Restless legs syndrome: Difference between revisions

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* RLS also known as Willis-Ekbom disease (WED)
* RLS also known as Willis-Ekbom disease (WED)
* It is a long-term disorder that causes a strong urge to move legs or limb twitching during sleep.
* It is a long-term disorder that causes a strong urge to move legs or limb twitching during sleep.
* An unpleasant feeling in the legs that amel by moving, therefore can make it hard to sleep.
* An unpleasant feeling (Aching/Tingling /Crawling) in the legs that amel by moving  therefore can make it hard to sleep.
* This is often described as aching, tingling, or crawling in nature.
* Occasionally arms may also be affected.
* Occasionally arms may also be affected.
* RLS is not the same as habitual foot tapping or leg rocking.
* RLS is not the same as habitual foot tapping or leg rocking.


 
* This is often described as aching, tingling, or crawling in nature.
=== Related disease ===
* The feelings generally happen when at rest and therefore can make it hard to sleep.
 
* Daytime sleepiness, low energy, irritability and a depressed mood is the consequence of bad night sleep.
* Low iron levels
* Additionally, many have limb twitching during sleep.
* Kidney failure
* [[Parkinson disease|Parkinson's disease]]
* Diabetes mellitus
* [[Rheumatoid arthritis]]
* [[Celiac disease]]
 


=== Signs and symptoms ===
=== Signs and symptoms ===


* Different sensations: Pain / Muscle ache / An itch that you can't scratch / Buzzing sensation/ An unpleasant tickle that won't stop / Crawling feeling / Limbs jerking  
* Uncomfortable/ Painful / Antsy / Electrical / Creeping / Itching / Pins and needles / Pulling / Crawling / Buzzing / Numbness /Muscle ache / An itch that you can't scratch / An unpleasant tickle that won't stop / Limbs jerking
* The sensations typically begin or intensify during quiet wakefulness, such as when relaxing, reading, studying, or trying to sleep.
* The sensations typically begin or intensify during quiet wakefulness, such as when relaxing, reading, studying, or trying to sleep.
* It is a "spectrum" disease with some people experiencing only a minor annoyance and others having major disruption of sleep and impairments in quality of life.
* It is a "spectrum" disease with some people experiencing only a minor annoyance and others having major disruption of sleep and impairments in quality of life.
* The sensations are unusual and unlike other common sensations therefore it is hard to describe them
** Uncomfortable/ Painful / Antsy / Electrical / Creeping / Itching / Pins and needles / Pulling / Crawling / Buzzing / Numbness.


* Motor restlessness, expressed as activity, which relieves the urge to move.
* Motor restlessness, expressed as activity, which relieves the urge to move.
* Movement usually brings immediate relief, although temporary and partial.  
* Movement usually brings immediate relief, although temporary and partial.  
* Walking is most common; however, stretching, yoga, biking, or other physical activity may relieve the symptoms.
* Continuous, fast up-and-down movements of the leg, and/or rapidly moving the legs toward then away from each other, may keep sensations at bay without having to walk. Specific movements may be unique to each person.
* Worsening of symptoms by relaxation.


* Variability over the course of the day-night cycle, with symptoms worse in the evening and early in the night.
* Variability over the course of the day-night cycle, with symptoms worse in the evening and early in the night.
* Some experience RLS only at bedtime, while others experience it throughout the day and night. Most people experience the worst symptoms in the evening and the least in the morning.


* Restless legs feel similar to the urge to yawn, situated in the legs or arms.




 
=== Miasmatic analysis ===
=== RLS Miasmatic analysis ===
It belongs to EPS COD.
{| class="wikitable"
{| class="wikitable"
!Entities
!Entities
!HTLV-1
!HTLV-1
!NVCJD
!NVCJD
!GSS
![[GSS, Gerstmann Straussler Scheinker syndrome|GSS]]
|-
|-
|Dysesthesia
|Dysesthesia
Line 65: Line 49:
| ++
| ++
| ++
| ++
|-
|[[Extrapyramidal|EPS]] [[Cluster of disease|COD]]
|
|
| +++
|}
|}
As you see, Here we have a big question. Twitching, Myoclonous, Fasciculation, Tremor and Jerking are very similar entities, therefore which of them are the exact entity of RLS?
Twitching, Myoclonous, Fasciculation, Tremor and Jerking are very similar entities, therefore which of them are the exact entity of RLS?


