100 Questions & Answers About Restless Legs Syndrome

Title......Page 2
Copyright......Page 3
Contents......Page 4
Preface and Acknowledgment......Page 6
Part One: The Basics......Page 8
1. What is restless legs syndrome?......Page 9
2. How common is RLS?......Page 10
3. Is RLS a disease of the contemporary time or was it known in earlier times?......Page 12
4. How do physicians diagnose RLS?......Page 14
5. What causes RLS?......Page 19
Part Two: Risk, Prevention, and Epidemiology of Restless Legs Syndrome......Page 22
6. I am a 65-year-old woman. For the past two years, I have been having restless feelings in my legs when lying down in bed at night. My friend says I may have RLS. Is my friend correct?......Page 23
7. My mother has RLS. I am a 35-year-old woman. Could I get RLS from my mother?......Page 24
8. I am a 50-year-old man with diabetic neuropathy (nerve damage). Sometimes I get uncomfortable feelings in my legs and an urge to move while I’m resting. Are these symptoms due to nerve damage as a result of diabetes or do I have another condition?......Page 25
9. I am 7 months pregnant. Recently I noticed that I get strange feelings in my legs with an urge to move my legs in the evening while resting in bed. A friend who has RLS tells me that I may be developing symptoms of RLS. Is my friend correct?......Page 26
10. If I am diagnosed with RLS during pregnancy, what are my chances of having this condition permanently?......Page 27
11. I have chronic kidney problems. I have started experiencing symptoms of restlessness in the legs in the evening while I am lying in bed trying to get to sleep. Am I developing symptoms of RLS? How common is RLS in kidney failure?......Page 28
12. I am a 60-year-old man with Parkinson’s disease on levodopa treatment. Recently, I noticed an urge to move my legs while I am in bed trying to get to sleep. Am I developing RLS symptoms? How common is RLS in patients with Parkinson’s disease?......Page 29
14. I suffer from rheumatoid arthritis. I experience pain and indescribable uncomfortable feelings in my legs in the evening while resting. A friend told me that I may have RLS. Is this true? How common is RLS in patients with rheumatoid arthritis?......Page 30
15. I am a 59-year-old man who has been experiencing restlessness of the whole body throughout the day. I cannot sit still; I keep moving all the time. I have been taking a neuroleptic medication for a “nervous breakdown.” My friend looked up my symptoms on the Internet and told me that I have RLS. Is this true?......Page 31
16. I have RLS that is moderately controlled on medication (see Question 71). Will I have RLS all my life or does the medication cure the disease?......Page 33
18. My 6-year-old child is always fidgety and restless. Does he have attention-deficit/hyperactivity disorder or can he have RLS?......Page 34
19. How do physicians diagnose RLS in children who may not be able to describe their symptoms adequately?......Page 35
20. My father, who is 69 years old, has been diagnosed with Alzheimer’s disease. Recently, I have noticed that in the evening when lying in bed, he moves his legs and tries to get up and walk. Are these symptoms due to the nighttime agitation commonly seen in Alzheimer’s disease or is he developing another movement disorder?......Page 37
Part Three: Symptoms and Diagnosis of Restless Legs Syndrome......Page 38
21. How do physicians diagnose RLS in elderly or cognitively impaired (demented) patients who may not be able to provide an adequate history?......Page 39
23. Why do RLS symptoms get worse in the evening?......Page 40
24. I am a 38-year-old woman with iron-deficiency anemia. I have noticed recently that I am getting an urge to move my legs, preceded by creepy-crawly feelings in the evenings while I am trying to get to sleep. Could these symptoms be due to iron deficiency or am I developing RLS symptoms?......Page 42
26. Is RLS a neurological disorder, a movement disorder, a sleep disorder, or a systemic disease?......Page 43
27. Because of my RLS symptoms (which are frequent, occurring almost every night), I have severe difficulty falling asleep and staying asleep—so I do not get an adequate amount of quality sleep. Will this sleep deficit be harmful in the long term?......Page 44
28. Is there a laboratory test to measure leg movements and assess the severity of these movements?......Page 45
29. I have been diagnosed with RLS based on my symptoms and pattern of progression. Which blood tests are important for me?......Page 47
31. What is a PSG test?......Page 48
32. How do physicians determine the severity of RLS?......Page 51
33. I am a 55-year-old man. On average, on three out of every seven nights, I experience severe leg cramps in the middle of the night that disturb my sleep. I toss and turn, and I rub my legs to get relief. What can I do? What causes the cramps?......Page 53
34. My bed partner tells me that I toss and turn in bed and sometimes keep moving my legs with a regular rhythm, kicking my partner. Is this RLS?......Page 55
35. I am a 65-year-old woman who has had RLS symptoms for many years. Recently, I have become very depressed. Can RLS cause depression?......Page 57
