Why do my legs twist in the weather and what can be done?

Restless legs syndrome (RLS) is a condition characterized by unpleasant, painful sensations in the lower extremities, which appear mainly at rest (usually in the evening and at night) and force the patient to make movements that relieve them, which leads to sleep disturbance.

Medical statistics state that worldwide, from 10 to 25% of the entire adult population have some form of RLS. RLS occurs in all age groups, but is more common in middle and old age. Sometimes remissions may occur, during which the symptoms weaken significantly or disappear altogether. However, symptoms usually reappear after some time and get worse over time. RLS accounts for approximately 15% of cases of chronic insomnia.

What is Restless Legs Syndrome?

Restless legs syndrome is a pathological condition consisting of an obsessive desire to move the legs, caused by a number of certain unpleasant sensations in the lower extremities. These sensations with restless legs syndrome can be pain or aching in the muscles, as well as itching, a burning sensation, crawling distension or twitching in the lower extremities.

Restless legs syndrome

These subjective symptoms more often occur at night or when taking a horizontal body position and relaxing. A significant weakening of the above symptoms occurs with contraction of the muscles of the lower extremities. Therefore, patients with restless legs syndrome have an obsessive need to move the lower extremities.

What are we dealing with?

RLS is not an independent disease, but one of the symptoms accompanying insomnia that occurs with endocrine, neuropsychiatric and other ailments. The syndrome is expressed in an unpleasant “itching” sensation in the lower - and occasionally upper - limbs. It occurs against the background of a person’s inability to relax and fall asleep.

Unpleasant sensations force the patient to look for ways to “extinguish” them. A person constantly changes his body position, tries to cover himself more comfortably with a blanket, wiggles his legs, gets up and walks around the room. The more such movements you have to make, the more nervous tension increases. Sleep disappears completely.

Treatment for restless legs syndrome

Taking multivitamins, anticonvulsants, and giving up bad habits often help get rid of restless leg syndrome.

Restless legs syndrome is a fairly common complaint in patients suffering from varicose veins for a long time. Chronic venous insufficiency, which occurs with varicose veins, disrupts the electrolyte balance in the tissues of the lower extremities, leading to the appearance of restless legs syndrome. This condition is well known to many patients with varicose veins. In some cases, wearing compression stockings may help, providing some relief. However, after some time, restless legs syndrome returns. Only radical treatment of varicose veins helps patients completely get rid of restless legs syndrome.

Restless legs syndrome is not a symptom exclusively of varicose veins. There are many other causes of restless legs syndrome. It is very likely that a therapist or neurologist will be able to help. However, if you have restless legs syndrome, it is better to visit a phlebologist and undergo a diagnosis of the venous system of the lower extremities.

Diagnosis of restless legs syndrome

If you have varicose veins, lifestyle changes and vitamin supplements will not be able to completely rid you of restless legs syndrome. Only good treatment for varicose veins will be an effective remedy for restless legs syndrome in this situation.

Causes of the syndrome

RLS can be both a cause and a consequence of insomnia.
Most often it occurs in patients over forty with one or another chronic disease, accompanied by problems with night sleep. It occurs with diabetes, joint diseases, hypertension, etc. RLS can also be associated with a deficiency of iron, magnesium, and vitamin B. It often occurs in pregnant women - in 20% of cases - due to changes in hormonal levels. Doctors and patients themselves noticed that after childbirth, the symptoms of RLS disappear by themselves.

The syndrome can also occur in healthy people without any hormonal changes. The reasons in such cases are:

• regular consumption of tonic drinks;
• permanent stress;
• excessive physical activity.

Scientists note: RLS is hereditary, which reflects the ability of the nervous system of relatives to react to external stimuli in a similar way.

Patient Questions About Restless Legs Syndrome

My legs twitch when falling asleep, what should I do?

If your legs twitch when falling asleep, you need to figure out the cause of this phenomenon. Convulsive contractions of the muscles of the lower extremities can be caused by a number of reasons. First you need to visit the following specialists: a neurologist and phlebologist. An ultrasound duplex examination of the veins of the lower extremities must be performed. Having understood the cause of the condition, it will be possible to completely get rid of convulsive twitching at night.