My answer is, RLS is related to [[UMNS, Upper Motor Neuron Syndrome entities|Upper motor neuron]] because of its Jerking / Twitching / Hyperreflexia. Therfore I prefer tremor to Fasciculation  
My answer is, RLS is related to [[Upper motor neuron, UMN|Upper motor neuron]] because of its Jerking / Twitching / Hyperreflexia. Therfore I prefer tremor to Fasciculation  


* Fasciculation or muscle twitch, is a spontaneous, involuntary muscle contraction and relaxation, involving fine muscle fibers.
* Fasciculation or muscle twitch, is a spontaneous, involuntary muscle contraction and relaxation, involving fine muscle fibers.
Line 75: Line 64:
* I think Myoclonus is the best for RLS because of its briefness and irregularity. Tremor is rhythmic and Fasciculation involve fine muscle fibers. Therefore I consider Myoclonous at first and Fasciculation for the second position
* I think Myoclonus is the best for RLS because of its briefness and irregularity. Tremor is rhythmic and Fasciculation involve fine muscle fibers. Therefore I consider Myoclonous at first and Fasciculation for the second position
* This means that NVCJD/ HTLV-1 /GSS and PLV are the first and second candidate for RLS.
* This means that NVCJD/ HTLV-1 /GSS and PLV are the first and second candidate for RLS.
* Due to strong relation of RLS to RBD, I consider Hyper reflexia as a good entity of RLS.
* Due to strong relation of RLS to [[RBD, Rapid Eye Movement Sleep Behavior Disoder|RBD]], I consider Hyper reflexia as a good entity of RLS.
 
=== 4 Causes ===


* While the cause is generally unknown, it is believed to be caused by changes in the nerve transmitter dopamine resulting in an abnormal use of iron by the brain. RLS is often due to iron deficiency (low total body iron status). Other associated conditions may include end-stage kidney disease and hemodialysis, folate deficiency, magnesium deficiency, sleep apnea, diabetes, peripheral neuropathy, Parkinson's disease, and certain autoimmune diseases, such as multiple sclerosis. RLS can worsen in pregnancy, possibly due to elevated estrogen levels. Use of alcohol, nicotine products, and caffeine may be associated with RLS. A 2014 study from the American Academy of Neurology also found that reduced leg oxygen levels were strongly associated with restless legs Syndrome symptom severity in untreated patients.
* Many medical conditions are linked to low levels of dopamine, including
** Parkinson's disease
** Depression
** Schizophrenia
** ADHD


=== Related disease ===
=== Related disease ===
Many medical conditions are linked to low levels of dopamine, including Parkinson's disease and Schizophrenia


==== ADHD ====
==== [[ADHD]] ====


* There is an association between ADHD and RLS
* Both have links to dysfunctions related to the neurotransmitter dopamine
* Both have links to dysfunctions related to the neurotransmitter dopamine
* A 2005 study suggested that up to 44% of people with ADHD had comorbid RLS, and up to 26% of people with RLS had confirmed ADHD or symptoms of the condition.
* A 2005 study suggested that up to 44% of people with ADHD had comorbid RLS, and up to 26% of people with RLS had confirmed ADHD or symptoms of the condition.
* An association has been observed between ADHD and RLS or [[periodic limb movement disorder]].


==== Parasomnia ====
 
==== [[Parasomnia]] ====


* [[Obstructive sleep apnea]] and other sleep-related respiratory events have been recognized as triggers of disorders of arousal in children.  
* [[Obstructive sleep apnea]] and other sleep-related respiratory events have been recognized as triggers of disorders of arousal in children.  
* Previous studies suggest that parasomnias occur commonly in children with RLS and can be precipitated by periodic limb movements in sleep (PLMS).
* Previous studies suggest that parasomnias occur commonly in children with RLS and can be precipitated by periodic limb movements in sleep (PLMS).


