Restless leg is a condition characterized by an urge to move the legs due to pain, uneasiness, cramping, which typically becomes worse at night and at rest with partial relief by movement or walking. Diagnosis is primarily based on history and physical examination, but it is imperative to rule out secondary causes. Secondarily it can occur due to distinct conditions such as iron deficiency anemia, pregnancy, end-stage renal disease, and venous disease . However, the direct etiology remains unclear.
Restless leg syndrome and chronic venous insufficiency (CVI) share similar circadian timings and epidemiological characteristics.
RLS was first described in 1945 with an estimated prevalence of 5% . Since its discovery, the prevalence has been found to be 3%-15%.
RLS is reported more frequently in women with a near 2:1 female to male ratio. RLS can occur during pregnancy and be affected by trimester and number of parity. It has also been shown to have a positive correlation with increasing age . Genetics plays a role as well, with up to 25% of first degree relatives of those with RLS reporting RLS-like symptoms. RLS associations including female sex, multiparity, old age, and family history are also risk factors for chronic venous disease (CVD).
Diagnostic criteria for RLS
1. an urge to move the legs usually but not necessarily associated with feelings of discomfort
2. an urge to move the legs and unpleasant sensations are worse at rest
3. the symptoms are partially or totally relieved with movement
4. the symptoms worsen later in the day or at night
The following are factors that can aggravate symptoms of restless leg syndrome:
Medication: certain antidepressants, antipsychotics, lithium, antihistamines, metoclopramide.
Excessive intake of alcohol and caffeine
Vein disease, including chronic venous insufficiency
Excessive smokingObesity or being overweight
A sedentary lifestyle
The association between venous reflux and RLS was suggested by Kanter et al., who found those treated with sclerotherapy had improvement of RLS symptoms.
The decrease in RLS scoring points and significant improvement in the degree of severity of RLS after varicose vein laser treatment/ varicose veins radiofrequency ablation and varicose vein sclerotherapy suggests an association between CVI and RLS. Venous procedures that correct superficial venous reflux should be considered as therapeutic treatment options with more definitive potential for patients with RLS.