Restless legs syndrome and akathisia

What is it about ?

Restless Legs Syndrome (RLS) or impatience in the legs is a pathology that causes an unpleasant sensation in the legs in the evening and at night, difficult to describe, which subside with movement. The following elements can explain the pathology:

• the pregnancy ;
• old age ;
• a iron deficiency ;
• kidney problems;
• the presence of similar symptoms in other family members.

Akathisia means you can’t sit still. It is caused by drugs that block the action of the hormone dopamine, such as antipsychotics. Akathisia is considered to be the most bothersome side effect of this drug.

Where and how often?

Restless legs syndrome is very common. About 2 to 5 in 100 people suffer from it. It is twice as present in women than in men. The phenomenon increases with age, but can begin at any age, even in childhood. Complaints start around the age of 27, on average.

In people who take conventional antipsychotics, akathisia occurs in 2 to 3 in 10 people.

How to recognize it?

The characteristic of restless legs syndrome is that you slightly bend your foot and knee every 20 to 30 seconds while sleeping. It can lead to serious insomnia.

With Akathisia, you experience an inner restlessness that prompts you to cross and uncross your legs, swing, stamp, or walk in place.

How is the diagnosis made?

The doctor will listen to your symptoms. He will examine your legs and pay special attention to abnormalities in the skin, blood circulation, tenderness, and muscles. If the doctor suspects restless legs, they will take a blood test to check for iron and kidney function.

What can you do ?

Often, there isn’t much you can do about restless legs. Here are some general tips for promoting good night’s sleep:

• It is best not to drink coffee in the evening.
• Get enough exercise during the day.
• Do not exercise before bedtime.
• It is better to quit smoking.
• Drink no more than two glasses of alcohol per day.

If your sleep is so disturbed that you can’t do what you want during the day (insomnia), it is recommended to consult a doctor. Restless legs syndrome during pregnancy almost always goes away automatically after childbirth.

If you have akathisia from taking antipsychotics, contact a doctor or psychiatrist.

What can your doctor do?

The doctor will check if there is a trigger for restless legs. If you are in lack of iron, he will prescribe an iron supplement. In case of’insomnia, it is possible to administer a light sleeping pill (benzodiazepine). Numerous sleeping tablets have a relaxing effect on the muscles. But the problem is, you may become addicted to it and need to increase the doses to get any effect. The doctor, along with you, will weigh the pros and cons of treatment with a sleeping pill, especially in relation to the severity of theinsomnia. There are also drugs that sometimes reduce symptoms, but the side effects of these drugs when taken for a long time are not known. This is why often there is no good treatment for restless leg syndrome.

In case of akathisia, the doctor will see if it is possible to reduce the dose of the antipsychotics, or even to stop the medicine completely and replace it with another one.

Want to know more?

• Sleep – Christian mutuality

• Physical activity – Eat Move – Health question
• Stop smoking. It’s possible – Tabacstop
• Alcohol, the point on your consumption – Stop or else?
• Sleeping pills and sedatives, think of other solutions first (video) – SPF Public health, food chain safety and the environment
• Benzodiazepines – CBIP – Belgian Center for Pharmacotherapeutic Information

• Antipsychotics – CBIP – Belgian Center for Pharmacotherapeutic Information

Source

Foreign clinical practice guide ‘Restless legs syndrome and akathisia’ (2000), updated on 19.02.2016 and adapted to the Belgian context on 31.03.2018 – ebpracticenet