==== Mood disorder ====
==== Mood disorder ====


* RLS may contribute to higher rates of depression and anxiety disorders in RLS patients.
* RLS may contribute to higher rates of depression and anxiety disorders in RLS patients.
==== Extrapyramidal disorders ====
* (17.5% in male and 23.5% in female) <ref>Banno K, Delaive K, Walld R, Kryger MH. Restless legs syndrome in 218 patients: associated disorders. Sleep Med. 2000 Jul 1;1(3):221-229. doi: 10.1016/s1389-9457(00)00023-x. PMID: 10828433.</ref>
=== Others ===
* [[Parkinson disease|Parkinson's disease]]
* Multiple sclerosis
* Sleep apnea
* Peripheral neuropathy
* Low iron levels
* Kidney failure
* Diabetes mellitus
* [[Rheumatoid Arthritis|Rheumatoid arthritis]]
* [[Celiac disease]]


=== Mechanism ===
=== Mechanism ===
Line 107: Line 111:
* Although it is only partly understood, pathophysiology of restless legs syndrome may involve dopamine and iron system anomalies. There is also a commonly acknowledged circadian rhythm explanatory mechanism associated with it, clinically shown simply by biomarkers of circadian rhythm, such as body temperature. The interactions between impaired neuronal iron uptake and the functions of the neuromelanin-containing and dopamine-producing cells have roles in RLS development, indicating that iron deficiency might affect the brain dopaminergic transmissions in different ways.
* Although it is only partly understood, pathophysiology of restless legs syndrome may involve dopamine and iron system anomalies. There is also a commonly acknowledged circadian rhythm explanatory mechanism associated with it, clinically shown simply by biomarkers of circadian rhythm, such as body temperature. The interactions between impaired neuronal iron uptake and the functions of the neuromelanin-containing and dopamine-producing cells have roles in RLS development, indicating that iron deficiency might affect the brain dopaminergic transmissions in different ways.
* Medial thalamic nuclei may also have a role in RLS as part as the limbic system modulated by the dopaminergic system which may affect pain perception. Improvement of RLS symptoms occurs in people receiving low-dose dopamine agonists.
* Medial thalamic nuclei may also have a role in RLS as part as the limbic system modulated by the dopaminergic system which may affect pain perception. Improvement of RLS symptoms occurs in people receiving low-dose dopamine agonists.
== Remedies ==
=== [[Lyc , Lycopodium clavatum|Lyc]] ===
* From the knee down with circular movement. Lyc child also moves his leg while sleeping
=== [[Nat-m, Natrium muriaticum|Nat-m]] ===
* Nat-m moves the ankle down
=== [[Zinc, Zincum Metallicum|Zinc]] ===
*Zinc's leg is out of his control and vibrates regularly with low amplitude and high frequency.
*He can't sit still and not move his legs. ([[Rhus-t ₳ Zinc]])
*It seems that Zinc is more useful in [[Periodic limb movement disorder]].
**PLMD often only last the first half of the night during [[Non REM sleep|non-REM sleep]] stages.
**Movements do not occur during [[REM sleep|REM]] because of muscle atonia.
**This would be a good diagnostic feature for Zinc
=== [[Rhus-t, Rhus toxicodendron|Rhus-t]] ===
* Opposed to Zinc, he moves them in different directions and voluntarily.

Latest revision as of 00:57, 24 October 2023

Clinic

  • RLS also known as Willis-Ekbom disease (WED)
  • It is a long-term disorder that causes a strong urge to move legs or limb twitching during sleep.
  • An unpleasant feeling (Aching/Tingling /Crawling) in the legs that amel by moving therefore can make it hard to sleep.
  • Occasionally arms may also be affected.
  • RLS is not the same as habitual foot tapping or leg rocking.
  • This is often described as aching, tingling, or crawling in nature.
  • The feelings generally happen when at rest and therefore can make it hard to sleep.
  • Daytime sleepiness, low energy, irritability and a depressed mood is the consequence of bad night sleep.
  • Additionally, many have limb twitching during sleep.

Signs and symptoms

  • Uncomfortable/ Painful / Antsy / Electrical / Creeping / Itching / Pins and needles / Pulling / Crawling / Buzzing / Numbness /Muscle ache / An itch that you can't scratch / An unpleasant tickle that won't stop / Limbs jerking
  • The sensations typically begin or intensify during quiet wakefulness, such as when relaxing, reading, studying, or trying to sleep.
  • It is a "spectrum" disease with some people experiencing only a minor annoyance and others having major disruption of sleep and impairments in quality of life.
  • Motor restlessness, expressed as activity, which relieves the urge to move.
  • Movement usually brings immediate relief, although temporary and partial.
  • Variability over the course of the day-night cycle, with symptoms worse in the evening and early in the night.


