The night walkers
Little-understood 'Restless Legs' can make sleep an elusive dream
05/28/2001
By SHERRY JACOBSON / The Dallas Morning News
A strange medical condition has been robbing Bob Whitehead of sleep
since the mid-1980s.

"It feels like worms or snakes are crawling up the inside of my legs all
night long," says the 57-year-old former public official.

Restless Legs Syndrome
The syndrome is a sleeping disorder estimated to affect 12 million
Americans.

It is often described as a burning, creeping feeling that is like
insects crawling inside the legs.

Lying down and trying to sleep activates the feeling.

Its cause is unknown, but it affects more women than men.

Half of all sufferers share the condition with family members,
suggesting a genetic component.

Symptoms worsen at rest or at night, causing sleeplessness due
to tossing and turning in bed, rubbing of legs and pacing.

Certain medications relieve symptoms temporarily, allowing longer
periods of sleep.

SOURCE: National Institutes of Health
The symptoms got so bad that Mr. Whitehead took early retirement last
December as director of public works in Colleyville. He was worried that
his lack of sleep was compromising his ability to oversee the dramatic
growth of the northeast Tarrant County community.

"I had a general feeling of not being able to do my job mentally because
I was so sleep-deprived," recalls Mr. Whitehead. "Retirement has
allowed me to take a nap in the afternoon."

Mr. Whitehead's mysterious condition is shared by an estimated 12
million Americans, many of whom are forced to modify their lives
because their legs won't let them sleep through the night. Although
certain medications have been shown to reduce the symptoms, the
syndrome ranks as the fourth-leading cause of insomnia. Stress,
depression and anxiety are the top causes underlying sleep
disorders, according to the National Sleep Foundation.

Still, researchers around the world have been unable to unlock the
mysteries of this restlessness, other than to agree that it is a
neurological disorder. They also have concluded that it strikes
more women than men. Children get it. So do some women during
pregnancy.

But nobody can say why.

Maybe that will change soon. For the first time, the National
Institutes of Health is seeking grant applications for researchers
willing to delve into the disorder. The studies are expected to
investigate who has restless legs, what drugs work best to
control it, and how and when the condition manifests itself.

Findings
People who suffer from Restless Legs Syndrome have renewed hope
that someone soon will unlock the secrets of their troubling sleep
disorder. So far, studies have found that the syndrome:
May be linked to attention deficit hyperactivity disorder. A New
Jersey study recently concluded that almost 40 percent of people
diagnosed with the condition appear to meet the criteria for the
behavior disorder, which is characterized by inattention,
restlessness, distractibility and impulsiveness.

Can be alleviated by several classes of drugs, including dopamine
precursors that modify the signals sent between nerves and muscles.

Other positive results have been found by those who use certain
sedatives and anticonvulsant drugs.

May include a high percentage of people who also suffer prickly
feelings in their arms. However, one study found that periodic arm
movements do not seem to occur during sleep.

Hits hardest among senior citizens. Several studies estimate that as      
many as 30 percent of people over age 65 suffer from nighttime
restlessness of their legs.

"The key is its circadian rhythm. It comes in the evening hours, usually
between 4 p.m. and 4 a.m.," says Dr. Philip Becker, a Dallas psychiatrist
with training in neurology who has published three papers on the
condition.

Restless Legs Syndrome is more than a sleeping problem. Some people
say they can't sit through a movie, a concert or a long road trip because
of their jittery legs.

"The symptoms are always relieved by movement," Dr. Becker says,
describing how his patients often must get out of bed and walk to quiet
their legs. It has earned them the nickname "night walkers."

"Unfortunately, their relief is temporary. It keeps coming back, night
after night," says Dr. Becker, who is executive director of the Sleep
Medicine Institute at Presbyterian Hospital of Dallas, where he
monitors 300 patients diagnosed with Restless Legs Syndrome.

People who suffer from the condition often join support groups that
have sprung up across the country in the past decade. They are
surprised to learn how common the ailment is, says Helen Simons,
80, who oversees a support group in the Houston area.

"We compare notes and often discover that this is a problem that has
been in a family for generations," she says. "My daughter remembers
my grandmother up walking in the night when she visited. Nobody
talked about it. If they did, they called it 'funny legs.'

About half the people with restless legs have a close relative with the
condition, suggesting a possible genetic component.

Although the syndrome was identified and named in 1945 by a Swedish
researcher, its symptoms have been described in medical literature
dating back to 1672. An English physician, Sir Thomas Willis, had called
it a "terrible restlessness" that turned a bed into "the place of greatest
torture."

Restless leg syndrome
• Fact sheet (National Institutes of Health)
•Extra content index
More than 300 years later, an international study group agreed that four
basic criteria must be present for a diagnosis of Restless Legs
Syndrome. The 1995 guidelines require that a person feel uncomfortable
sensations in the legs, along with an urge to move to relieve the
discomfort. The symptoms must occur during periods of rest, and grow
worse in the evening and night.

Still, many such sufferers probably don't seek medical attention because
the condition is difficult for them to comprehend, says Cate Murray,
spokeswoman for the Restless Legs Syndrome Foundation, a 10-year-
old advocacy group based in Rochester, Minn. The foundation has
funded a number of small research efforts over the past four years and
attracted 10,000 financial contributors, she says.
So far, treatment includes dietary and lifestyle changes that promote
good sleeping habits, such as moderate exercise and not drinking
caffeine or alcohol. A number of medications intended for other
ailments, including Parkinson's disease, also provide some relief. And
some sufferers are found to have an iron deficiency that can be treated
allowing them to sleep again.

But the foundation's leaders are frustrated, Ms. Murray says, that no
drug company has conducted a single clinical trial that targets Restless
Legs Syndrome, although a number of medications are commonly used
for it. Instead, doctors prescribe drugs based on "open-label" studies
that show some measure of sleep improvement in a small group of
patients.

"It's an injustice to patients to get a prescription for a drug, and the only
information is about Parkinson's," she notes. "Our goal is to identify
effective treatment through research or, if we must, through anecdotal
reports from patients."

Even before his retirement, Mr. Whitehead says, he tried a number of
medications in search of a good night's sleep.

"One medicine made my movements more violent and I would kick my
wife out of bed," he recalls. "Even on medication that works, my legs
feel tense and I have to get up two or three times in the middle of the
night to stretch or walk around."

But at least nobody thinks he's crazy anymore when he describes his
symptoms.
"It's kind of coming out of the woodwork," the former public official
says of the syndrome. "And that's got to be a good thing."

http://www.dallasnews.com/lifestyles/stories/378641_jitterleg_28li.html

**********

----------------------------------------------------------------------
To sign-off Parkinsn send a message to: mailto:[log in to unmask]
In the body of the message put: signoff parkinsn