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Sleep Disorders

Tingling sensation in legs and arms

07/23/2008

Question:

I want to know why lately I cannot sleep due to tingling sensation on my legs. And then it runs through my arms. It`s like tingly and wants to be moved, and once I fight the urge to move it will only feel worse, more tingly. I would like to know the exact term of this and cause and cure. Thank you.

Answer:

Uncomfortable sensations in the lower extremities that cause an irresistible urge to move the limbs is a very common disorder known as Restless Legs Syndrome (RLS).  RLS is quite common, affecting roughly 5-10% of the adult population.

The diagnosis of RLS rests upon the history of symptoms with 4 key elements necessary to make a diagnosis:  1) an urge to move the legs, usually associated with an uncomfortable or unpleasant sensation in the legs, 2) the symptoms typically occur at rest, 3) the symptoms typically occur in the evening or at night, and 4) the symptoms are totally or partially relieved with movement, such as walking or stretching.  Occasionally, the sensations will progress to involve other areas of the body also.

If you do have RLS, it is important to have a thorough check up that includes tests for diabetes, neuropathy (sickness in the nerves going to the extremities), kidney failure, thyroid problems and for deficiencies of vitamin B12 and iron (as judged by a serum ferritin level).  These are all conditions that may cause or contribute to the symptoms of RLS.  If one of these problems is present, then the symptoms are treated by treating the underlying condition (i.e., taking iron supplements if the iron level is found to be low). Some medications may cause or worsen RLS and so a close review of the medications you are taking (including over the counter drugs) is important.

Some examples of these offending drugs include antipsychotics, antihistamines and some antidepressants. Often, just stopping one of these medications can lead to relief of the symptoms. Excessive caffeine intake, alcohol use and tobacco use also may aggravate RLS.

If no cause is found, there are a number of different medications that can be tried for RLS symptoms. At present roperinole (Requip) and pramipaxole (Mirapex) are the only drugs with FDA approval. Both of these drugs are known as dopaminergic agonists, or drugs that mimic or help to release the chemical dopamine in the brain. Problems with this chemical are thought to be an important factor in the underlying cause of RLS in most RLS patients. In general, this class of agents is about 80-90% effective in controlling RLS symptoms and the medications are fairly well tolerated. The other main drug in this class is caridopa-levodopa (Sinemet), though this agent has the problematic side-effect of increasing RLS symptoms with long term usage and therefore is not routinely used these days.

While there is less data to support their use, other non-FDA approved medications commonly used for the treatment of RLS include the antiepileptic medications gabapentin (Neurontin) and carbamazepine (Tegretol), narcotics such as oxycodone (Percocet or Roxicet) and *propoxyphene (Darvocet), sedatives such as clonazepam (Klonipin), and antihypertensive medications such as clonidine (Catapres). Each of these medications has its own list of contraindications and side effects. Some individuals respond best to one class of medication more so than the others and often a “trial and error” approach is required to determine which medication(s) may be most effective for a given individual.

* Learn important new information concerning the FDA withdrawal of the medication Propoxyphene (Darvocet)


You should consider discussing your problems with your primary care physician. Specific factors in your history may be useful in tailoring a strategy that might work best for you. Referral to a Sleep Specialist in your area may also be helpful.

If you would like further information about restless legs syndrome, sleep disorders or sleep itself, I recommend the American Academy of Sleep Medicine website. In addition to information about sleep medicine, the website also contains a list of accredited Sleep Centers and may help you to locate one nearest you. Another organization that may be very useful for those that suffer from RLS is the Restless Legs Syndrome Foundation.Their website has plenty of good information about RLS and is regularly updated.

For more information:

Go to the Sleep Disorders health topic, where you can:

Response by:

Karen M Thomas, DO Karen M Thomas, DO
Formerly:
College of Medicine
The Ohio State University