36. I have been told that some RLS symptoms (e.g., insomnia, excessive daytime sleepiness, lack of concentration) may also occur in people who suffer from major depression. How would I know that I am developing true depression? What are the specific symptoms of depression?......Page 59
37. My psychiatrist diagnosed comorbid depression and RLS and wants me to take some strong antidepressant medications. How should I be treated?......Page 60
38. Is RLS a real disease or is it just “disease mongering” as many have said?......Page 61
39. What are some of the conditions that can mimic RLS?......Page 63
40. What are some of the conditions that may be associated with RLS?......Page 66
41. Is there an association between sleep apnea and RLS?......Page 68
42. I was told that RLS is common in patients with chronic bronchitis and emphysema. Is this true?......Page 72
44. What causes pain in general, and how does RLS cause pain?......Page 73
Part Four: Physical and Psychological Effects of Restless Legs Syndrome......Page 78
45. I was told that after many years of having RLS symptoms, a person may develop high blood pressure, stroke, or heart disease. Is this true and how does RLS cause these conditions?......Page 79
46. I have moderately severe RLS. I recently noticed that I have a compulsion to eat in the evening and during the night. As a result of this behavior, I have gained quite a bit of weight. Is this common in patients with RLS or do I have another condition?......Page 80
47. Do RLS patients suffer from other compulsive behaviors, such as compulsive gambling, smoking, or eating?......Page 81
48. Is RLS associated with increasing incidence of obesity?......Page 83
49. Is RLS due to a deficient or excessive amount of dopamine?......Page 84
50. Can RLS be produced experimentally in animals so that we will have a better understanding of and treatment for this condition?......Page 85
51. Can RLS symptoms be acute, requiring an emergency room visit? Can these symptoms be so severe as to drive someone to have suicidal thoughts?......Page 86
52. Does RLS affect short-term and long-term memory?......Page 89
53. As I am about to fall asleep, I get electric shock-like feelings in my legs immediately followed by jerking movements. Do I have RLS or periodic limb movements in sleep?......Page 90
54. My husband keeps tapping his feet on the ground, and sometimes he rhythmically shakes his legs when ever he is relaxing in a chair. He has restlessness of his legs. Does he have RLS?......Page 91
56. I am a 55-year-old woman with generalized aches and pains. I feel fatigued all day. I also have intense discomfort in my legs, with an urge to move while trying to sleep. Do I suffer from RLS, fibromyalgia, or chronic fatigue syndrome?......Page 92
57. My toes and feet keep moving on their own. I cannot control these movements. These movements are painful (sometimes painless) and occur all day long, while I am both resting and walking. Do I have RLS?......Page 94
58. I have RLS but I do not have a positive family history of RLS, nor do I have any systemic disease (e.g., anemia, kidney failure, rheumatoid arthritis). Could my RLS be due to any environmental factor?......Page 95
59. Is RLS a disorder of the main brain hemisphere, brainstem (the portion of the brain below the main brain hemisphere), or spinal cord (a tubular structure descending from the brainstem and connected to the peripheral [e.g., nerve roots or nerves going to the limbs] nervous system)?......Page 96
60. Is RLS common in patients with chronic bowel disorders?......Page 97
61. Is RLS a benign condition (as most people think) or is it a serious disorder (as most RLS specialists think) causing significant morbidity (impaired quality of life and suffering) and increased mortality with reduced longevity?......Page 98
62. Is there a difference in early-onset and late-onset RLS in terms of the clinical presentation or the natural progression of the disease?......Page 99
63. Why is there a delay (sometimes lasting 20 to 30 years) in making a definitive diagnosis of RLS?......Page 100
65. Are RLS patients more prone to have anemia or iron deficiency, or are they more sensitive to low iron levels in the body or the brain?......Page 101
Part Five: Treatment of Restless Legs Syndrome......Page 104
67. Do mild cases of RLS remain mild, or do they inevitably progress to become moderate or severe? In other words, what are the natural history and course of RLS?......Page 105
68. My family physician thought I might have RLS and referred me to an RLS specialist. Should I be treated now with drugs, which may have side effects, or should I wait to begin treatment? When should I be treated?......Page 106
69. How does the RLS specialist decide on treating a patient, including whom to treat and when to treat?......Page 107
70. Are nonpharmacologic measures helpful for RLS?......Page 108
71. What are some of the medications found to be useful for RLS?......Page 111
72. What are the side effects of dopaminergic and other medications used to treat RLS?......Page 115
