Restless Legs

It must be said the root cause for RLS is not fully understood by medical science. However, it can be inferred that patients with peripheral artery disease (PAD) may be at a higher risk for RLS due to the underlying vascular condition. In fact, studies have shown that vascular factors such as endothelial dysfunction, changes in the peripheral microvasculature, and peripheral hypoxia (when the limbs experience oxygen deprivation) may exacerbate or even cause the symptoms of RLS.

Listed below are some other factors and underlying conditions that RLS accompanies, or may be related to:

• End-stage renal disease/hemodialysis
• iron deficiencies
• Some medications may aggravate RLS, including antinausea drugs, antipsychotics, antidepressants that increase serotonin production, and some cold and allergy medications
• Alcohol, nicotine, and caffeine use
• Pregnancy, particularly in the third trimester
• Nerve damage/neuropathy
• Sleep deprivation and/or sleep apnea

There is no specific test available for RLS, per se.  However, some tests may be used to explore contributing factors. Evaluation by a doctor is the basis for an RLS diagnosis.

There are five general criteria that doctors use for producing a clinical diagnosis:

1. A strong urge to move the legs, often associated with unpleasant or uncomfortable sensations
2. The urge to move the legs begins or worsens during rest or inactivity
3. Moving the legs will partially or totally relieve the uncomfortable sensations, at least temporarily
4. The urge to move the legs begins in the evening or at night
5. None of the above are correlated with any other medical or behavioral conditions

Physicians will evaluate the descriptions of symptoms given by the patient, any triggers or relieving factors, and the presence or absence of symptoms during the day. Neurological and physical examinations may be performed and the patient’s medical and family history will be thoroughly explored, as well as current medications.

There are some tests that may be appropriate. Sometimes a doctor will want to run blood tests to rule out other conditions like kidney failure or iron deficiency anemia. For some patients it may be appropriate to have a sleep study (polysomnography) performed to explore other factors that may contribute to sleep disruptions and RLS symptoms.

Patients with peripheral artery disease (PA) may be at greater risk for developing restless leg syndrome. Therefore, it is important for patients with underlying vascular conditions to consider methods for controlling the symptoms of RLS. Also, controlling the symptoms of RLS may involve treating an underlying condition that is not PAD-related. Every patient is unique and must be evaluated by a qualified health care professional.

Treatment for RLS may include:

• Lifestyle changes — reducing alcohol and tobacco, changing sleep patterns, a prescribed exercise program, leg massage, warm baths, and using heating pads or ice packs are all options.
• Iron supplements taken orally, or intravenously may improve symptoms.
• Dopaminergic agents, opioids, and benzodiazepines may be used depending on the patient’s unique circumstances.