Miasmatic analysis

It belongs to EPS COD.

Entities HTLV-1 NVCJD GSS
Dysesthesia

Hyperstasia

++ ++ +
Fasciculation

Myoclonous

++ ++ +
Hyper Reflexia ++ ++ ++
EPS COD +++

Twitching, Myoclonous, Fasciculation, Tremor and Jerking are very similar entities, therefore which of them are the exact entity of RLS?

My answer is, RLS is related to Upper motor neuron because of its Jerking / Twitching / Hyperreflexia. Therfore I prefer tremor to Fasciculation

  • Fasciculation or muscle twitch, is a spontaneous, involuntary muscle contraction and relaxation, involving fine muscle fibers.
  • Tremor is an involuntary, somewhat rhythmic, muscle contraction and relaxation involving oscillations or twitching movements of one or more body parts.
  • Myoclonus is a brief, involuntary, irregular (lacking rhythm) twitching of a muscle or a group of muscles
  • I think Myoclonus is the best for RLS because of its briefness and irregularity. Tremor is rhythmic and Fasciculation involve fine muscle fibers. Therefore I consider Myoclonous at first and Fasciculation for the second position
  • This means that NVCJD/ HTLV-1 /GSS and PLV are the first and second candidate for RLS.
  • Due to strong relation of RLS to RBD, I consider Hyper reflexia as a good entity of RLS.


Related disease

Many medical conditions are linked to low levels of dopamine, including Parkinson's disease and Schizophrenia

ADHD

  • Both have links to dysfunctions related to the neurotransmitter dopamine
  • A 2005 study suggested that up to 44% of people with ADHD had comorbid RLS, and up to 26% of people with RLS had confirmed ADHD or symptoms of the condition.
  • An association has been observed between ADHD and RLS or periodic limb movement disorder.


Parasomnia

  • Obstructive sleep apnea and other sleep-related respiratory events have been recognized as triggers of disorders of arousal in children.
  • Previous studies suggest that parasomnias occur commonly in children with RLS and can be precipitated by periodic limb movements in sleep (PLMS).


Mood disorder

  • RLS may contribute to higher rates of depression and anxiety disorders in RLS patients.


Extrapyramidal disorders

  • (17.5% in male and 23.5% in female) [1]

Others

  • Multiple sclerosis
  • Sleep apnea
  • Peripheral neuropathy


Mechanism

  • Although it is only partly understood, pathophysiology of restless legs syndrome may involve dopamine and iron system anomalies. There is also a commonly acknowledged circadian rhythm explanatory mechanism associated with it, clinically shown simply by biomarkers of circadian rhythm, such as body temperature. The interactions between impaired neuronal iron uptake and the functions of the neuromelanin-containing and dopamine-producing cells have roles in RLS development, indicating that iron deficiency might affect the brain dopaminergic transmissions in different ways.
  • Medial thalamic nuclei may also have a role in RLS as part as the limbic system modulated by the dopaminergic system which may affect pain perception. Improvement of RLS symptoms occurs in people receiving low-dose dopamine agonists.

Remedies

Lyc

  • From the knee down with circular movement. Lyc child also moves his leg while sleeping

Nat-m

  • Nat-m moves the ankle down

Zinc

  • Zinc's leg is out of his control and vibrates regularly with low amplitude and high frequency.
  • He can't sit still and not move his legs. (Rhus-t ₳ Zinc)
  • It seems that Zinc is more useful in Periodic limb movement disorder.
    • PLMD often only last the first half of the night during non-REM sleep stages.
    • Movements do not occur during REM because of muscle atonia.
    • This would be a good diagnostic feature for Zinc

Rhus-t

  • Opposed to Zinc, he moves them in different directions and voluntarily.
  1. ↑ Banno K, Delaive K, Walld R, Kryger MH. Restless legs syndrome in 218 patients: associated disorders. Sleep Med. 2000 Jul 1;1(3):221-229. doi: 10.1016/s1389-9457(00)00023-x. PMID: 10828433.
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