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Neurology (Expert Forum)
RLS
Answered by
CCFNeuroMD JT, MD - Neurology/Epilepsy, Neurology/General
Cleveland - OH
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury
RLS
by Cairn, Jan 24, 2008 02:19PM
Hello..I wonder if anyone can help me..preferably a doctor. For years I have suffered from hot tight aching calf muscles which wakes me every night about 3.00am. Massage and stretching helps a bit and getting up...but there is no urge to move my legs (except to find a cool spot in the bed) as in RLS or uncontrolled movement. This feeling is also often in my lower arms; the ache has a numb quality to it. I used to be such a chilly mortal, now my legs feel better uncovered. I have seen a neurologist who said it was RLS and prescribed Dopamine...which did not help so I stopped taking it...even a higher dosage did not help - in fact it appeared to get worse. I don't want to take this drug for the rest of my life if I am not sure I have Restless legs
Doctor's Answer
by CCFNeuroMD JT, MD, Jan 24, 2008 06:27PM
, Jan 24, 2008 06:27PM
To: Cairn
Dear Cairn,
Thank you very much for your question. I am happy to address the issues that you pose, although it is important that you recognize that my impression is based entirely on the information you have provided in your posting and is by no means a replacement for an office visit with a neurologist. Diagnosis is contingent on detailed history and physical exam and as such, the following information should be considered solely for educational purposes.
As you may have already come across in your reading about Restless Leg Syndrom (RLS), there are a number of diagnostic criteria that should be met. As a review, these criteria incude:
(1) An urge to move the legs, usually caused by an uncomfortable sensation in the legs.
(2) Relief of the unpleasant sensation with movement.
(3) Onset or worsening of symptoms at rest.
(4) Worsening of symptoms at night.
Although you surely seem to fulfill the latter 2 criteria, from the history you have given, it is not clear to me that you have an urge to move the legs nor that movement makes your symptoms better. Although without a thorough history and exam, it is difficult to give you a concrete diagnosis, it sounds to me that you are suffering from "nocturnal leg cramps." In this condition, patients describe a sudden involuntary spasm of the calf muscles (and sometimes feet); the contraction phase usually lasts 10-20 seconds, although there may be some post-contraction soreness that lingers. This condition is more common in middle-aged to older individuals but can also occur in younger people as well. Interestingly, it is often mistaken for RLS. No definite causes have been identified, yet there are stipulations that various conditions such as diabetes, hormone imbalances, Parkinson's Disease, and medications may be linked with symptoms (this is just speculation). In the general population, it is very often an isolated ailment and not associated with any worrisome problems.
Unfortunately, there are no miracle cures for nocturnal leg cramps. Most physicians advise patients to drink plenty of water throughout the day, stretch the affected muscles, and to wear good shoes. Some patients have noted a reduction in symptoms by exercising the muscles for 5-10 minutes before bed (i.e. treadmill or bike). Moist, warm compresses (be careful not to burn yourself) or a warm shower at bedtime may also help. If these conservative measures are unhelpful, some patients find relief with quinine sulfate. because this medication can have adverse effects, it is important to consult your physician prior to initiation.
So, to sum things up, it does not sound like you have RLS but may be experiencing nocturnal leg cramps. I hope that I have given you some useful information, and I wish you the best of luck with finding some relief.
Best,
JBT, MD
Thank you very much for your question. I am happy to address the issues that you pose, although it is important that you recognize that my impression is based entirely on the information you have provided in your posting and is by no means a replacement for an office visit with a neurologist. Diagnosis is contingent on detailed history and physical exam and as such, the following information should be considered solely for educational purposes.
As you may have already come across in your reading about Restless Leg Syndrom (RLS), there are a number of diagnostic criteria that should be met. As a review, these criteria incude:
(1) An urge to move the legs, usually caused by an uncomfortable sensation in the legs.
(2) Relief of the unpleasant sensation with movement.
(3) Onset or worsening of symptoms at rest.
(4) Worsening of symptoms at night.
Although you surely seem to fulfill the latter 2 criteria, from the history you have given, it is not clear to me that you have an urge to move the legs nor that movement makes your symptoms better. Although without a thorough history and exam, it is difficult to give you a concrete diagnosis, it sounds to me that you are suffering from "nocturnal leg cramps." In this condition, patients describe a sudden involuntary spasm of the calf muscles (and sometimes feet); the contraction phase usually lasts 10-20 seconds, although there may be some post-contraction soreness that lingers. This condition is more common in middle-aged to older individuals but can also occur in younger people as well. Interestingly, it is often mistaken for RLS. No definite causes have been identified, yet there are stipulations that various conditions such as diabetes, hormone imbalances, Parkinson's Disease, and medications may be linked with symptoms (this is just speculation). In the general population, it is very often an isolated ailment and not associated with any worrisome problems.
Unfortunately, there are no miracle cures for nocturnal leg cramps. Most physicians advise patients to drink plenty of water throughout the day, stretch the affected muscles, and to wear good shoes. Some patients have noted a reduction in symptoms by exercising the muscles for 5-10 minutes before bed (i.e. treadmill or bike). Moist, warm compresses (be careful not to burn yourself) or a warm shower at bedtime may also help. If these conservative measures are unhelpful, some patients find relief with quinine sulfate. because this medication can have adverse effects, it is important to consult your physician prior to initiation.
So, to sum things up, it does not sound like you have RLS but may be experiencing nocturnal leg cramps. I hope that I have given you some useful information, and I wish you the best of luck with finding some relief.
Best,
JBT, MD
thank you so much for taking the troble to answer my enquiry.
Like you, I am not convinced that I have RLS..but..I have been seeing an allopathic/naturopath for 6 months who made all kinds of tests, for magnesium definciency, including blood tests and has tried all kinds of chinese medicines on me plus kinesiology..and finally sent me to a neurology specialist who also did nerve tests. He said I didn't have to have a restless feeling in my legs for it to be RLS - which didn't make alot of sense to me, but, well he was the doctor.
Anyway I don't have cramps or spasms in my legs...just a very uncomfortable, hard to describe ache in the muscles and sometimes my feet and arms are affected. I get some relief by stretching the calf muscles, also after getting up and going to the bathroom. But I don't have an urge to move my legs particularly - I have not read anywhere that this awful heat in my legs is a symptom. Perhaps I should try another doctor or specialist. What do you think?
Many thanks
Magie Christen
Honestly, I would try drinking Gatorade or a similar electrolyte laiden sports drink each evening for a week or two and see if it helps.
You can ask your doctor to do a blood test to check your electrolytes, however it won't show what your electrolytes are like at 3am when you have these problems!
One thing I know I get low on is potassium because bananas are forbidden in my house (no one would ever move their bowels again if I have them around!).