How to treat restless legs syndrome?

To understand how to treat restless legs syndrome, it is necessary to find out the cause of its occurrence. This will require consultations with the following specialists: a neurologist, phlebologist and therapist.

My legs twist a lot at night, what should I do?

If you experience severe leg cramps at night, seek medical attention. A very common cause of this condition is chronic venous insufficiency, complicating varicose veins.

Pain in legs at night when lying down, which doctor should I go to?

If you have pain in your legs at night when lying down, the first doctor you should visit is a phlebologist. At the beginning, it is necessary to exclude venous pathology. Perhaps a phlebologist will completely solve your problem.

How is it treated

The primary task of the doctor is to find out the causes of RLS and treat the underlying disease. As it is eliminated, the syndrome usually subsides, sleep improves, and the nervous system stabilizes.

In 28% of cases, RLS is obsessive and does not go away even after the root cause is eliminated. In this situation, medications are used (prescribed by a psychotherapist). It is also important to maintain a sleep schedule, equip the bed with a comfortable mattress, and exclude spicy foods and stimulating drinks from the menu.

help yourself

First of all, you should correct your own lifestyle, i.e. pay attention to compliance with the following rules:

• Normalize your sleep duration.
• A complete diet, excluding overeating and abuse of “junk” food.
• Smoking, drinking alcohol and drinking large amounts of coffee during the day. Take all this away.
• If pulling and aching sensations develop closer to the feet, valerian extract in tablet form or another herbal tranquilizer is recommended.

Causes

In most cases, RLS occurs in the absence of any other neurological or physical disease. RLS can be primary (ideopathic) or secondary (associated with various pathological conditions).

Medical conditions that may cause secondary RLS.

• Pregnancy
• Peripheral neuropathy
• Iron deficiency
• Radiculopathy
• Kidney failure
• Parkinson's disease
• Spinal cord injuries
• Diabetes
• Postgastrectomy syndrome
• Rheumatoid arthritis
• Abuse of strong drinks, coffee, tea and smoking.

It should be noted that not all patients with these conditions experience RLS. Sometimes there are familial cases when the disease is observed in several generations.

Traditional methods

The express method is a hot bath based on a decoction of chamomile flowers. The latter should be prepared as follows: pour 50 g (about three tablespoons) of medicinal herb into 1 liter of water and boil for a quarter of an hour. Then leave the broth for 2 hours and add warm bath water.

As a method of treatment, local (on the “twisting” area) use of an ordinary cabbage leaf can be used, then it should be fixed and such a compress should be maintained for several hours.

Etiological information

The described discomfort condition occurs mainly in the area from the knee joints to the feet, in the area of ​​the calf muscles. And as a rare option, it turns above the knee joints. What is the reason for this? There are many causes of pain in the limbs:

1. In the ankle-knee area, pain may be felt due to the accumulation of excess blood volume, and excessive expansion of the vascular network occurs, which, in fact, provokes discomfort.
2. Hereditary tendency. It appears when parents experience a similar phenomenon.
3. Changes in weather conditions. During a change in weather, a transformation of atmospheric pressure occurs, the body perceives such changes instantly, which also acts as a causative factor when it twists its legs.

Weather sensitivity is the body's ability to physically sense weather changes. This reason is quite common, and it is believed that 50% of the fair sex and 30% of the masculine sex are weather sensitive.

Meteopathy is a pathological dependence of the human condition on climatic fluctuations. The disease can mainly occur in people with chronic pathologies in the musculoskeletal system, or with a history of leg injuries. They accurately predict the weather, especially in combination with exacerbations of arthrosis-arthritis.

The most noticeable weather transformations include a decrease in atmospheric air pressure, colder temperatures, and an increase in air humidity. The pathphysiology is explained by the course of most degenerative disorders of articular joints, accompanied by death or damage to the neuro-terminals in them. An increase in humidity or pressure in the joint activates inflammation with subsequent involvement of the “sick” nerve in the algic process, and this gives rise to sharp and characteristic pain.

