Commentary by Jeffery P. Schoonover
Restless Leg Syndrome affects as much as 15 percent of the general population and negatively impacts their quality of life. Those with RLS experience irresistible urges to move their legs; a “creeping” feeling in their legs; persistent leg movement during sleep; or tingling, burning, aching or numbness in their legs. Symptoms of RLS are worse at night or during periods of relaxation, such as when a person is lying down during the day, and tend to improve with activity. The symptoms disrupt the sleep of not only RLS sufferers, but also their sleeping partners. The standard treatment for RLS is neurologic medication. Unfortunately, the available medications only relieve the symptoms; they do not cure the condition and must be taken long-term.
An often-overlooked cause of RLS is venous insufficiency, which several studies indicate that as many as 22 percent of those with RLS also have. Venous insufficiency, or varicose vein disease, means the blood vessels’ valves do not work properly and allow some blood to flow backward and pool in the legs, which can, but does not always, result in bulging veins and symptoms such as pain, swelling, tiredness, redness or restlessness. Edema, or swelling, that occurs with venous disease often lessens at night, which is believed to somehow cause the “creeping” sensation described by patients with restless leg syndrome. When restless legs occur with venous insufficiency, treating the varicose veins can significantly improve the RLS. A study published in the Journal of Phlebology reported that varicose vein treatment relieved RLS symptoms in 98 percent of patients with both RLS and venous disease, and 80 percent of those treated experienced long-term relief.
Anyone who suffers from the symptoms of RLS should be evaluated for venous insufficiency, typically with a diagnostic ultrasound assessment. If varicose vein disease is present, a course of endovenous laser treatment (EVLT), sometimes combined with sclerotherapy, offers the best opportunity for improving the symptoms of RLS and possibly eliminating the need for medication.