Routine tests like TFT, LFT, FBC, urea, electrolytes, blood glucose, were normal. Nerve conduction study did not reveal anything. She was diagnosed to have restless leg syndrome.
discussion Restless Leg Syndrome
Burning feet is a very common problem in practice and very frustrating for the patients and the doctors because of suboptimal therapeutic response. While dealing with this condition one should rule out different causes of peripheral neuropathy like diabetes, thyroid problems, alcoholism, vitamin B1, vitamin B6, and vitamin B12 deficiency by appropriate tests. Multivitamin tablets (injection vitamin B1-B6- B12) may be prescribed. Restless leg syndrome (Ekbom Syndrome) is an uncommon condition mainly found in western population and occasionally in our practice, characterized by peculiar burning sensation in the feet along with pain mainly at night time and irresistible desire to move the legs to find a suitable posture. This is a very distressing symptom which causes sleep disturbance resulting in morning drowsiness.
Management Restless Leg Syndrome
This condition is DOPA-responsive and a nocturnal dose of levodopa should be tried first as a single dose. If this fails to control the symptoms accurately, carbamazepine may be added in combination. Sleep disturbance is common and the addition of clonazepam or zopiclone is both helpful for the symptoms and the sleep. Strong analgesics are sometimes (tramadol) required at night time.
The nocturnal muscle cramp is another common problem that we see every day in our practice. Hypothyroidism should be excluded. Although vitamin E is commonly prescribed, there is no strong evidence that it works. Quinine sulphate (300 mg) at bedtime is the drug which is uniformly effective. However, it should be used with caution as long-term use in the elderly population can cause subtle hearing loss and thrombocytopenia so appropriate precautionary measures should be taken.
Common medical conditions that should be excluded include
Drugs that can cause muscle cramps include
- R agonists
Drugs for restless leg syndrome
- Monoamine oxidase inhibitors
- Tricyclic antidepressants, SSRIs
- Calcium channel blockers
- Dopamine antagonists
Symptoms of Restless Leg Syndrome
- Insomnia (10%)
- Mood disorders like anxiety and depression
- Increased risk of cardiovascular disease
Treatment: Is directed towards the underlying causes like iron deficiency should be treated, massaging the legs may be helpful.
Dopaminergic agents: These are mainly taken before sleep. Levodopa, ropinirole (0.25-4 mg) and pramipexole (0.125-0.75 mg) may be used at night time. A long-acting drug called rotigotine patch 1-3 mg may be used at night time. Opioids like codeine, tramadol may be used.
Anticonvulsants: Gabapentin and pregabalin may be used in conjunction with the dopaminergic drug. • Benzodiazepine— Clonazepam or Zopiclone may relieve insomnia caused by restless leg syndrome.
So a careful drug history should be taken and acted upon accordingly.
- Burning feet is a common clinical problem with the suboptimal therapeutic response.
- Peripheral neuropathy should be excluded.
- The nocturnal muscle cramp is also common in elder populations and hypothyroidism along with iatrogenic causes should be excluded.
- Restless leg syndrome is uncommon in Indian population.
- Restless leg syndrome is DOPA responsive.