Restless Legs Syndrome

　　The pathophysiological mechanism of Restless Legs Syndrome has not been fully elucidated, and it is currently believed that it may be related to various factors such as the nervous system and mental health, possibly related to iron ion metabolism or abnormal dopamine system. Iron is an important cofactor of tyrosine hydroxylase, and iron deficiency can lead to changes in the dopamine signaling pathway, resulting in a decrease in D1 and D2 receptors in the caudate nucleus and putamen, and a decrease in the function of dopamine transporters, leading to an increase in extracellular dopamine levels in the caudate nucleus and putamen, and a decrease in the dopamine clearance capacity of the transporters.

　　Abnormal iron metabolism may be involved in the pathogenesis of Restless Legs Syndrome, but further research is still needed. In addition, many patients with Restless Legs Syndrome respond well to dopamine medications or dopamine receptor agonists. Therefore, abnormal dopamine system may also play an important role in its pathogenesis. Some people speculate that it may be related to the circulation disorder in the feet, leading to the accumulation of tissue metabolic products. Some believe that this syndrome is more common in anemia, diabetes, alcoholism, and vitamin deficiency, which are metabolic disorders.

　　It is currently believed that Restless Legs Syndrome belongs to central nervous system diseases, and the specific etiology has not been fully elucidated. It is mainly divided into primary and secondary types. Patients with primary Restless Legs Syndrome often have a family history, and it is currently believed that genes such as BTBD9, Meis1, MAP2K5, and LBXCOR1 may be related to Restless Legs Syndrome; secondary Restless Legs Syndrome patients can be seen in iron deficiency anemia, pregnant or postpartum women, late stages of kidney disease, rheumatic diseases, diabetes, Parkinson's disease, type II hereditary motor sensory neuropathy, type I/II cerebellar ataxia, and multiple sclerosis. Traditional Chinese medicine believes that the disease is caused by evil attacking the skin and muscles, blood stasis in the meridians and collaterals, or deficiency of Yin and blood, leading to malnutrition of the meridians and skin. The disease is mainly located in the meridians and skin, related to the heart, liver, and kidneys; its nature is deficiency in the interior and excess in the exterior.

　　Restless Legs Syndrome patients often suffer from complications such as anxiety, depression, attention deficit, drug dependence, and memory decline. In addition, some patients may experience complications such as augmentation, rebound, and drug tolerance during the treatment process. Augmentation refers to the situation where a few patients may experience deterioration of the condition when the medication is increased (especially when taking dopa-complex preparations every day for a long time), such as the onset time of the disease being 3-4 hours earlier each day, symptoms spreading from the lower limbs to the upper limbs or trunk, occurring after a short rest, the severity of discomfort symptoms increasing, the effective period of the drug shortening, and periodic limb movements occurring when awake. The diagnosis and treatment of these complications are quite challenging and often require doctors with more experience in treating Restless Legs Syndrome.

　　The main clinical manifestation of restless legs syndrome is an involuntary, intolerable, abnormal sensation occurring in the lower limbs. This abnormal sensation often involves the deep lower leg, such as muscles or bones, most commonly the gastrocnemius muscle. Some patients may also experience symptoms in the thigh or upper limb, usually symmetrically. Patients often complain of sensations such as ants crawling or insects biting, itching, pain, tingling, burning, tearing, and creeping in the deep lower limbs. Sometimes, the sensation is difficult to describe. Patients therefore have a strong urge to move, leading to excessive movements such as tossing and turning or walking around. Symptoms can also occur during rest, such as prolonged sitting or driving for a long time, and can be partially or completely relieved by movement.

　　Under normal circumstances, the symptoms become severe when lying in bed at night and reach a peak after midnight, forcing patients to kick their legs, move their joints, or massage their legs. Patients often describe that 'there is no comfortable place to put their legs down.' Severe cases may require getting up and walking continuously to relieve symptoms. Some patients need to constantly tap their legs to alleviate the symptoms. Approximately 90% of patients have periodic movements of sleep (PMS) during sleep. PMS is a rigid, repetitive flexion movement of the legs that occurs during rapid eye movement (REM) sleep and can awaken patients. As a result, patients suffer from insomnia due to sleep disturbances at night, leading to severe daytime sleepiness, decreased work capacity, and even memory decline. Restless legs syndrome patients are often misdiagnosed or missed, with many patients experiencing symptoms for years, even up to 30-40 years. Although the disease does not pose a threat to life, it severely affects the quality of life of patients. Most sedative drugs are ineffective, and patients are very painful. Many patients develop depression, anxiety, attention deficit, drug dependence, and some even have suicidal thoughts.

