Restless Leg Syndrome: Diagnosis and Treatment Guide

Introduction to Restless Leg Syndrome

Restless Leg Syndrome (RLS) is a neurological disorder characterized by an overpowering urge to move the limbs—especially the legs—that occurs most often when a person is relaxing or trying to sleep. This disorder is a major causative factor of nighttime blood pressure spikes and associated circulatory consequences, which reduce sleep quality and, in some cases, eliminate the possibility of sleep altogether. The resulting sleep deprivation causes adverse effects such as nervousness, persistent sadness, and a reduced quality of life. Patients who initially suffer from hemodialysis and subsequently develop RLS have a significantly higher mortality rate, and in most cases they present with disorders that are difficult to explain.

This paper's objective is to educate medical personnel on the need to understand and draw conclusions from a patient's signs—the factors from which a determination is made as to whether a patient has RLS or some other disorder (Einollahi & Izadianmehr, 2014).

RLS is a serious condition that can greatly reduce one's standard of living. Several substances have successfully treated or mitigated RLS, including ropinirole, pramipexole, rotigotine, and gabapentin enacarbil, all of which are FDA-approved. It is important, nonetheless, to consider the advantages, the serious side effects, and the long-term effects of drugs aimed at treating RLS (Comella, 2014).

Subjective: Patient Presentation and Symptoms

The subject patient suffers from disturbing sensations in both legs that worsen at night. The subject considers the situation routine and separate from activities of daily living (ADL). The patient is following a low-salt/low-sodium diet as instructed. The subject has a history of hypertension and currently suffers from hyperlipidemia. The subject's father died with a history of hyperlipidemia and hypertension, while the subject's mother is still living but suffers from fibromyalgia. The subject is a parent of two sons who have no health issues.

Restless Leg Syndrome is a nerve condition typically accompanied by symptoms such as vibrating, stretching, and other disturbing sensations in the legs, along with an irrepressible desire to keep them moving—as is the case for the subject patient. These unpleasant feelings are more prevalent when the subject is calm and at bedtime. When the legs are moved, the patient experiences a brief period of relief. These symptoms, referred to as paresthesias (abnormal sensations) or dysesthesias (painful abnormal sensations), range from mildly unpleasant to deeply agonizing.

A notable aspect of this disorder is that it is triggered by lying down and resting; as a result, nearly all patients find it difficult to fall asleep or to achieve restful sleep—which is also among the subject's primary complaints. If not promptly addressed, RLS causes general weakness and fatigue during the day. Many RLS patients report that the disorder has affected their occupation, personal life, and general daily activities due to its associated sleep problems. Difficulty concentrating, memory impairment, and trouble performing normal daily tasks are common complaints among RLS patients, and the subject expresses several of these same concerns. Travelling is also affected, and the disorder can lead to depression (NINDS, 2010).

Objective: Diagnostic Methods and Clinical Evaluation

RLS has no specific confirmatory test; however, it can be identified through four key indicators:

• Problems are prevalent at bedtime and diminish in the morning.
• An irresistible urge to move the affected legs or arms, commonly accompanied by paresthesias or dysesthesias.
• Symptoms are initiated when the patient is at rest, relaxing, or asleep.
• Symptoms are reduced when the legs are moved and do not resurface until movement ceases.

The physician paid close attention to the patient's account of symptoms, causative factors, and relieving actions, as well as whether problems were prevalent or infrequent during the day. Physical and neurological examinations, combined with details from the patient's clinical history and current medications, also proved useful. The rate, duration, and severity of associated discomfort—along with its relationship to sleep, sleep deprivation, and daytime productivity—were among the questions posed to the patient.

Other possible conditions were ruled out through laboratory examinations, including blood tests that identify iron and vitamin deficiencies and other physiological conditions associated with RLS. A possible scenario explored was the identification of other causes of sleep problems—such as sleep apnea—by conducting sleep assessments such as polysomnography, an examination that records a person's brain waves, heart rate, respiration, and limb movements during sleep. This condition could affect the successful treatment of RLS; in this case, however, little or no effect on RLS treatment was recorded.