Tuesday, 27 November 2012

How Is Restless Leg Syndrome Different To Neuropathy?

 Today's post comes from breathesleeplivewell.com (see link below) and talks about something which confuses many people with either peripheral neuropathy or restless leg syndrome ie: what's the difference? Because they are both neurological disorders, some doctors will tell you that your restless leg syndrome is another version of neuropathy and some of the treatments are also the same for both conditions but there are significant differences and these are highlighted here. The fact that people can have both problems at the same time, confuses the issue even further but it is important for you to see both conditions as being different, while at the same time hopefully taking the same medication for both (the less pills you have to swallow the better!)  
Restless legs or neuropathy, which is it?
November 11, 2012 
David Ostransky, DO, DABSM

Restless Legs Syndrome, Peripheral Neuropathy, or Both?

Restless Legs Syndrome (RLS) is one of the most important causes of insomnia to recognize – because it is so common (5-15% of the general population), and it responds so well to treatment. It is often related to heredity factors (40%), but other causes include anemia, iron deficiency, neuropathies, kidney failure, and the use of certain medications. It is important to differentiate this condition from peripheral neuropathy, because of the symptoms are so similar, sometimes RLS and peripheral neuropathy occur together in some patients, and the use of some of the same medications for these conditions. Patients and primary care providers often have a difficult time differentiating between the two conditions.

Peripheral neuropathy may be caused by many different conditions including the following:

Diabetes Mellitus
Vitamin Deficiency, especially B12 and folate
Auto immune disorders including lupus, rheumatoid arthritis, vasculitis, amyloidosis, or Guillain Barre
HIV infection, and its complications
Inherited disorders, Charcot Marie Tooth
Exposure to toxins, heavy metals, gold, lead, arsenic, mercury, and pesticides
Medications, including chemotherapy drugs, antibiotics, & isoniazid
Peripheral vascular disease

RLS is described by patients as the experience of vague or unpleasant sensations involving usually the lower extremities, but sometimes the upper extremities. This discomfort appears primarily during periods of inactivity, particularly during the transition from wake to sleep, or during the day, sitting on a plane, lone car rides, or sitting in a movie theater. RLS patients often have difficulty describing the sensations, rarely using conventional terms of discomfort such as “numbness, tingling, or pain,” but rather bizarre terms such as “pulling, searing, drawing, creepy, crawly, fluttering, shimmering, butterflies, or boring sensations,” with the sensations often causing anxiety. Distinct from sensory neuropathy patients, these unpleasant sensations are typically relieved by movement or counter stimulation (rubbing, massaging, hot water) of the affected part. Although, these manoeuvers are effective while being performed, the discomfort returns as soon as the individual becomes inactive or tries to return to bed. The International RLS Study Group has developed diagnostic criteria:

Minimal Criteria-IRLS Group

1. Desire to move the limbs usually associated with paresthesias/dysesthesias

2. Motor restlessness

3. Symptoms are worse or exclusively present at rest with at least partial or temporary relief by activity

4. Symptoms worse in evening/night

Supportive Criteria- IRLS Group

1. Positive response to dopaminergic treatment

2. Periodic limb movements (leg movements after sleep)

3. Positive family history( 40%)

Important differences between RLS and peripheral neuropathy(PN) are as follows:

1. Peripheral neuropathy occurs as a consequence of damage to the peripheral nervous system, whereas RLS occurs as a consequence of an imbalance of chemicals that control movement in the basal ganglia of the brain. Because there are different types of nerve fibers, motor, sensory, and autonomic, PN is a much more heterogeneous condition (more than 100 types) with a lot more variability of symptoms compared to RLS.

2. Though, the symptoms of PN and RLS may be somewhat similar, such as numbness, tingling, and prickly sensations, PN patients do not report the relief that occurs with movement that RLS patients report. PN patients often focused on the discomfort that they experience, RLS patients seem to focus on the anxiety that they experience as a consequence of the discomfort.

3. The diagnosis of PN is typically based on electromyography and nerve conduction velocity (yes, the sticking of needles into your muscles) whereas the diagnosis of RLS is based on history, specifically meeting the International RLS criteria. Sometimes, we draw a serum ferritin level (iron studies) and blood count

4. Treatment considerations for RLS include agents used to treatment Parkinson’s disease like ropirinole, pramipexole, sinemet, neupro, gabapentin (Neurotin), and horizont, benzodiazepines, opiates, and anticonvulsants, whereas PN sometimes are given medications such as gabapentin (Neurotin), lyrica, and antidepressants to manage the pain.

5. Many conditions may result in with patients having both PN and RLS, such as chronic renal failure with dialysis, neurological conditions such as multiple sclerosis, spinal cord insults and diabetic neuropathy .


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