Those restless legs

Sophia Bielecki describes it as having "crazy legs."

"It feels like there are creepy crawlers all over my legs," said Bielecki, 86, of Greensburg.

Physicians know the symptoms as restless legs syndrome, or RLS. It's a sensory disorder, an uncomfortable sensation that causes an almost irresistible urge to move the legs, especially when a person is at rest.

Movement eases the twitchy feelings, but only for awhile. And medication recently approved to treat the syndrome has side effects that make some RLS sufferers shy away.

Bielecki was diagnosed with the syndrome in 1979.

"It hits me at night," she said. "My feet will start to move from side to side, up and down."

It may sound like a minor problem, but that jittery, tingling, burning or achy feeling robs people of sleep. In fact, RLS is a major cause of insomnia and fatigue.

"When patients diagnosed with RLS do sleep, it's not a restful sleep, so they wake up very tired," said Dr. Steven B. Gelfand, a neuro-psychiatrist with Neuropsychiatric Associates in Indiana. "Most people have a fairly mild form, and medicine will help. One in 100 has a severe form of the disease."

Researchers at the Johns Hopkins Center for Restless Legs Syndrome say about 12 million Americans suffer from RLS. Many are older adults, but the syndrome can make itself known at any age.

"It was discovered 300 years ago," Gelfand said. "In 2003, the International Restless Legs Syndrome study group estimated that 10 percent of the European population is affected. Five percent of the U.S. population and a very small percentage of the Asian population have RLS. It tends to run in families."

Despite its prevalence, the condition isn't well understood. The National Institutes of Health identifies two types of RLS: primary, or idiopathic RLS, the most common type, and secondary RLS.

No one knows the cause of primary RLS, but once it starts, it usually is a lifelong condition, specialists say. Symptoms tend to worsen with time and to occur more often, especially if they begin in childhood or early in adult life. Patients with milder cases may experience long period with no symptoms, or symptoms may last only for a limited time.

Secondary RLS is caused by another disease or condition, or sometimes by medications such as antidepressants or anti-nausea drugs. Symptoms usually go away when the underlying disease or condition improves, or if the medication is stopped. Iron deficiency, kidney failure, diabetes, damage to the nerves in the hands or feet, rheumatoid arthritis and even pregnancy can trigger secondary RLS.

Some people with RLS also have a condition called periodic limb movement disorder, which causes their legs -- or occasionally their arms -- to twitch or jerk uncontrollably every 10 to 60 seconds, usually while they sleep. Like restless legs, these movements cause repeated awakenings.

Bielecki's symptoms began after she suffered a bad fall at work.

"I worked as a waitress and fell in the restaurant," she said. "I injured my foot, ankle and both knees. My doctor told me the fall injured nerves in my legs."

Gelfand said the condition may be caused by an imbalance in chemical activity in some regions of the brain.

"There is no damage that can be discerned through the muscle or tissue level," added Dr. Michael Sauter, of Westmoreland Neuroscience Center, in Greensburg.

Roughly twice as many women as men suffer from RLS. "This suggests there is a hormonal contribution that makes women more susceptible to restless legs syndrome," he said.

Doctors frequently suggest lifestyle changes as the first step toward quieting the unwanted sensations. They often recommend that sufferers quit smoking and reduce their intake of caffeine and alcohol. They may suggest daytime exercise, stretching or massage, as well as warm baths to ease the muscles and a regular sleep schedule to help fight fatigue.

"Our awareness of restless legs syndrome has increased," Sauter added. "It is a frequent problem, so individuals don't have to feel so isolated."

Jacqueline Brunot, of Scottdale, had symptoms for several years before she was diagnosed with RLS in July.

"I was having a lot of leg cramping when I was pregnant with my first son," said Brunot, 24. "During my second pregnancy, the symptoms got even worse."

Her twitching legs awakened her nearly every night during her pregnancies. Now, she said, symptoms occur about twice a week.

"My doctor prescribed Requip, but I don't take it because it can cause sleepiness," said Brunot, who works as an admissions clerk at Westmoreland Regional Hospital. "The longer I sit, the worse the symptoms get. If I elevate my legs, they start to move.

"I was supposed to eliminate caffeine from my diet, but I'm so tired all the time, I have no other way to stay alert."

Requip, a brand name for ropinirole, was approved by the U.S. Food and Drug Administration in October 2005 to treat restless legs syndrome. Ropinirole is a member of a class of drugs called dopamine agonists, which originally were developed to treat Parkinson's disease.

"Patients with restless legs respond very well to drugs that are used to treat Parkinson's because of the dopamine. Dopamine agonists enable the dopamine in the body to work better," Gelfand explained.

Dopamine is a chemical in the brain that controls body movement, and dopamine agonists stimulate the brain's dopamine receptors to ease movement and balance problems. Other dopamine agonists include pergolide, sold as Permax, and pramipexole, sold as Mirapex. Both are used to treat moderate to severe RLS.

Although the medication may ease symptoms, they also have side effects. In addition to sleepiness, dopamine may cause hallucinations, upset stomach, irritability and irregular movements during waking hours, Gelfand explained.

Bielecki and Brunot both have declined to take medication to alleviate their RLS symptoms. Instead, they try to keep their restless legs in motion.

"I walk and walk, or I lie down on the floor and exercise," Bielecki said.

"Walking is the only thing I found that helps," echoed Brunot. "I walk around until I get tired."

Additional Information:

Easy does it