Restless Legs Syndrome

Dr. Parang Mehta, MD.

Ants crawling in the legs. The gotta moves. Like Coca cola in my veins. Legs tingle and hurt when I sleep. Tickly inside the leg. Legs want to move at night.

These are some of the descriptions children with the restless legs syndrome (RLS) give of their symptoms. RLS is a common and well recognised condition in adults, especially the elderly. It occurs in children also, albeit less frequently, but is rarely diagnosed and treated. These children usually suffer for years before receiving appropriate help.

RLS usually appears in the evening and night, and is triggered off by rest. There are unpleasant sensations in the legs, and an almost uncontrollable desire to move. Moving the legs or walking helps temporarily. The unpleasant sensations subside, but come back when movement stops. Those severely affected find it difficult to fall asleep and to stay asleep. Sleep is fragmented, inadequate and not refreshing. These children are tired, irritable and inattentive in school. Academic performance suffers.

These children often have great difficulty in sitting for a period of time, and are fidgety and restless in class. Long car and plane journeys are also a problem for them. RLS usually starts from the legs, but can spread to involve the trunk, arms, and even the face.

How does it happen?

The causation of RLS is not fully known at present. Two mechanisms are believed important - a deficit of the dopaminergic system in the brain, and iron deficiency. Many other mechanisms have been suggested but not proved.

RLS runs in families, though it also occurs in isolation. About two-thirds of children with RLS have an affected biological parent or sibling. RLS can also be triggered by kidney failure, hypothyroidism, diabetes, and pregnancy. Attention deficit hyperactivity disorder (ADHD) and RLS often coexist in children.

What to do

What to avoid

Drugs for RLS

This is not a curable condition. Drugs can help reduce the discomfort and improve sleep. However, any drug treatment started is likely to be long term.

Levodopa and dopamine agonists (like pramipexole and ropinirole) are the drugs of choice. Levodopa is recommended for children who need treatment intermittently. Dopamine agonists are better for daily therapy.

Benzodiazepines are sleep inducing drugs, and they improve sleep and reduce daytime fatigue. They can be habit forming.

Opioids reduce the symptoms and improve sleep. However, they are avoided because of risk of addiction.

Anti epilepsy drugs like gabapentin are also effective in RLS, and are especially recommended when pain is a major component.

Last Revision: February 14, 2016

Does Your Child Have RLS?

Essential criteria for adults

  1. An urge to move the legs, usually accompanied or caused by uncomfortable or unpleasant sensations in the legs. (Sometimes the urge to move is present without the uncomfortable sensations and sometimes the arms or other body parts are involved in addition to the legs).
  2. The urge to move or unpleasant sensations begin or worsen during periods of rest or inactivity such as lying or sitting.
  3. The urge to move or unpleasant sensations are partially or totally relieved by movement, such as walking or stretching, at least as long as the activity continues.
  4. The urge to move or unpleasant sensations are worse in the evening or night than during the day or only occur in the evening or night. (When the symptoms are very severe, the worsening at night may not be noticeable, but must have been previously present).

Supportive criteria

  1. Sleep disturbance for age.
  2. A biological parent or sibling has definite restless legs syndrome.
  3. The child has a PLMS index of 5 or more per hour on polysomnography.

Additional diagnostic criteria in children


 

Contact Information

Dr. Parang Mehta,
Mehta Childcare,
Opposite Putli, Sagrampura,
Surat, India.    Tel: +91 9429486624.
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