Restless legs syndrome

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.

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.

RLS 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)

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.

Parkinson's disease

Multiple sclerosis Sleep apnea Peripheral neuropathy

• Low iron levels
• Kidney failure
• Diabetes mellitus
• Rheumatoid arthritis
• Celiac disease

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.

Clinic

• Also known as Willis-Ekbom disease (WED)
• It is generally a long-term disorder that causes a strong urge to move one's legs.
• There is often an unpleasant feeling in the legs that improves somewhat by moving them.
• 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.
• Due to the disturbance in sleep, people with RLS may have daytime sleepiness, low energy, irritability and a depressed mood.
• Additionally, many have limb twitching during sleep.
• RLS is not the same as habitual foot tapping or leg rocking.

Risk factors

• Low iron levels
• Kidney failure
• Parkinson's disease
• Diabetes mellitus
• Rheumatoid arthritis
• Celiac disease
• Peripheral neuropathy
• MS

• There is a common overlapping in people with varicose veins and other chronic venous insufficiency

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.