A. What are the clinical manifestations of restless legs?
1, a spontaneous, unbearable painful abnormal sensation and pain in the lower extremities: sensory abnormalities are most common in the distal extremities, especially the gastrocnemius muscle, occasionally also occurs in the thighs, feet or upper extremities, usually symmetrical.
2. Symptoms occur at rest, i.e., at rest, and can be partially or completely relieved by activity: bed rest is the most common aggravating factor, and symptoms become intense at night when lying in bed and reach a peak of pain and discomfort late at night, walking is most effective in reducing leg symptoms.
Forced restless movement: Restless movement is related to the patient’s desire to move the affected limb. Forcing the patient to remain still often aggravates the symptoms and occasionally causes involuntary limb contractions.
4. The symptoms are aggravated in the evening or late at night.
5.Secondary insomnia.
Etiology: restless legs are divided into primary and secondary types according to the etiology of the disease.
1, primary restless legs usually onset at the age of 10 to 20 years, after excluding any possible secondary causes, 25% to 50% have a family history. Causes of secondary RLS include pregnancy, end-stage renal disease, iron deficiency anemia, folic acid and/or vitamin B12 deficiency, peripheral neuropathy, lumbosacral radiculopathy, myelopathy, tremor palsy, diabetes, rheumatoid arthritis, hypothyroidism, amyloidosis, dry syndrome, macroglobulinemia, chronic obstructive pulmonary disease, post-partum gastrectomy, tumors, peripheral vascular micro The author has encountered disturbances in clinical practice. The author encountered in the clinical treatment of patients with restless legs, after 15 to 30 years of painful abnormal sensation and pain at night, there are three cases whose daughters also have similar symptoms, all three patients are caused by iron deficiency anemia, after a clear diagnosis of taking iron for 1 to 3 months, the symptoms are eliminated.
2, peripheral nerve abnormalities: many patients with restless legs have abnormal sensory and motor nerve conduction velocities.
3, vascular factors: some scholars have proposed that restless legs are due to vascular disease resulting in the accumulation of metabolites in the legs, leg exercise can promote blood circulation, so that the symptoms are reduced. Vasodilators can reduce the symptoms also support this view.
Treatment: Restless legs (RLS) has become a treatable disease.
Treatment should be individualized according to the following conditions.
(1) Iron series examination.
(2) Severity of the disease.
(3) frequency/duration of symptoms.
(4) Presence of pain.
(5) Adverse drug reactions.
1. Etiological treatment.
A. Iron Iron replacement therapy
Many patients with restless legs have been suffering from iron deficiency for years or even decades without being taken seriously, and are often misdiagnosed and misdiagnosed, leading to misdirection of treatment. For patients with iron deficiency, iron supplementation is the only treatment. Each dose of 50 to 65 mg of iron should be given orally, and depending on the degree of iron deficiency, it can be given orally once a day to three times a day.
B. Etiological treatment of other diseases causing restless legs: With the elimination of the cause, the symptoms of restless legs will disappear, such as the etiological treatment of diabetic patients; the etiological treatment of uremic patients such as renal transplantation or iron supplementation; folic acid supplementation for patients with folic acid deficiency, etc. Inositol 1g, taken once a night. Use of vasodilators; antispasmodics, etc.
2. Other drug treatments.
Treatment drugs for restless legs dopaminergic drugs, opioids, benzodiazepine agonists, antiepileptic drugs.
A, levodopa and dopaminergic drugs: levodopa is a classic drug for the treatment of Parkinson’s disease . Levodopa drugs have become the main drugs for the treatment of restless legs. Later, some scholars found that compound levodopa is more effective than levodopa in the treatment of RLS.
B. Opioids: opioids can be considered as the first-line treatment for patients with restless legs who have neuropathic or painful abnormal sensory manifestations.
C. Anticonvulsants and benzodiazepines: The anticonvulsant drug carbamazepine and the recently used gabapentin are also effective drugs for the treatment of restless legs.
3.Nerve block treatment.
Sacral block or low epidural block can be used. Twice a week, 5 times a course of treatment; medication: low concentration of lidocaine: 0, 5% lidocaine, or low concentration of bupivacaine 0, 125% bupivacaine; and vitamin B12 combination, this method combined with oral medication to treat restlessness receding has special effects.