1. A mechanism similar to the previous one can also be observed when driving in mountainous areas, mainly when climbing uphill.
2. Fatigue of the lower extremities. This is a rare phenomenon; it is typical for people with a sedentary lifestyle (sedentary work). In this position in the lower part of the body, blood retention develops in the vessels of the legs, while blood flow in them decreases.
3. And the main reason, probably, may be pathological changes in the vascular network of the extremities. In combination with a sedentary lifestyle, vascular pathologies can provoke the development of a painful syndrome.
4. Pregnancy. The phenomenon goes away after delivery, but women are most susceptible in the second and third trimester. This condition is explained:
   Iron deficiency anemia.
5. Hormonal changes in the body (increased estrogen levels)
6. Lack of magnesium and vitamins gr. IN.
7. Venous insufficiency, which occurs due to deterioration of blood circulation. In this case, wearing compression garments and frequently standing in a position with elevated legs is indicated.
8. Excessive consumption of coffee and tea. You should not drink more than 5 cups of coffee per day.
9. Drinking alcoholic beverages.
10. Taking lithium-containing drugs, neuroleptics, calcium antagonists, tricyclic antidepressants.

Symptoms

Twisting your legs in response to the weather is the main manifestation of this symptom. Moreover, the sensations can range from barely noticeable to quite strong.

Discomfort may develop in the knees and then gradually move down. The calf muscles become especially sensitive to this phenomenon. The condition is especially aggravated closer to night. The patient has to give up long walks and any activities that involve straining the legs, such as squats.

Pain in the calf muscles varies in intensity. It all depends on what caused the problem. If it is an old fracture, dislocation or other damage to the skeletal system, then it is mainly the bones and joints that suffer. In this case, muscles are rarely affected.

If the cause is a sprain or rupture of the ligaments, then discomfort will appear in these places. But one should not think that this condition is typical for all people who have had injuries. Usually at a young age everything passes without a trace. But in old age, the statement that the arms and legs are twisted in response to the weather can be considered very common.

Types of pain

With varicose veins, there is heaviness in the legs at the end of the working day. Along with it, swelling of the ankles appears. Over time, altered, dilated, deformed veins are noticeable. Thrombosis does not occur without sharp, ongoing pain. With pathology of the arteries, convulsions and pallor of the extremities are possible. Periodically there is a pulling pain that occurs when walking. Feet and calves may be cool. Muscle damage is manifested by a tugging, pulling pain. It bothers a person when making movements or performing active physical exercises. Legs hurt below the knees and with neuritis, polyneuritis. A person experiences severe, paroxysmal pain that spreads throughout the entire nerve, causing numbness. Legs hurt below the knees in women and men and during the inflammatory process. It is accompanied by hyperemia, increased tissue volume, temperature, and dysfunction of the organ. Rarely, but still, the bone on the leg below the knee in front or behind may hurt due to a tumor.

How to treat leg pain below the knees

After the doctor determines the reasons why the legs hurt below the knees in women and men, appropriate treatment will be prescribed. In each case it is individual. For varicose veins, compression therapy is used. It is possible to correct the movement of blood through the veins with the help of venotonics. Anti-inflammatory drugs and antibiotics will help reduce inflammation. Warming compresses are indicated for myositis, etc. Physiotherapeutic procedures are an excellent addition.

phlebolog.pro

Frequency and diagnostic criteria for restless legs syndrome (RLS)

The frequency of RLS, according to various sources, ranges from 2 to 10% among the adult population.
Diagnostic criteria for restless legs syndrome were proposed by Ekbom in the 60s, and a clear formulation of RLS as an independent disease was given in 1979, the last revision of the criteria was carried out in 2012. The diagnosis is established based on the patient's complaint, which must meet all 5 main criteria.

