Restless legs syndrome is a common disease in the elderly, with a prevalence estimated at 1,2-5% in China, with a much higher incidence than other neurological diseases such as multiple sclerosis, Parkinson’s disease or Alzheimer’s disease. Although the disease is not dangerous to life, it seriously affects the quality of life of patients and should be taken seriously.
When the patient rests or sleeps at night, a spontaneous, unbearable-like abnormal painful sensation appears in both lower limbs, such as soreness, tearing, burning, pain, tingling, itching and insect crawling. It is most common in the calf gastrocnemius, but can also occur occasionally in the thighs or upper extremities. Patients often describe it as “not having a comfortable place to put the legs”, lasting from a few minutes to all night long. Patients are forced to kick their legs, move their joints or massage their legs, and in severe cases, they have to get up and walk constantly to get relief, resulting in severe sleep disturbances and daytime sleepiness and reduced work capacity. In some cases, alternating, periodic muscle hyperactivity from one lower extremity to the other is accompanied by periodic limb movements during sleep. PMS is a stereotyped, repetitive flexion movement of the legs that occurs during REM sleep and can wake the patient up.
I. The syndromes are divided into two categories: primary and symptomatic.
1, primary restless legs syndrome, the cause of which is unknown, and a few patients have a family history.
2, symptomatic restless legs syndrome, secondary to other diseases, commonly caused by: uremia, iron deficiency anemia, folic acid deficiency, pregnancy, rheumatoid arthritis, Parkinson’s disease, multifocal neuropathy, metabolic diseases and certain drugs.
Second, the International Restless Legs Syndrome Study Group has developed a minimum diagnostic criteria consisting of four symptoms.
1. Abnormal sensations: indescribable discomfort in the limbs resulting in a strong desire to move the limbs, mainly the lower limbs. These abnormal sensations often occur deep in the limbs rather than on the surface, such as the skin.
2. Motor symptoms: The patient cannot sleep and keeps moving the limbs to relieve the abnormal sensations. The main manifestations are walking back and forth, constantly shaking or flexing and stretching the lower limbs, or grinding and turning in bed.
3. Symptoms are aggravated at rest and can be temporarily relieved by activity.
4. Symptoms are worse at night and reach a peak late at night.
Under normal circumstances, the blood circulation in the muscle tissue can ensure the adequate supply of oxygen and nutrients during muscle activity, and take away metabolic waste, so that the muscle can move freely. However, when the blood vessels supplying muscle blood become diseased, the lumen narrows, and the body is in a quiet state, the heart rate slows down, blood flow slows down, the blood supply decreases and metabolic wastes (such as lactic acid) accumulate, the normal activity of the muscle is affected and the disease is triggered. The elderly are mostly caused by senile atherosclerosis, so the key to preventing this disease is to prevent the occurrence of atherosclerosis in the elderly.
Specific measures are.
1, quit smoking and avoid alcohol, avoid mental tension, emotional excitement, anxiety, depression, sulking, irregular life, overwork, etc., which can affect lipid metabolism and promote the formation of atherosclerosis.
2, adhere to physical exercise, such as walking, jogging, tai chi, gymnastics, etc., can promote blood circulation, accelerate body fat metabolism, which is conducive to controlling weight growth and reducing blood lipid levels.
3, appropriate diet and reasonable diet to avoid overweight and high blood lipids; avoid eating more cholesterol-rich (fatty meat and animal offal) and high-sugar foods; should eat more high-fiber foods (coarse grains), green leafy vegetables and fruits.
4, vascular diastolic exercise, the method is to adhere to the cold and hot water alternating bath or cold and hot water alternating bath (that is, first with cold water bath or bath, then hot water bath or bath), so that vascular diastolic movement, can prevent or delay atherosclerosis.
5.If the blood lipid is too high, you can take lipid-lowering drugs under the guidance of a doctor to delay the occurrence of atherosclerosis.
6. Chinese herbal medicine can be used to prevent the occurrence of restless legs by treating the deficiency and dampness, activating blood circulation and removing blood stasis.
Third, the restless leg syndrome treatment.
1.General treatment Wash feet with warm water before going to bed, or wash lower limbs with mugwort water. Massage the local muscles. Should develop the habit of regular exercise, especially to strengthen the exercise of the legs, every morning or before bedtime after washing the feet, rub the heart of the feet with your hands, first in the heart of the feet left and right, then back and forth, and finally turn around and rub until hot, red and comfortable, which helps to improve the blood circulation and nutritional status of the legs and prevent symptoms such as numbness, weakness and coldness.
2, pay attention to a balanced diet, less meat and more vegetarian food, quit smoking to reduce blood viscosity.
3.Symptomatic treatment If anemia is present, correct the anemia. If the attack occurs during pregnancy, the symptoms can disappear after delivery.
4.Medication.
(1) Inositol 1g, taken once a night.
(2) Treatment with vasodilators, such as niacin, scopolamine 5mg. 1 time daily.
(3) Use dopaminergic drugs or dopamine agonists, such as methyldopa 125-250mg, Shinnymed 125mg, once a day. Less commonly used in China.
(4) Antispasmodics such as carbamazepine or sodium valproate, both 0,1g, once before bedtime.
(5) Use vitamin B1 100mg, and vitamin B2 50mg, alternately injected in the body parts of the commission, Chengshan or along the peroneal nerve stem, one point of the affected limb once a day, 5 days as a course of treatment.
5.Chinese medicine treatment: 10g of white peony, 10g of licorice, 18g of papaya, 18g of hyssop, decoction with water. White peony 12g, raw licorice 6g, raw oyster 30g (first decoction), yam 10g, papaya 10g, wai ling xian 10g, decoction with water.