restless legs syndrome

Posted on A to Z of Medical Conditions

Less than one third of restless leg syndrome sufferers are getting an accurate diagnosis

Restless leg syndrome (RSL) is a neurological movement disorder that affects more than 37 million people worldwide. A recent epidemiology analysis on adult sufferers of RSL by GlobalData, a leading data and analytics company found that while a significantly high proportion of the general population in the West experience RSL, less than one third are getting an accurate diagnosis. 

Kasey Fu, MPH, Director of Epidemiology at GlobalData commented: ‘’Many studies suggest that a lack of awareness and knowledge in physicians is causing underdiagnosis of restless leg syndrome. This is an area that deserves more attention, given how many people report uncomfortable sensations that can severely affect their sleep and daily life’’.

Restless leg syndrome sufferers feel uncomfortable sensations in their legs, such as tingling and numbing, and the feelings worsen at night. The sensations provoke a strong urge to move the legs, which makes it difficult to have restful sleep and can adversely affect productivity, quality of living, and mental and physical health.

In the seven major markets (7MM*), there is variation in the active total prevalence of restless leg syndrome. The UK had the highest proportion of the population that had positive symptoms of restless leg (around 11%) and Japan had the lowest (around 2%). However, GlobalData observed that diagnosis is extremely low, where only 5–25% of those with symptoms have previously been diagnosed. 

It is not clear what is causing the low diagnosis rate in these countries. In a US-based study of 15,391 people, 81% of those who had positive symptoms fulfilling the IRLSSG criteria had discussed their symptoms with a primary care physician, but only 6.2% of those were diagnosed with restless leg syndrome. Similarly, in a UK-based study of 23,052 people, 65% had sought medical help for the strange sensations in their legs, but only 13% of those had been diagnosed.

The sparse landscape of the RLS marketplace:

There are currently two food and drug (FDA)-approved therapies for RLS, Mirapex (pramipexole dihydrochloride) and Neupro (rotigotine). Mirapex is delivered in tablet form, taken orally once daily, and Neupro is a patch that, when attached to the skin, delivers rotigotine, a dopamine receptor agonist, over a 24-hour period.

Magdalene Crabbe, MA, Neurology and Ophthalmology Analyst, at GlobalData adds: “The highest stage of development is Vifor Pharma’s Ferinject (ferric carboxymaltose), an intravenously administered iron replacement therapy in Phase III of the RLS pipeline. Many RLS sufferers experience anemia, caused by Iron deficiency. Fewer circulating erythrocytes reduce dopaminergic signaling capabilities, triggering restlessness and disordered involuntary movements. Iron replacement therapy has been proven to be effective in relieving RLS symptoms.

“However, the sparse landscape of the RLS marketplace mean that patients are sometimes left untreated and can suffer severe consequences resulting from electrolyte imbalances and deficiency of essential nutrients”.

*7MM = US, France, Germany, Italy, Spain, UK, and Japan

Leave a comment Posted on Multiple Sclerosis

What is the connection between Restless Legs Syndrome and Multiple Sclerosis?




People with multiple sclerosis (MS) are five times more likely to lose sleep over restless legs syndrome (RLS) than the general population — however, the reason for this is not entirely known.

RLS is an uncomfortable — and often painful — condition affecting the nervous system. People with MS note feeling sensations such as pinching, crawling, tingling, among others, while in bed at night.

These feelings lead to an intense urge to move your legs, as the sensations feel worse when you’re still. MSers often confuse RLS with MS spasms, which can make diagnosis and treatment more difficult.

On top of being an unpleasant experience, RLS can seriously impede on sleep, which can make MS symptoms worse.

If you believe you’re experiencing RLS, it’s important to see your doctor so you can receive proper treatment and avoid fatigue.




Multiple Sclerosis Infographic - Restless Legs Syndrome and MS
Infographic: People with multiple sclerosis (MS) are five times more likely to lose sleep over restless legs syndrome (RLS) than the general population. – Source: New Life Outlook | Multiple Sclerosis




Leave a comment Posted on A to Z of Medical Conditions

Ekbom syndrome – Do you have RL syndrome? Find out about the signs here!




Restless Leg Syndrome

Restless Leg Syndrome




Restless legs syndrome, also known as Willis-Ekbom disease, is a common condition of the nervous system that causes an overwhelming, irresistible urge to move the legs.

It can also cause an unpleasant crawling or creeping sensation in the feet, calves and thighs. The sensation is often worse in the evening or at night. Occasionally, the arms are affected too.

Restless legs syndrome is also associated with involuntary jerking of the legs and arms, known as periodic limb movements in sleep (PLMS).

Some people have the symptoms of restless legs syndrome occasionally, while others have them every day. The symptoms can vary from mild to severe. In severe cases, restless legs syndrome can be very distressing and disrupt a person’s daily activities.

