Restless Leg Syndrome
Patient Education

Doctors Who Treat Restless Leg Syndrome

Initial consultations for Restless Leg Syndrome or RLS would most likely be with healthcare providers that you already have an ongoing relationship with. Those listed in this patient education guide include:

• General Practitioners (Family Practitioners) - Deals with prevention, discovery and treatment of illnesses in all age categories
• Internist - Focuses on diagnosis, treatment and prevention of adult illness
• Gynecologist - Deals with female health
• Pediatrician - Specializes in infant, childhood and adolescent care
• Gerontologist - Deals with senior or elder health
• Nurse Practitioner - Focuses on prevention, wellness and education of patients about health and health choices

However, after the initial consult, when other underlying medical conditions have been ruled out, the patient would be referred to a neurologist who specializes in sleep or movement disorders.

A team approach to diagnosing RLS would consist of the following:

• Neurologist - Specializes in the health and disorders of the brain, spinal cord and nerve action.
• Physiatrist - Focuses on improving the quality of life by diminishing disabilities or impairments through rehabilitative physical therapy
• Holistic Practitioner - Views the body overall, considering physical, mental, and spiritual components. Herbs and nutritional supplements are considered in addition to meditation, cleansing, diet and exercise protocols
• Acupuncturist - Relieves pain and enhances healing through the ancient traditional Chinese medicine using special needles inserted and manipulated in various body energy zones
• Nutritionist - Formulates diet plans to impact positively on health

How to Prepare for Your Restless Leg Syndrome Doctor Visit

Preparation for a General Exam

To get the maximum benefit from a doctor visit for your Restless Leg Syndrome or RLS, bring the following listed in this patient education guide:

• List of symptoms with associated times and activities
• Family history and medical history records
• Medications taken within the last 6 months (this includes any herbs and vitamins.

Preparation for a Glucose Blood Test

• Do not have any food or beverages (may have sips of water) for 8 hours prior to the glucose blood test.

Preparation for a Sleep Study

• Alcohol and caffeine as well as any stimulants must be avoided prior to a sleep study.
• Bring a book or magazine to the test site.

Questions to Ask Your Doctor About Restless Leg Syndrome

From your initial diagnosis throughout your treatment and care, you will have questions about your Restless Leg Syndrome, also called RLS.Our patient education guide makes sure you don't forget any of those important questions.

Question About My Diagnosis

• How did I get this condition? Did I cause RLS to happen?
• Is RLS caused by a vitamin deficiency or improper diet?
• Will the symptoms get worse? Does the condition progress?
• Will the muscle stimulations spread to other areas of my body?
• What other medical conditions is this diagnosis associated with?

Questions About My Treatment

• Are there drugs that can treat my condition?
• Why did you choose that particular medication? What are the side effects?
• Will the medication stop me from performing work or my daily activities?
• Is there surgery that would correct the condition?
• Are there alternative medicine options available? Does acupuncture help?
• Would physical therapy help?

Questions About My Lifestyle & Family

• Does this run in families?
• Can exercise improve the condition?
• Are there vitamins that will cure RLS?
• Is there a special diet that I should follow?
• Will I still be able to work? Can I still drive?

Common Tests or Labs to Diagnose Restless Leg Syndrome

The following tests listed in this patient education guide help to diagnose RLS:

• Complete Physical Examination
• Analysis of Medications and symptoms
• Scrutiny of Family History and Medical History

While there is no specific test for restless leg syndrome, RLS symptoms with tingling, cramping or pain of extremities, occurs more frequently in patients with:

• Pregnancy
• Parkinson's Disease
• Iron deficiency
• Peripheral neuropathy

Therefore, the following tests to help diagnose RLS are done.

Test	Why Test?	What Happens?	Normal Result
Neurological Exam	Peripheral nerves are tested for impairment	A doctor places 3 electrodes on the body part being tested and sends electrical impulses through the nerves. This feels like static electricity and takes 30 minutes. An electromyography (EMG) is also done where a doctor places a very small thin needle electrode into a muscle and then records the muscle's electrical activity (takes 15 minutes.	Reflexes, motor and sensory perceptions are intact
Sleep Study	Frequent or restless leg movements that interrupt sleep indicate restless leg disorder	Small electrodes (metal discs)are placed on the body and head with an adhesive. These measure brain activity,heartand breathing rates and rhythm, body muscle movements and eye movement.This is a polysomnogram study. The test takes 6 hours overnight in a sleep lab.	Minimal leg movements in sleep; sleep is not disturbed by body movements
Pregnancy Test	Checking for pregnancy Movement of legs is found more often when pregnant	First urine of the morning is collected in a sterile cup	Urine choriogonadotropin (UCG) is positive in pregnancy
Complete Blood Count	Iron level is tested	A tourniquet is applied to the upper arm and an alcohol swab wipes the skin above a vein. Using a small needle to puncture the skin and enter a vein, blood is drawn into the syringe and sent for analysis. The needle is withdrawn and a pressure bandage is applied.	Ferritin levels: Men= 18-270 mcg/L Women= 18-160 mcg/L Children (6 mo.to 15 yrs) = 7-140 mcg/L

Common Medications and Treatments for Restless Leg Syndrome

There are no cures for Restless Leg Syndrome. However, various treatments such as the ones listed in this patient education guide have been used to relieve symptoms. If RLS is caused by an associated medical condition, the actual cause is addressed and corrected.

• Baths-hot, whirlpool
• Compresses (hot or cold) to the affected areas
• Massage
• Stretching
• Meditation or system of relaxation
• Tonic water at bedtime (quinine water)
• Magnesium supplements
• Electric nerve stimulation
• Acupuncture

Eliminating or reducing the use of alcohol, tobacco and caffeine is also advised.

Evaluate all current medications to assess whether RLS symptoms are adverse reactions of the drugs taken.

See the following chart of medications.

Category	Drug	Mode of Action	Risks/Side Effects
Alpha2 agonist	Catapres Clonidine Guanfacine Tenex	*Activates alpha 2 receptors *Inhibits nerve stimulation to muscles (decreasing movement)	Dry mouth Dizziness Lethargy Constipation Contraindicated in breast-feeding
Alpha2 agonist	Catapres Clonidine Guanfacine Tenex	*Activates alpha 2 receptors *Inhibits nerve stimulation to muscles (decreasing movement)	Dry mouth Dizziness Lethargy Constipation Contraindicated in breast-feeding
Anticonvulsants	Horizant Neurontin	Causes peripheral Neuropathy (Decreased nerve stimulation to extremities)	Dizziness Drowsiness Rare-Suicidal ideology
Benzodiazepines	Klonopin Restoril Xanax	Sleeping sedatives	Dizziness Drowsiness Loss of coordination Tiredness Depression Suicidal ideology (rare)
Dopamine agonists	Mirapex parlodel Permax Requip	Mirrors dopamine in the brain	Dizziness Nasal inflammation Daytime sleepiness Lazy Eye Abnormal hypotension Indigestion Nausea Rare-Confusion Hallucinations Depression Difficulty Moving Constipation
Dopaminergic agents	Carbidopa Sinemet	*Increases the neurotransmitter dopamine level in the brain *Improves leg sensations	Nausea Vomiting Dyskinesia (involuntary movements) Hallucinations
Opiates (also known as narcotics)	Vicodin Morphine Codeine Fentanyl	*Relieves pain *Diminishes RLS symptoms	Last resort Very addicting