If your complaints do not meet the criteria for Restless Legs Syndrome, then you have a completely different disease and you should continue the diagnostic search. How to determine the cause of leg pain with a high degree of probability based on a complaint, read here>>

Differential diagnosis

RLS should be distinguished from other conditions with similar manifestations:

• night cramps
• positional discomfort of the lower extremities
• venous insufficiency
• arterial insufficiency
• akatasia
• polyneuropathy
• radiculopathy
• Parkinson's disease

Night cramps

more often they occur on one side, in the area of ​​the foot or lower leg; they also have a circadian rhythm and appear at rest. In this case, a short-term muscle spasm occurs, which, unlike RLS, quickly disappears if you pull the sock toward you or do stretching.

Positional discomfort of the legs

characterized by localized pain in a specific small part of the leg or foot. The pain occurs after prolonged sitting and does not follow a circadian rhythm.

RLS differs from both of these conditions in that larger areas of the lower extremities are involved, the symptoms are persistent and long-lasting, and relief is provided only by walking or other activity.

For venous diseases (chronic venous insufficiency)

patients complain of discomfort in a standing position, which goes away when walking or lying with their legs raised up. Complaints may intensify in the evening or in the afternoon, while patients feel better in the morning. Taking dopaminergic drugs does not improve the condition of venous insufficiency.

Changes in the skin of the legs may be of vascular or neurotrophic origin. Trophic skin disorders are not typical for RLS.

For arterial lesions (atherosclerosis, endarteritis)

the pain appears when walking a certain distance, for example 200-300 meters, and quickly goes away at rest. This is called intermittent claudication. Unlike RLS, patients feel better at rest and have no desire to move.

Akathisia

is a condition that is most often a side effect of antipsychotic medications. Characterized by internal motor restlessness, the need to move, change position. It is difficult for the patient to sit still and remain in one position. However, there is no circadian rhythm, RLS mainly occurs at night and disrupts sleep. If the patient is taking antipsychotics, akathisia should be suspected first.

Polyneuropathy

manifests itself as a painful burning sensation in the arms or legs. Paresthesia (tingling, goosebumps), increased skin sensitivity, and painful touch are also characteristic. Neuropathy is not characterized by circadian rhythms and motor restlessness; movement does not bring relief. Dopaminergic treatment does not help.

Lumbosacral radiculopathy

differs from RLS by low back pain and asymmetric sensory paresthesia. It is necessary to keep in mind that radiculopathy can be combined with RLS.

Parkinson's disease (PD)

RLS may occur. Both conditions improve with dopaminergic drugs, although their pathogenesis is different. Parkinson's disease can mimic the symptoms of RLS, presenting with akatasia and restless legs. Restless legs is diagnosed in patients with Parkinson's disease who feel the urge to move their legs but do not meet the basic criteria for RLS.

RLS can be quite painful for the patient. However, this disease is treatable. It is recommended to base treatment on the severity of the disease and the presence of comorbidities.

According to the characteristics of the symptoms, three forms of the disease can be distinguished - intermittent RLS (periodic courses of treatment), chronic persistent RLS (daily therapy), refractory RLS (ineffectiveness of dopamine agonists / intolerance or side effects / enhancement effect in response to treatment).

Iron supplements

There is now convincing evidence that iron deficiency in the brain plays a role in the development of RLS. Treatment with iron supplements in patients with anemia resulted in significant improvement in several studies.

It is known that restless legs syndrome is detected in every fourth patient with iron deficiency anemia; the likelihood of developing RLS with anemia is 9 times higher compared to the general population.

It is recommended to examine serum iron levels

in all patients with RLS. When serum iron levels are below 75 ng/L, replacement therapy leads to significant improvement in most cases.

Conventional treatment begins with 325 mg of ferrous sulfate taken orally daily along with 100-200 mg of vitamin C to increase iron absorption.

Intravenous iron supplementation is known to rapidly replenish iron stores and require fewer administrations than oral therapy, but is less convenient. Intravenous administration of iron supplements is carried out when oral therapy is ineffective, intestinal absorption is impaired, and blood loss continues.