Restless legs syndrome typically causes an overwhelming urge to move your legs and an uncomfortable sensation in your legs.




The sensation may also affect your arms, chest and face, too. It has been described as:

tingling, burning, itching or throbbing

a “creepy-crawly” feeling

feeling like fizzy water is inside the blood vessels in the legs

a painful, cramping sensation in the legs, particularly in the calves

These unpleasant sensations can range from mild to unbearable, and are usually worse in the evening and during the night. They can often be relieved by moving or rubbing your legs.

Some people experience symptoms occasionally, while others have them every day. You may find it difficult to sit for long periods of time – for example, on a long train journey.

Just over half of people with restless legs syndrome also experience episodes of lower back pain.

Periodic limb movements in sleep (PLMS)

Up to 80% of people with restless legs syndrome also have periodic limb movements in sleep (PLMS).

If you have PLMS, your leg will jerk or twitch uncontrollably, usually at night while you’re asleep. The movements are brief and repetitive, and usually occur every 10 to 60 seconds.

PLMS can be severe enough to wake up both you and your partner. The involuntary leg movements can also occur when you’re awake and resting.

What causes restless legs syndrome?

In the majority of cases, there’s no obvious cause of restless legs syndrome. This known as idiopathic or primary restless legs syndrome, and it can run in families.

Some neurologists (specialists in treating conditions that affect the nervous system) believe the symptoms of restless legs syndrome may have something to do with how the body handles a chemical called dopamine. Dopamine is involved in controlling muscle movement and may be responsible for the involuntary leg movements associated with restless legs syndrome.

In some cases, restless legs syndrome is caused by an underlying health condition, such as iron deficiency anaemia or kidney failure. This is known as secondary restless legs syndrome.

There’s also a link between restless legs syndrome and pregnancy. About 1 in 5 pregnant women will experience symptoms in the last three months of their pregnancy, although it’s not clear exactly why this is. In such cases, restless legs syndrome usually disappears after the woman has given birth.

Read more about the causes of restless legs syndrome.

Treating restless legs syndrome

Mild cases of restless legs syndrome that aren’t linked to an underlying health condition may not require any treatment, other than making a few lifestyle changes, such as:

adopting good sleep habits – for example, following a regular bedtime ritual, sleeping regular hours, and avoiding alcohol and caffeine late at night

quitting smoking if you smoke

exercising regularly during the daytime

If your symptoms are more severe, you may need medication to regulate the levels of dopamine and iron in your body.

If restless legs syndrome is caused by iron deficiency anaemia, iron supplements may be all that’s needed to treat the symptoms.

Read more about treating restless legs syndrome.

Who’s affected by restless legs syndrome?

As many as 1 in 10 people are affected by restless legs syndrome at some point in their life.

Women are twice as likely to develop restless legs syndrome than men. It’s also more common in middle age, although the symptoms can develop at any age, including childhood.

Outlook

The symptoms of restless legs syndrome will usually disappear if it’s possible to address an underlying cause.

However, if the cause is unknown, the symptoms can sometimes get worse with time and severely affect the person’s life. Restless legs syndrome isn’t life threatening, but severe cases can severely disrupt sleep (causing insomnia) and trigger anxiety and depression.

The charity Restless Leg Syndrome UK provides information and support for people affected by restless legs syndrome, and may be able to put you in touch with other people in your area affected by the condition.

Leave a comment Posted on Pain Management

Acupuncture – Does it work? Read some of the evidence here




Acupuncture

Acupuncture

Have you ever used Acupuncture?

Did it work?  Tell us your view in the comments section below?

Acupuncture is a treatment derived from ancient Chinese medicine in which fine needles are inserted at certain sites in the body for therapeutic or preventative purposes.

It is often seen as a form of complementary or alternative medicine (CAM), although it is used in many NHS general practices, as well as the majority of pain clinics and hospices in the UK.

Theory

Western medical acupuncture is the use of acupuncture after a proper medical diagnosis. It is based on scientific evidence that shows the treatment can stimulate nerves under the skin and in muscle tissue.




This results in the body producing pain-relieving substances, such as endorphins. It is likely these substances are responsible for any beneficial effects seen with this form of acupuncture.

Traditional acupuncture is based on the belief that an energy, or “life force”, flows through the body in channels called meridians. This life force is known as Qi (pronounced “chee”).

Practitioners who adhere to traditional beliefs about acupuncture believe that when Qi does not flow freely through the body, this can cause illness. They also believe acupuncture can restore the flow of Qi, and so restore health.

Read more about what happens during acupuncture.

What is it used for?

Acupuncture practitioners – sometimes called acupuncturists – use acupuncture to treat a wide range of health conditions.

It is often used to treat pain conditions such as headache, lower back pain and osteoarthritis, but is also sometimes used in an attempt to help people with conditions ranging from infertility to anxiety and asthma.




