09.23.19 Dr. Paul McNeill Varicose Veins

What is Restless Legs Syndrome

Impacting approximately 1 in 10 Americans, Restless Legs Syndrome (RLS) is an uncomfortable, twitching sensation in the legs that makes a person feel like they must move their legs to soothe the sensation. It tends to occur when a person sits for long periods, relaxes or goes to sleep. RLS can also flare up when a person is in a space where movement is limited (such as an airplane seat).

What are the Symptoms of Restless Legs Syndrome?

RLS is different for every patient. RLS tends to occur in the legs and feet but can also impact the arms. Symptoms range from mild to severe and sporadic to constant. Patients can experience a variety of sensations, including:

  • Electric shocks
  • Pins and needles
  • Burning
  • Aching
  • Itching
  • Tingling
  • Crawling
  • Tugging

Patients who have RLS typically experience these sensations when they rest or lie down. Patients use movement—walking, stretching, pacing, jiggling—to ease the discomfort. Symptoms tend to worsen at night; thus, RLS patients often have disrupted sleep patterns.

Who is at Risk for Developing Restless Legs Syndrome?

RLS can affect children and adults, although it is more prominent in women and middle-aged or older individuals. Symptoms tend to worsen and become more frequent with age.

What Causes Restless Legs Syndrome?

The exact cause of RLS is unknown; however, researchers believe the following factors may cause RLS:

  • Genetics
  • Iron deficiency
  • Dopamine deficiency

Specific gene variants have been identified and linked to RLS. Further, if the onset of RLS occurs before the age of 40, there is usually a genetic component. As iron levels decrease in a patient, RLS symptoms tend to worsen. A dopamine deficiency disrupts the way nerves communicate. When the pathways are disrupted, it can cause impaired or involuntary muscle movement.

Other factors can impact the development or worsening of RLS symptoms:

  • Pregnancy: While the exact reasons are unknown, it is suspected that a change in hormones, lower iron levels, trouble sleeping and enhanced senses during pregnancy may contribute to RLS symptoms. RLS symptoms tend to worsen during the third semester of pregnancy and usually resolve one month postpartum.
  • Medications: Some medications can magnify RLS symptoms, including certain antidepressants that increase serotonin levels, antipsychotic drugs, anti-nausea medications and sedating antihistamines present in cold and allergy medicine.
  • Chronic Diseases: Certain medical conditions—kidney failure, Parkinson’s disease, diabetes and peripheral neuropathy—can trigger RLS side effects.
  • Lifestyle: Alcohol, nicotine and caffeine can aggravate RLS symptoms.
  • Sleep habits: Sleep apnea, interrupted sleep patterns or nightshift work schedules can promote RLS symptoms.

Treatments for Restless Legs Syndrome

RLS is a serious but treatable condition. If untreated, it can negatively impact a person’s quality of life, work, relationships, sleep habits and overall health. The key to living with RLS is to manage the symptoms. Because everyone experiences RLS differently, it is important to work with your health care professional to develop the best treatment plan to control your symptoms. Below are a variety of treatment options to consider.

Lifestyle Changes

A detailed list of some other lifestyle changes you and your health care professional may want to consider include:

  • Get tested for an underlying iron or vitamin deficiency. If a deficiency is present, consider supplementing your diet with iron, vitamin B12 or folate.
  • Evaluate the medications you are taking and discuss them with your doctor. Pay close attention to drugs that are used to treat high blood pressure, heart conditions, nausea, colds, allergies and depression.
  • Review any herbal and over-the-counter medicines you are taking to see if they are worsening your RLS.
  • Identify habits and activities that aggravate your RLS symptoms.
  • Assess your diet to assure it is healthy and balanced.
  • Eliminate or lessen your alcohol consumption.
  • Reduce or eliminate caffeine from your diet.
  • Incorporate physical activities into your routine that may lessen your symptoms, such as walking, yoga, using hot or cold packs, stretching or taking a bath.
  • Try alternative therapies like massage, acupressure, meditation, or relaxation techniques.
  • Keep your mind engaged with activities like talking, knitting or computer games when you have to remain seated for an extended period of time.
  • Implement a program of good sleep habits.
  • Wear compression stockings ofat least 20-30 mm/ Mercury during the day, particularly if you have a desk job or standing occupation.

Vein Treatment

Many doctors believe that underlying chronic venous insufficiency (CVI) causes RLS symptoms. CVI is a condition where the one-way valves in the veins do not work correctly to return blood to the heart, resulting in pooled blood and dilated veins in the lower extremities. The added pressure and volume of the pooled blood can cause twisted, bulging veins, also known as varicose veins. Varicose veins cause similar symptoms to RLS, including pain, fatigue, itching, burning, cramping, restlessness and throbbing. For this reason, RLS is often misdiagnosed or missed altogether.