73. I have been taking dopaminergic medication (Sinemet) for my RLS symptoms in the evening and night for more than two years with fairly good response. Lately, my symptoms have begun to start later in the afternoon; they are growing more intense, and sometimes the symptoms spread to my arms. Is this worsening due to the progression of the disease or is it augmentation?......Page 118
74. How is augmentation diagnosed?......Page 119
75. How is augmentation differentiated from disease progression, tolerance to the drug, or rebound effects of the drugs?......Page 120
76. How is augmentation treated?......Page 122
77. I am an RLS patient on dopaminergic medication. I have had several episodes of sudden attacks of sleepiness in the daytime in an inappropriate time and under inappropriate circumstances. Are these due to medication or RLS?......Page 123
78. I suffer from RLS symptoms intermittently, but the symptoms are intense on some nights. I get these symptoms one or two nights per week. At other times, I remain symptom free for weeks at a time. Should I see my family physician for treatment or should I try over-the-counter medications?......Page 125
79. What can I do for my sleep problem associated with my RLS symptoms? Should I take sleeping medications in addition to RLS drugs?......Page 126
80. I am a 60-year-old woman and have suffered from RLS for almost all of my life. Medications controlled the symptoms untilrecently. Now the symptoms are intense and intolerable; they are disturbing my sleep and making my life miserable. Do I have intractable or refractory RLS? How do physicians treat this severe condition?......Page 129
81. My RLS specialist told me that certain medications and agents can worsen my RLS symptoms and I should avoid these medications. What are these medications?......Page 135
82. I am a 60-year-old man who has severe depression. Recently, my psychiatrist put me on a strong antidepressant medication (a selective serotonin reuptake inhibitor). Soon after I started taking the medication, my RLS symptoms (which I have had for the last 10 years) became worse. They are now intolerable. Should I stop taking the antidepressant?......Page 138
83. I read on the Internet that for severe and intractable RLS, sometimes drug holidays and rotating the medications may be useful. I was warned that the information on the Internet may occasionally be misleading and false. What should I do?......Page 140
84. I am a 62-year-old woman who is scheduled to have knee replacement surgery. Should I tell my surgeon or my anesthesiologist that I have RLS, or should I keep quiet about my RLS because these physicians may think that all my symptoms are psychosomatic?......Page 141
85. My Chinese girlfriend told me that I should try acupuncture and herbal medications for my RLS symptoms. Should I listen to her advice or should I see an RLS specialist?......Page 142
86. Is there a role for complementary and alternative medicine in the treatment of RLS?......Page 143
87. I read that taking lots of vitamins and minerals will cure my RLS and I do not need any prescription medications. Is this true?......Page 145
89. I have heard that patients with severe Parkinson’s disease are treated with deep brain stimulation. Given that both RLS and Parkinson’s disease result from dopamine dysfunction, can deep brain stimulation also be a treatment for intractable or refractory RLS?......Page 146
90. How do physicians treat periodic limb movements in sleep and periodic limb movement disorder? At what point in the disease course does this treatment begin?......Page 147
91. I am a 60-year-old woman who has been taking opioids for severe and intractable RLS for two years. Recently, I have been feeling very fatigued during the daytime, and my bed partner noticed that my breathing has been irregular, with pauses in breathing during sleep. What is happening to me?......Page 149
92. A friend who has RLS received Botox injections for RLS symptoms and obtained some relief. What is Botox injection and does it help RLS?......Page 150
93. Are there any new medications undergoing clinical trials that may be available soon? What are the advantages of these new medications?......Page 151
94. In clinical drug trials focusing on RLS, some patients get a placebo and some get the real drug. What is a placebo and why is it used?......Page 153
Part Six: Coping and Management Techniques......Page 156
95. How does one cope with a condition such as RLS that is often misdiagnosed, misunderstood, and labeled as a psychosomatic (psychoneurotic) disorder?......Page 157
96. What is the role of exercise and lifestyle changes in treatment of RLS?......Page 158
98. I am in my third trimester of pregnancy and my RLS symptoms are getting worse, seriously affecting my quality of life. My obstetrical/gynecological specialist told me to avoid all medications, as they may harm the baby. What should I do?......Page 159
99. How do physicians treat RLS in children?......Page 161
100. Where can I get more information about RLS?......Page 162
Appendix......Page 164
Glossary......Page 168
Index......Page 172