　　The main clinical manifestations can be summarized as follows:

　　1. Restlessness, often walking around or constantly rubbing their legs while lying in bed, or tossing and turning or shaking the body on the bed.

　　2. Sensory abnormalities, particularly in the deep thigh area during rest, especially in the morning and at night, cause a crawling-like discomfort, often affecting both sides, forcing patients to frequently move their legs.

　　3. Periodic leg movements during sleep, characterized by repetitive flexion movements, occur at least 40 times or more in a 6-hour sleep period.

　　4. Uncontrollable leg movements when awake commonly occur with involuntary flexion movements of the lower limbs during rest in a lying or sitting position.

　　5. Sleep disorders often lead to insomnia in patients due to sensory abnormalities and leg movements.

　　6. The symptoms worsen at night, although abnormal leg movements and restlessness can also occur during the day when resting, but there is a significant trend of aggravation at night.

　　Restless legs syndrome is common in middle-aged and elderly people over 50 years old, affecting both men and women. Most patients have symmetrical symptoms in both lower legs, and some may have symptoms on one side first, which later develop into symmetrical symptoms. Mild cases often occur after fatigue, with only mild discomfort and a short duration; severe cases have no obvious precipitating factors, with severe symptoms that can last for one year or even several decades.
　　The etiology of the disease is unknown at present, mainly related to vascular motor dysfunction. Research has confirmed that iron deficiency anemia, uremia, diabetes, cancer, and others may become precipitating factors. Some people may also experience symptoms of restless legs syndrome after taking antihistamines, phenothiazines (such as chlorpromazine, promethazine, and perphenazine).
　　To prevent restless legs syndrome in the elderly, it is first necessary to develop good exercise habits. Pay attention to strengthening leg movements, such as walking, jogging, squatting, kicking, etc. Rub the soles of the feet with your hands after washing your feet in the morning or before going to bed until they are warm and red, which helps to improve the blood circulation and nutritional status of the legs, prevent symptoms of numbness and coldness, etc. Secondly, pay attention to a balanced diet, eat less meat and more vegetables. Those with a smoking habit should quit, and also prevent passive smoking, reducing the harmful effects of nicotine on blood vessels.

　　Restless legs syndrome is mainly identified and examined based on clinical symptoms.

　　⑴ Akathisia:Mostly an adverse reaction in people who have been long-term users of antipsychotic drugs and tranquillizers. Sometimes even a small amount can cause it. Patients often complain of anxiety and restlessness, unable to put their legs down. Severe patients often stand up and walk back and forth repeatedly, with symptoms more pronounced at night than during the day. Antianxiety treatment is effective, and some patients may show abnormal iron deposition in the basal ganglia on cranial MRI.

　　⑵ Periodic leg movement in sleep:Periodic involuntary movements of the muscles in both feet during sleep. Often coexists with restless legs syndrome, or in some cases is a precursor to restless legs syndrome. Both have a common pathophysiological basis. When occurring alone, it does not accompany sensory abnormalities. Awakening due to lower limb movements during sleep, patients often complain of insomnia.

　　⑷ Painful legs and moving toes:Pain in the lower limbs and feet, accompanied by discomfort, with characteristic involuntary movements of the toes. This can occur in one or both limbs of the patient. Abnormal pain in the lower limbs can often persist. The involuntary movements of the lower limbs are mainly manifested as the extension and flexion, and the internal and external rotation of the toes, and the flexion and extension of the foot joints, which are different from the nature and characteristics of the pain of restless legs syndrome. It is common in diseases of the spinal cord and nerve endings such as heel pain, lumbar pain, and sciatica.

　　⑷ Acroparesthesia:Numbness and tingling pain in the fingers and toes during sleep, often awakening due to pain. More common in adult females.

　　(5) Nighttime paroxysmal leg pain muscle cramps (Cramp):It often manifests as sudden muscle pain in the lower calves during sleep at night, which improves after activity or massage. However, it is usually unilateral, and the painful muscle can be felt to contract during the attack. Other diseases that need to be differentiated include diabetic peripheral neuropathy, lower limb vascular lesions, senile pruritus, rheumatoid arthritis, lumbar disease, and so on.

