Restless Legs Syndrome and the dopamine connection

We’re nearing the summer solstice, and putting my kids to bed when it’s still light outside poses a definite challenge in my household. I’ve always wondered how parents living in places like Sweden or Iceland get their children to sleep when it’s light all night long…

Eventually the little ones do settle down and get a good night’s sleep. “Too bad that’s not the case for those who suffer from restless legs syndrome,” my NeuroScience colleague Deanna Fall told me. RLS, or Willis-Ekbom disease, is a neurological condition characterized by uncomfortable sensations of itching, burning, pulling, crawling, or creeping. This can affect not only the legs, but also the arms and other parts of the body. This sensation usually occurs at night, but really can happen during any period of inactivity.

I asked Deanna to tell us more about RLS, and she summarizes her findings here.

dog twitchingRLS can cause a variety of social and psychological issues, and can create safety risks to sufferers and those around them. That’s because RLS can greatly impact sleep quality, and quality of life overall. More than 80% of individuals with RLS suffer from periodic limb movement during sleep that can interrupt the sleep cycle. RLS sufferers are more likely to drive while drowsy, and have reported that their performance at work has been affected by being late or making mistakes due to RLS-associated insomnia.

Who gets RLS? It’s been estimated that up to 10% of the population may be affected, especially in those over 65; while it occurs in both men and women, the incidence is about twice as high in women. Stress can make the symptoms of RLS worse. RLS is often associated with pre-existing conditions such as:

  • obesity
  • diabetes
  • kidney disease
  • anemia
  • Parkinson’s disease
  • rheumatoid arthritis
  • pregnancy
  • infection of the central and/or peripheral nervous system (and resulting inflammation)

There’s also a genetic component to RLS, with variants in several genes including BTBD9 and MEIS1, both of which are implicated in iron storage and metabolism.

It comes down (again) to biochemistry

“Are there biochemical imbalances in RLS?” I asked Deanna. After all, here at NeuroScience, we like to dig down to the biochemical basis of a health issue. Absolutely, she replied. There’s considerable support for the idea that RLS is related to dopamine dysregulation – a dysfunction in the brain’s basal ganglia circuits that utilize dopamine for the regulation and control of muscle activity. Insufficient iron availability can lead to deficiencies in the dopaminergic system as well, since dopamine synthesis is dependent on iron. Magnesium and folate deficiencies have also been implicated.

So when you’re trying to find the best way to manage the symptoms of RLS, laboratory evaluation of possible dopamine or mineral deficiencies can help determine the course of treatment.  Any intervention should be complemented with non-pharmaceutical approaches such as good sleep hygiene, stretching, moderate exercise, and avoidance of alcohol, caffeine, and nicotine.

If the midnight sun is keeping you up at night, why not spend those sleepless hours learning more about RLS from these selected references Deanna’s shared.

Restless Legs Fact Sheet. National Institute of Neurological Disorders and Stroke, NIH. http://www.ninds.nih.gov/disorders/restless_legs/detail_restless_legs.htm
Allen R.P., Earley C.J. The role of iron in restless legs syndrome. Mov Disord. 2007;22 Suppl 18:S440-8.
Connor J.R., Wang X.S., Allen R.P., Beard J.L., Wiesinger J.A., Felt B.T., Earley C.J. Altered dopaminergic profile in the putamen and substantia nigra in restless leg syndrome. Brain. 2009 Sep;132(Pt 9):2403-12. Epub 2009 May 25.
Ryan M., Slevin J.T. Restless legs syndrome. Am J Health Syst Pharm. 2006 Sep 1;63(17):1599-612.
Weinstock L.B., Walters A.S., Paueksakon P. Restless legs syndrome – Theoretical roles of inflammatory and immune mechanisms. Sleep Med Rev. 2011 Jan 16. [Epub ahead of print]
Yun C.H., Lee S.K., Kim H., Park H.K., Lee S.H., Kim S.J., Shin C. Association between irritable bowel syndrome and restless legs syndrome in the general population. J Sleep Res. 2012 Mar 29. doi: 10.1111/j.1365-2869.2012.01011.x. [Epub ahead of print]
Zintzaras E., Kitsios G.D., Papathanasiou A.A., Konitsiotis S., Miligkos M., Rodopoulou P., Hadjigeorgiou G.M. Randomized trials of dopamine agonists in restless legs syndrome: a systematic review, quality assessment, and meta-analysis. Clin Ther. 2010 Feb;32(2):221-37.
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3 Responses to Restless Legs Syndrome and the dopamine connection

  1. Ted says:

    With Violent Leg , body and arm involuntary jerks..I attached Heat wraps 4 on each leg ( Theromo Care) probably any heat source , on leg mucles..and problem Went Away..Hope this helps others.

    God bless
    Ted

  2. Hello there, You have performed a great job. I will certainly digg it and for my part recommend to my friends. I’m sure they’ll be benefited from this site.

  3. jimjuliea says:

    At the worst the RLS is intense tingling of lower legs along with burning feeling in my feet. They are very warm to touch at that time too while my legs might be cool. I had a little less sensation in my feet to ankles when tested by touching my skin with a u shaped sound device and tiny pin. My Dr. diagnosed me with peripheral neuropathy and recommended Magnesium 400mg and Vit D3 2000IU daily to help. This did nothing after using for 6 months time. I use cool gel packs out of the refrigerator and have these wrapped around my feet to get some
    relief after 15 to 20 minutes time. If I remove the packs, the sensation and burning returns. I keep the packs on until I am able to go to sleep. This along with need for sleeping supplement quite often, is what seems to help me. Does anyone else use cold packs for relief? Julie

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