Restless Legs Syndrome in Hyderabad: Crawling Sensations, Sleep Disruption & Treatment

Restless Legs Syndrome (RLS) — also called Willis-Ekbom Disease — is a neurological sensorimotor disorder affecting 5–10% of adults. Despite being common, it is frequently misdiagnosed as anxiety, leg cramps, circulation problems, or 'growing pains' in children. Most patients suffer for years before receiving correct treatment.

The Four Core Symptoms of RLS

The International RLS Study Group diagnostic criteria (the 'URGE' criteria):

1. Urge to move the legs, usually accompanied by uncomfortable or unpleasant sensations
2. Rest brings on or worsens the symptoms
3. Getting up and moving provides partial or complete temporary relief
4. Evening and nighttime are worse — circadian pattern

The sensations are described as: crawling, tingling, pulling, burning, electric, itching inside the bone, or an irresistible urge to move without a clear sensation. They are extremely difficult to ignore — most patients walk around at night, shake their legs, or massage their calves.

Is It Leg Cramps or RLS?

• Leg cramp: Sudden painful muscle contraction (usually calf), lasts seconds to minutes, relieved by stretching
• RLS: Uncomfortable sensation with urge to move, present continuously at rest, partially relieved by movement, returns when you stop moving
• Peripheral neuropathy: Burning or numbness mainly in the feet, present day and night, not relieved by movement

What Causes RLS?

Primary (Idiopathic) RLS

Often familial — strong genetic component. Associated with dopamine dysregulation in the brain (which is why dopaminergic drugs work). Brain iron deficiency (even when serum iron is normal) is increasingly recognised as a central mechanism.

Secondary RLS — Treat the Cause

• Iron deficiency: Even ferritin below 75 µg/L (without anaemia) can cause RLS. Iron supplementation alone often resolves symptoms
• Pregnancy: Common in the third trimester — usually resolves after delivery
• Chronic kidney disease: Affects 20–25% of dialysis patients
• Peripheral neuropathy
• Medications: Antihistamines (common cold medicines), antidepressants (SSRIs, TCAs), antipsychotics, metoclopramide — all worsen RLS

Investigation at Sri Anand CNC

Dr. Anand Karnam checks: serum ferritin (essential), full blood count, kidney function, vitamin B12, blood glucose, and thyroid function. NCS (nerve conduction study) is done if peripheral neuropathy is suspected. A sleep study may be arranged for complex cases.

Treatment

1. Iron supplementation: First step in all cases — ferrous sulphate 200 mg twice daily if ferritin is below 75 µg/L. Check ferritin level again after 3 months
2. Pramipexole or ropinirole: Dopamine agonists — highly effective but monitor for long-term augmentation
3. Pregabalin or gabapentin: Increasingly preferred — also improves sleep quality and pain
4. Avoid triggers: Antihistamines, alcohol, caffeine (especially in the evening), antidepressants where possible
5. Lifestyle: Regular moderate exercise, leg massage, warm bath before bed

If you have uncomfortable leg sensations that are worse at rest and at night, call Sri Anand CNC for a neurological consultation: +91 90633 66983. Chanda Nagar, Hyderabad.