the day and before going to bed, it is useful to do exercise therapy, to perform hiking, doing Pilates, swimming, yoga or stretching. But too active sports can provoke an increase in symptoms, so running, jumping, football and volleyball are contraindicated in people suffering from Willis disease.
3. Contrasting pours. Take contrast foot baths, alternating cold and hot water.
4. Hobbies. At home you can find something to do: drawing, knitting, reading. Concentration helps relieve stress.
5. Regular foot massage. Rubbing the lower extremities before going to bed can reduce discomfort and make it easier to fall asleep.

You can take a cream or resort to folk remedies that we indicated earlier. Be sure to avoid caffeinated products. Eat iron-rich foods, sleep in cotton socks. Some sources talk about the benefits of wearing sheepskin socks. You shouldn't eat at night. Having received a boost of energy, it will be more difficult for the body to fall asleep.

Prevention

Does not exist consensus patients on how to get rid of unpleasant attacks in the legs at night. Each patient has his own methods and means. It can only be noted that in order to reduce night attacks it is useful to carry out preventive measures:

1. Cancel late dinner, do not go to bed on a full stomach;
2. Yoga or Pilates classes;
3. Swimming;
4. In the autumn and spring, taking vitamins;
5. Often change your working position, take breaks with small gymnastic exercises;
6. Walk outside before bed
7. Wear only cotton clothing, no synthetic materials. Feet should always be warm.

In general, specific prevention of restless leg syndrome hereditary form does not exist. The main prevention measures are aimed at treatment primary diseases, which over time can lead to the development of polyneuropathy and disruption of the dopaminergic system.