Acupuncture is occasionally available on the NHS, although access is limited. Most acupuncture patients pay for private treatment.

Read more about the common uses of acupuncture.

Does it work?

Currently, the National Institute for Health and Care Excellence (NICE) only recommends considering acupuncture as a treatment option for chronic lower back pain, chronic tension-type headaches and migraines. NICE makes these recommendations on the basis of scientific evidence.

There is also some evidence that acupuncture works for a small number of other problems, including neck pain and post-chemotherapy nausea and vomiting.

Acupuncture is sometimes used for a variety of other conditions as well, but the evidence is not conclusive for many of these uses.

Read more about the evidence for and against acupuncture.

Having acupuncture

When it is carried out by a qualified practitioner, acupuncture is generally very safe. Some people experience side effects such as feeling drowsy or dizzy, but these are usually mild and short-lived.

If you choose to have acupuncture, make sure your acupuncture practitioner is either a regulated healthcare professional or a member of a recognised national acupuncture organisation.

Read more about acupuncture safety and regulation.

[Original article on NHS Choices website]

Evidence for and against acupuncuture

There is some scientific evidence acupuncture has a beneficial effect for a number of health conditions.

However, there is less clear scientific evidence about the benefits of acupuncture in the majority of conditions it is often used for.

The National Institute for Health and Care Excellence (NICE) only recommends considering acupuncture as a treatment option for chronic lower back pain, chronic tension-type headaches and migraine.

Assessing the evidence

One of the best ways researchers can assess the evidence behind a particular treatment is by carrying out a systematic review. This is a “study of studies” that combines findings from separate but similar studies to come up with an overall conclusion.

Systematic reviews are an important part of health research because they can identify findings that might otherwise be missed in individual studies. They can also help distinguish the effects of treatment from the effects of chance.

It is important to remember that when we use a treatment and feel better, this can be because of a phenomenon called the placebo effect and not because of the treatment itself. Systematic reviews can help reduce the potential influence of the placebo effect.

While systematic reviews cannot always determine conclusively whether a treatment does or does not work, they can be useful in assessing how a particular treatment (such as acupuncture) compares to another (such as “sham” acupuncture or medication).

However, even this can be challenging – both acupuncture and placebo treatments can stimulate the release of natural painkilling substances called endorphins, which can make it difficult to distinguish between them.

What evidence is there for acupuncture?

One of the largest and most respected organisations that carries out and publishes systematic reviews into the effectiveness of medical treatments is The Cochrane Collaboration.

A number of systematic reviews into the effectiveness of acupuncture have been published by The Cochrane Collaboration, and the basic results are summarised below.

Some positive evidence

Systematic reviews carried out by The Cochrane Collaboration have found there is some evidence acupuncture may have a beneficial effect on the following conditions:

However, because of disagreements over the way acupuncture trials should be carried out and over what their results mean, the existence of some positive evidence does not mean acupuncture definitely works for these conditions.

In many cases, the evidence appears contradictory. For example, some high-quality studies may suggest acupuncture is no better than “sham” acupuncture, whereas some lower-quality studies may suggest acupuncture is better than an established medical treatment.

The issue is sometimes also further complicated by the fact some “sham interventions” include active needling and are therefore not true placebos.

In addition, it can be difficult to make sure the patients involved in acupuncture studies are unaware of the specific treatment they are receiving (known as “blinding”).

This is because it is obvious whether you are receiving a conventional medical treatment such as medication or if you are receiving acupuncture, for example. This is a problem as it means the preconceptions of the person being treated may influence the result.

Some systematic reviews, however, have demonstrated the effects of acupuncture over sham treatment in studies where patients are unaware whether they are having real acupuncture or sham treatment.

For example, one large meta-analysis (a type of systematic review) not carried out by The Cochrane Collaboration included data from more than 17,000 patients. It compared acupuncture to sham acupuncture or no acupuncture without patients being aware of whether they had received real or sham treatment.

This review found acupuncture to be superior to both sham and no treatment for headaches, osteoarthritis, back pain and neck pain.

Little or no evidence

In many conditions where acupuncture is used, there is not enough good quality evidence to draw any clear conclusions over its relative effectiveness compared with other treatments.

For example, systematic reviews published by The Cochrane Collaboration have suggested more research is needed to assess whether acupuncture is effective for: asthma, glaucoma, schizophrenia, depression, shoulder, pain, elbow, pain, rheumatoid arthritis, Bell’s palsy, restless legs syndrome, insomnia vascular ,dementia, stroke, stroke rehabilitation and swallowing problems caused by stroke

More research is needed to establish whether acupuncture is better or worse than best standard treatments for these conditions.

More information and research

If you want to find out more about studies into acupuncture, you can search for high-quality research using the NHS Evidence and Cochrane Library websites.