In recent years, restless leg syndrome has become increasingly common and is found at a high rate. Our department cured a case of this patient, and we will first briefly review it.
I. Restless legs syndrome in children
A report in the new issue of the American Journal of Pediatrics shows that approximately 2% of children in the United States and the United Kingdom are currently affected by restless legs syndrome. The prevalence of this disorder in children has drawn the attention of the pediatric medical community. Zhang Jianxin, Department of Spinal Orthopedics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine
Restless legs syndrome is a neurological sleep disorder with the typical symptom of very uncomfortable non-painful abnormalities in both lower limbs during nighttime sleep and involuntary movement to relieve the discomfort, thus making sleep disrupted. And moderate to severe restless legs syndrome, will also be accompanied by sleep disorders, negative mood and other serious symptoms.
Researchers say that when children complain of leg discomfort while sleeping, adults and even many doctors often think it’s a “growing body” or “growing pains. Now, it seems, doctors and parents should pay enough attention to leg abnormalities in children. Moreover, many adult patients with restless legs syndrome often have symptoms as children. The survey also confirmed that restless legs syndrome has a strong genetic component, with 70% of the children surveyed having at least one parent with the condition and 16% having both parents with the condition.
Restless legs syndrome in the elderly
Restless legs syndrome is a condition that occurs when there is discomfort in the limbs during sleep, forcing the limbs to move involuntarily and causing insomnia. As early as 1672, Thomas Willis, an English doctor, first described Restless legs syndrome (RLS), also known as Ekbom syndrome, whose clinical manifestation is usually extreme discomfort in both lower limbs during sleep at night, forcing the patient to keep moving the lower limbs or walking on the floor, resulting in severe sleep disturbance. Although the disease is not life-threatening, it seriously affects the quality of life of patients. Foreign epidemiological data show that the prevalence is 1-10% of the total population, and the prevalence in China is estimated to be around 1.2-5%, common in middle-aged and elderly people. It is a more common disease, and its incidence is much higher than other neurological diseases such as multiple sclerosis, Parkinson’s disease or Alzheimer’s disease.
III. Classification
The syndrome is divided into two categories: primary and symptomatic.
The cause of primary restless legs syndrome is unknown, and a few patients have a family history.
2, symptomatic restless legs syndrome secondary to other diseases, commonly due to the following causes: uremia, iron deficiency anemia, folic acid deficiency, pregnancy, rheumatoid arthritis, Parkinson’s disease, multifocal neuropathy, metabolic diseases and drugs.
IV. Clinical diagnosis and performance
Diagnostic criteria: The International Restless Legs Syndrome Study Group (IRLSSG) has developed a minimum diagnostic criteria consisting of four symptoms
1. Abnormal sensations: Indescribable discomfort in the limbs leads to 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 extending the lower limbs, or grinding and turning in bed.
3. Symptoms are aggravated at rest and can be temporarily relieved by activity.
4. The symptoms worsen at night and reach a peak late at night. The clinical features are a spontaneous, unbearable painful abnormal sensation occurring in the lower extremities. It is most common in the gastrocnemius muscle and can occasionally occur in the thighs or upper extremities, usually symmetrically. Patients often complain of a tearing, creeping, tingling, burning, painful or itchy sensation deep in the lower extremities. Patients have an urgent and intense feeling of needing to move and this leads to hyperactivity. Symptoms occur at rest and can be partially or completely relieved by activity. Normally, symptoms become intense at night while lying in bed and peak after midnight, forcing patients to kick their legs, move their joints or massage their legs, often describing “not having a comfortable place to put their legs.” In severe cases, the patient has to get up and walk constantly to get relief. Insomnia is a natural consequence, and most patients experience periodic movements of sleep (PMS), a stereotypical, repetitive flexion of the legs that occurs during REM sleep and wakes the patient. As a result of the nocturnal sleep disorder, the patient suffers from severe daytime sleepiness and reduced ability to work.
Laboratory tests: For patients with recent symptoms blood glucose, serum iron, ferritin, folic acid, vitamin B12, creatinine, and thyroid stimulating hormone should be checked.
Other ancillary examinations: head
Imaging of the lower extremities is overwhelmingly normal
V. Differential diagnosis
The disease should be differentiated from leg spasticity, fibromyalgia and antipsychotic-induced sedentary inability. It should also be differentiated from neurosis, which often has traumatic factors, psychological background, variable symptoms, daytime and nighttime, and is not limited to the lower extremities.
Prevention and treatment
(1) Find the cause as far as possible, and treat the primary cause, such as iron supplementation to correct iron deficiency anemia, treatment of hypothyroidism, and control of diabetes.
(1) Find the cause as much as possible and treat the original cause, such as iron supplementation to correct iron deficiency anemia, treatment of hypothyroidism, and control of diabetes.
(2) Avoid factors in daily life that may lead to certain neurotransmitter dysfunction, such as smoking, drinking alcohol, drinking large amounts of coffee or strong tea, etc.
(2) Avoid factors in daily life that may lead to certain neurotransmitter dysfunction, such as smoking, drinking alcohol, drinking large amounts of coffee or strong tea, etc.
(3) Sleep on time every day, soak your feet in warm water for 10-20 minutes before going to bed, or massage your calves to help you fall asleep.
(4) If the symptoms seriously interfere with sleep, you can use sedative-hypnotic drugs (such as Snow or Valium tablets) before bedtime.
(5) To be in a good frame of mind, do not count gains and losses, to achieve a difficult time.
(6) Do not overdo work, labor, exercise and walking, climbing stairs to avoid muscle soreness and over-exhaustion.
VII. Epidemiology
The incidence is reported abroad as 5% to 15, most of which are idiopathic, of which about 1/4 to 1/2 have family history, mostly autosomal dominant inheritance. The incidence can occur at any age, with 40% of the patients showing symptoms before the age of 20, 11% in pregnancy, up to 24% in anemia, and secondary factors in the elderly.