Dr. McNeill and Dr. Rosenberg have a long history of being at the forefront of venous disease management and have been actively involved in various clinical trials. Through their experience, as researchers and care providers, they have witnessed the positive benefits of treating underlying varicose veins to improve RLS symptoms: Dr. McNeill and Dr. Rosenberg have helped patients resolve their RLS symptoms and vein disease pain by utilizing modern treatments for varicose veins that are minimally invasive, non-surgical and highly effective:

  • Sclerotherapy with Varithena: During this varicose vein treatment, a thin needle is inserted into the diseased vein and a sclerosant medication, called Varithena, is injected into the vein. The sclerosant causes a chemical ablation to the lining of the vein. The weakened vein wall collapses and seals off. Eventually, the body will absorb the treated vein and blood flow will reroute to nearby, healthy veins. There is minimal discomfort during or after this procedure and no downtime or recovery time afterward. In a recent study, 98% of patients affected by RLS found symptom relief after treating varicose veins in their legs with sclerotherapy.
  • Clarivein: This is a mechanical-chemical treatment used for incompetent veins. A thin catheter is inserted into the base of the diseased vein and threaded up to the top of the vein. As the catheter is gently removed, the tip spins 360 degrees to ablate the vein wall while a sclerosant is administered to chemically injure the lining of the vein. The injured vein will collapse and close. Over time, the body will reabsorb the treated vein and blood flow will reroute to neighboring veins. There is minimal discomfort during the treatment, little or no bruising, virtually no pain afterward and most patients return to normal activities the following day.
  • VNUS Closure: This procedure is the most studied method to treat saphenous vein reflux. During this procedure, a catheter is inserted into the diseased vein and threaded to the top of the vein. As the catheter is slowly removed, it emits radiofrequency (RF) energy to the vein wall. The RF energy heats the lining of the vein, causing it to collapse and close. VNUS Closure is highly effective at treating diseased veins, has positive cosmetic results with little or no scarring, swelling or bruising, and patients can return to work and normal activities in one to two days following the procedure.

Medication Options

For those who do not have chronic venous insufficiency yet still suffer from RLS , a two-pronged approach using lifestyle changes in conjunction with medication can dramatically improve symptoms and quality of life. Keep in mind that drugs and dosages may need to be changed over time; thus, regular consultations with your primary care physician are recommended to monitor and manage.Medications approved explicitly for the treatment of moderate-to-severe primary RLS include:

  • Horizant® (gabapentin enacarbil) was approved by the FDA in 2011.
  • Mirapex® was approved by the FDA in 2006.
  • Requip® (ropinirole hydrochloride), a drug commonly used to treat Parkinson disease, was given FDA approval at lower doses in 2005.

All three drugs may cause side effects, such as sedation, nausea, dizziness and daytime drowsiness. More alarming, these medications may cause patients to fall asleep without any warning, even while doing normal daily activities such as driving or working. Close monitoring by a medical professional is advised.

In addition to Horizant®, Mirapex® and Requip®, there are several drugs approved for other conditions that have been shown to alleviate RLS symptoms. They are:

  • Dopaminergic agents attempt to replace dopamine or prevent dopamine loss, which reduces RLS symptoms
  • Benzodiazepines allow for a more restful sleep
  • Opiates induce relaxation and diminish pain

Dopaminergic agents, benzodiazepines and opiates can effectively treat RSL symptoms; however, some of the side effects can outweigh the benefits of using these medications. Side effects that can occur include daytime sleepiness, hallucinations, nausea, constipation and dependency. In addition, long-term use of dopaminergic agents can cause augmentation. This phenomenon causes severe RLS symptoms that may begin earlier in the day and can spread to other parts of the body. Before taking any medication to treat your RLS symptoms, discuss the benefits and possible side effects with your primary care physician.

Dr. McNeill, Dr. Rosenberg and their caring team at Capitol Vein and Laser Centers are experienced vein disease specialists who have evaluated and treated a myriad of unique vein problems. They have helped countless patients who were misdiagnosed or unaware of their underlying venous insufficiency. You can read about one such patient here: If you are suffering from RLS symptoms, leg pain or varicose veins, call Capitol Vein at 866-695-8346 to schedule an appointment with one of our expert health care professionals. We offer seven convenient locations across Maryland, Northern Virginia, West Virginia and Pennsylvania and look forward to helping you regain a new lease on life.

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