Non-drug therapy

Non-drug therapy is prescribed in all cases, but there is not much reliable data on effectiveness. Typically recommended:

• abstaining from alcohol and caffeinated drinks
• proper sleep hygiene
• pneumatic compression devices
• compression jersey (knee socks)
• gymnastics complex
• light aerobic exercise

Previously proposed vibration devices or massagers, when carefully evaluated, did not demonstrate benefits and their effect has not been proven.

Intermittent form (periodically occurring symptoms)

Symptoms occur no more than twice a week, but cause obvious discomfort. Non-drug treatment is started, and if there is no effect, medications are added.

Drug therapy includes carbidopa/levodopa, dopamine agonists, low-potency opioid analgesics (codeine or tramadol), or sedative hypnotics (temazepam or zolpidem).

When prescribing carbidopa/levodopa, one must remember the possibility of rebound syndrome, as well as amplification or “augmentation” syndrome. This complication of drug therapy is an increase in the manifestations of RLS and is characterized by an increase in the intensity of symptoms, their earlier appearance (during the daytime), a decrease in the asymptomatic period at rest, and the involvement of other parts of the body - arms, torso, face. Recent studies suggest that augmentation occurs more frequently with levodopa compared with dopamine agonists. The amplification phenomenon can cause worsening treatment outcomes, switching to the use of a drug of another class, or discontinuation of treatment.

Chronic persistent form of RLS

This form of RLS is characterized by a moderate to severe course, symptoms appear at least 2 times a week and are persistent. Before prescribing pharmaceutical therapy, it is necessary to explain to the patient that the goal of treatment is not to completely eliminate symptoms, but to reduce their intensity to a level where their quality of life is not affected.

Primary therapy usually includes either dopamine agonists or anticonvulsants (β2 calcium channel ligands) - Gabapentin, Pregabalin.

Recently, treatment is often started with anticonvulsants due to the difficulties that arise when taking dopamine agonists. Clinical studies have shown a decrease in the effectiveness of these drugs with long-term treatment, and some patients develop augmentation syndrome (increased complaints).

Other pharmacotherapy options include low- and intermediate-potency opioids.

Calcium channel ligands ?2? should be preferred in cases where the patient suffers from chronic pain, anxiety, insomnia, or impulse control disorders ICD (characterized by the inability to resist a strong impulse or urge to perform an act that is satisfying in the short term, despite long-term harm to both the subject and others people).

Conversely, dopamine agonists are prescribed when the patient has severe symptoms of depression, obesity/metabolic syndrome, risk of falls, or cognitive impairment, as these conditions may be aggravated by calcium channel 2 ligands.

table 2

Recommended doses of ligands ?2? calcium channels

Gabapentin is best prescribed when the patient's symptoms of RLS are accompanied by pain or there is polyneuropathy. Since gabapentin is known to cause peripheral edema, dizziness, and drowsiness, it is recommended to take 300 mg of the drug two to three hours before bedtime. Start with a low dose and increase weekly until symptoms improve or a maximum dose of 900–2000 mg is reached. Caution should be exercised when prescribing gabapentin to patients with renal failure.

Pregabalin is known to increase the risk of suicidal ideation, dizziness, fatigue, and weight gain. Despite these risks, pregabalin has been clinically demonstrated to improve treatment outcomes and has a significantly lower rate of augmentation syndrome compared with dopamine agonists.

Gabapentin enacarbil is a slow-release prodrug of gabapentin. Numerous RCTs have demonstrated its clinical effectiveness in reducing RLS symptoms. There are currently insufficient long-term studies examining its effectiveness or side effects beyond a 12-week period. Common side effects include dizziness and drowsiness, which appeared to be dose dependent.

Dopaminergic medications are among the most studied and widely used treatments for RLS. A meta-analysis of 29 RCTs using dopamine agonists found a greater than 50% reduction in symptoms (as measured by the International Anxiety Syndrome Scale) compared with placebo (61% versus 41%).