　　Although the diagnosis of Restless Legs Syndrome mainly relies on clinical symptoms, auxiliary examinations can exclude some secondary causes, including serum ferritin, transferrin, serum iron-binding capacity, renal function, blood sugar, and so on. In some cases, it may be necessary to check cranial MRI, electroencephalogram, electromyogram, polysomnogram, lumbar CT or MRI, lower limb vascular Doppler ultrasound, and so on. For patients with a short history of symptoms, it is necessary to check blood sugar, serum iron, ferritin, folic acid, vitamin B12, creatinine, and thyroid-stimulating hormone, etc.

　　Restless Legs Syndrome, also known as Restless Legs Syndrome, is a common central nervous system disease, mainly manifested as discomfort in the lower limbs during rest, inability to sit still for a long time, and symptoms worsening during sleep at night. After exercising the lower limbs, the symptoms can temporarily alleviate. It is reported that 10% to 28% of elderly people over 65 are prone to this disease, and the symptoms worsen with age, severely affecting the quality of life of the elderly. Scientific home care can help patients alleviate physical and psychological pain and improve the quality of life.
　　Dietary care   Avoid consuming caffeine, nicotine, and alcohol, which are stimulants, before bedtime. Quit smoking and limit alcohol consumption, drink less coffee and caffeine-containing beverages. Reasonably adjust the diet structure, avoid overweight, and reduce the load on the joints to alleviate symptoms. Eat more vegetables, fruits, and high-fiber foods rich in iron and vitamins. Eat less high-cholesterol, high-fat, and high-sugar foods to maintain smooth bowel movements, shorten the time spent squatting, and alleviate discomfort.
　　Symptom care　Patients mostly manifest an indescribable discomfort in the deep lower limbs, especially the deep lower calves, with some experiencing sensations such as acidosis, pricking, burning, and crawling. These symptoms worsen during rest, especially during sleep at night, making it difficult for patients to fall asleep. Therefore, finding ways to alleviate the symptoms of patients is the key to home care. Manual local massage, kneading, striking, and hot compresses can be performed, or electric massagers can be used to massage the limbs to promote blood circulation and alleviate symptoms. Acupoint massage or acupuncture at points such as Stomach 36 (Zusanli) and Yanglingquan can also relax the muscles and effectively alleviate discomfort.
　　Safety nursing　Most patients are elderly. Due to the intolerable discomfort in the lower limbs, they exhibit强迫动作,强迫体位, and the symptoms are more pronounced at night. To alleviate discomfort, patients often need to walk back and forth or extend their limbs, tossing and turning, unable to lie still. Therefore, it is necessary to strengthen nursing care, pay attention to the cleanliness and dryness of the ground, prevent slipping, place items in an orderly manner, promptly remove obstacles from the ground, and prevent injuries or falls. Single beds should be placed against the wall or with railings to prevent patients from falling out of bed at night. The bedside lamp should be placed in an easily accessible and closable position to provide more convenience for patients and ensure their safety.
　　Psychological Care　Patients often experience emotions such as restlessness, anxiety, and anxiety. Family members should show deep understanding and sympathy for the patient's suffering, patiently listen to the patient's complaints, relieve the patient's psychological pain, and build courage and confidence in life. Spend more time talking and chatting with patients, distract their attention, eliminate loneliness, and pay special attention to single elderly individuals.
　　Lifestyle Care　Restless legs syndrome has the characteristics of exacerbating symptoms when lying down, and alleviating symptoms after activity or local massage. Therefore, encourage patients to engage in appropriate physical activities during the day, such as walking, practicing Tai Chi, kicking legs, cycling, etc. Help patients develop good sleeping habits, adjust the sleep cycle, appropriately delay the time of getting up, and ensure adequate sleep; soak feet in hot water or apply heat to the lower calves before going to bed, which can alleviate symptoms and promote sleep. Do not engage in strenuous exercise, relax completely, and maintain emotional stability; the patient's bed should be soft and comfortable, the pillow height should be appropriate, the blanket should be soft and warm, the clothing should be loose and comfortable, and the room temperature should be kept between 18℃ and 20℃. Help patients adjust the optimal sleeping position to minimize patient suffering.

　　Precautions before the treatment of restless legs syndrome;

　　1. Eliminate and reduce or avoid factors leading to the disease, improve the living environment, develop good living habits, prevent infection, pay attention to dietary hygiene, and rationally allocate diet.

　　2. Pay attention to physical exercise, increase the body's resistance to diseases, do not overwork or over-consume, quit smoking and drinking. Maintain a balanced psychology, overcome anxiety and tension.

　　3. Early detection, early diagnosis, early treatment, establish confidence in overcoming diseases, persist in treatment. Remember not to be impulsive.