Restless legs syndrome: Is relief is at hand for the often ridiculed condition?
Those with restless legs syndrome say it feels like bugs crawling deep in their legs or water moving in their legs, or electricity. Photo / Getty Images
Restless legs syndrome is one of those health problems that isn’t always taken seriously. Mark Buchfuhrer has a collection of comic strips that make fun of the condition. But there is nothing amusing or trivial about it, says the Stanford University professor, who treats some of the worst affected patients at his clinics.
About 10% of people suffer from restless legs syndrome (RLS) and about a third have it so severely they need medical help. Many struggle to explain what they are experiencing.
“If you ask them to describe the sensations, they’ll say it feels like bugs crawling deep in their legs, or water moving in their legs, or electricity,” says Buchfuhrer. “Moving the legs gives some relief but if they don’t keep moving or rubbing them for long enough, it comes back.”
Since RLS follows a circadian rhythm, typically it will worsen as the day progresses and be most problematic at bedtime. Unable to fall sleep, sufferers have to get up and walk about, and the long-term impact on lives can be devastating.
Today, Buchfuhrer is on the Medical Advisory Board of the Restless Legs Syndrome Foundation. But in 1992, when he first got involved with the condition, not many doctors knew how to treat it or even recognised it as a real disease.
RLS is termed a sensory motor neurologic condition and for a long time the answer seemed to be to treat it with drugs that activate dopamine receptors in the brain. This had unintended consequences, however. At higher doses, these drugs can cause compulsive and risk-taking behaviour, says Buchfuhrer.
“I’ve had at least a dozen patients who gambled and lost over a million dollars. For some reason, with women, we see more compulsive shopping. One patient had bought 300 pairs of shoes and, after I got her off the medication, she told me she didn’t like the vast majority but the rush she got from buying them was incredible.”
The other serious issue with dopamine agonists is that over time many patients experience a worsening of symptoms, known as augmentation. This is caused by one receptor that is not targeted by the medication adapting to become super-sensitive to dopamine. For that reason, these drugs are no longer recommended as a first-line treatment.
There are other potential solutions. For instance, RLS sufferers tend to have lower than normal levels of iron in their brains and eating iron-rich foods or taking supplements is often suggested.
“But with oral iron, there is only a very small chance of getting enough to the brain,” says Buchfuhrer. “Whereas, with an infusion of a slow-release iron preparation, we see more than 60% of patients get a dramatic improvement in their restless legs.”