The FDA has approved three dopamine agonist drugs for the treatment of RLS: ropinirole, pramipexole, and rotigotine. It is generally recommended to start therapy at the lowest dose (Table 3) and instruct the patient to take the medication two hours before the onset of RLS symptoms to allow the medication time to work. For relief, the dose can be carefully increased by 1 mg at the end of the week, but never exceed the recommended dose. Common side effects include nausea, headache, dizziness and vomiting, which usually resolve within two weeks.

Table 3

Recommended dosages of dopamine agonists

Patients with RLS receiving dopamine agonists are at increased risk of developing augmented or impulse control disorders (ICD), such as pathological gambling, hypersexuality, compulsive buying, and binge eating disorder.

Initially, drug-induced augmentation was mainly associated with the use of levodopa. However, this phenomenon has also been reported in long-term trials of dopamine agonists. In fact, within a year of short-term use of dopamine agonists, augmentation rates ranged from 7-8%. Several retrospective studies have reported that the incidence of augmentation increases to 50% after 10 years of drug use. Since augmentation increases over time, and RLS is a chronic disease requiring ongoing treatment, β2 ligands are increasingly preferred. calcium channels compared to dopamine agonists.

Factors that increase the risk of augmentation:

• low serum ferritin levels
• use of certain medications that worsen RLS (such as recent cessation of opioids or antidepressants)

In case of severe augmentation symptoms, three options are offered. One is to switch treatment entirely to a long-acting dopamine agonist. The second option involves adding the ligand ?2? calcium channels and a gradual decrease in the original dopamine agonist. The goal is to withdraw dopaminergic drugs and replace them with β2 ligands. calcium channels, so patients should be warned that this approach may temporarily worsen their symptoms. If the attempt to withdraw dopamine fails, then the addition of a low dose dopamine agonist with a ?2 ligand can be continued. calcium channel. The third and final option involves tapering off the dopamine agonist followed by a 10-day washout period. This approach can lead to extremely severe symptoms of RLS, which may require low doses of dopamine agonists for relief.

Refractory RLS

When monotherapy fails due to tolerance, enhancement, or side effects, potential factors influencing therapy, such as the use of drugs that increase RLS, changes in sleep habits, or other sleep-disrupting pathologies, must first be considered. A common protocol involves combining primary therapy with another class of drugs (eg, calcium channel ligands for patients taking dopamine agonists, or vice versa).

Because both drugs provide therapeutic effects through different pharmacological mechanisms of action, combination therapy may provide better symptom control. In addition, patients' ferritin levels can also be retested and treated with iron supplements if deficiency is detected.

Long-term therapy

To date, most evidence-based treatment guidelines have been developed from studies that lasted no more than four months. This is a major limitation because RLS is a lifelong condition and the potential side effects of long-term drug therapy have been little studied. The effectiveness of the drug levodopa can last up to two years in 40% of patients, while the effectiveness of dopamine agonists such as pramipexole and rotigotine lasts for one and five years, respectively.

As for the ligands ?2? calcium channel blockers, pregabalin and gabapentin enacarbil have proven effective for treatment for one year. For other drugs there is not enough evidence to conclude their long-term effectiveness, such as gabapentin and many opioid drugs.

Due to the lack of evidence, it is clear that further research is needed to explore long-term pharmaceutical therapy for RLS. Some drugs, such as pergolide and cabergoline, have been completely discontinued in the treatment of RLS due to reports of fibrosis of the heart valves.

conclusions

Although significant advances have been made in the etiology, diagnosis, and treatment of RLS over the past decade, patients continually suffer from misdiagnosis and numerous unnecessary referrals. With improved diagnostic criteria, treatment strategies, and updated guidelines, primary care physicians have more resources than ever to diagnose and effectively treat RLS. Further study of the outcome of long-term drug therapy is clearly needed.

Literature:

1. Differential Diagnosis and Treatment of Restless Legs Syndrome: A Literature Review Monitoring Editor: Alexander Muacevic and John R Adler Vishal Kwatra, corresponding author Muhammad Adnan Khan, Syed A Quadri, and Trevor S Cook