Restless Leg Syndrome

As we RTs are doing our rounds we occasionally see a patient with restless leg syndrome. When we do we now know there is a 50% chance that person has coronary artery disease (as I wrote about here). Still, we wonder what is this strange disease.

Basically, according to the Mayo Clinic, Restless leg syndrome (RLS) is a genetic disorder that causes the patient to feel leg discomfort while sitting or lying down, and temporary relief can be found by getting up and walking around.

The discomfort is often noted as "unpleasant sensations in their calves, thighs, feet or arms."

The Mayo clinic notes there is no known cause for RLS, although "researchers suspect the condition may be due to an imbalance of dopamine (a chemical found in the brain that sends messages to control muscle movements)."

This disorder can start at an early age, get progressively worse with age, and make sleeping and traveling difficult.

The Mayo clinic notes the disease is not particularly linked to other diseases, although is occasionally linked to:

• Peripheral neuropathy. This damage to the nerves in your hands and feet is sometimes due to chronic diseases such as diabetes and alcoholism.


• Iron deficiency. Even without anemia, iron deficiency can cause or worsen RLS. If you have a history of bleeding from your stomach or bowels, experience heavy menstrual periods or repeatedly donate blood, you may have iron deficiency.


• Kidney failure. If you have kidney failure, you may also have iron deficiency, often with anemia. When kidneys fail to function properly, iron stores in your blood can decrease. This, along with other changes in body chemistry, may cause or worsen RLS.

While this is not noted by the Mayo Clinic, many studies (like this one) link RLS to coronary artery disease. In fact, it has been noted that those with RLS may be at twice the risk as those without the disease.

Doctors suspect RLS may cause cardiovascular complications due to spikes in blood pressure during symptoms of RLS. When this occurs on a daily and nightly basis, the risk of coronary artery disease is at its highest.

However, this study is only preliminary, and further tests will be needed to confirm its findings.

The curse of restless leg syndrome

You don't see it very often, yet the last time I worked I had a patient in the ER with Restless Leg Syndrome. Her chief complaint was nausea and vomiting, yet as the morbidly obese lady set their in semi fowlers sleeping, her legs were waning this way and that.

I tapped her shoulder, and she didn't wake. So I nudged her harder, yelled her name, and she woke up long enough for me to tell her I needed to do an ABG on her. As I set up to do the procedure, I noticed her legs were flailing this way and that, her left way up in the air that way, her right way up in the air this way. How she could sleep with her legs moving like this I had no idea.

"I'm going to poke you now," I said, needle ready to pierce.

She said nothing.

"I'm going to poke you now!" I yelled.

Her eyes popped half way open. "Yeah, that's fine."

"Well, I don't want you to fall asleep and whack me a good one with your foot," I said.

"Oh, don't worry, I won't."

Yet just as I said that her feet were up in the air, moving around like those of a one-year-old happily kicking.

"I'm poking! I'm poking!"

"Yeah, go ahead!" Her legs were calm a moment, her eyelids at half mast.

I poked. As the blood returned into the syringe I saw through the corner of my eye her old legs just-a-movin'. I wondered if this had something to do with Ondine's Curse. Or perhaps Ondine had a sister who was crushed by an obese sleeping man's legs, so she cursed him to never sit still while sleeping again?

I removed the syringe, held the site, and observed as she didn't even acknowledge my existence except for the occasional unintelligible utterance. She woke up briefly as I was exiting the room, and I asked, "Do you have BiPAP at home?"

"I have one, yet I hate that...," as she trailed off, she grunted briefly, and her legs were off to their business once more.

I remember reading once how restless leg syndrome was linked to cardiac disease. Another thing that was linked to cardiac disease was a crease on the ear lobe (I write about this here). As she slept, I glanced a peak at her earlobe. Yet, the crease was there. Perhaps there was some validity to this theory.

We'll investigate this further later (see here for more on RLD).