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Sleep Disorders

Feet Drawing and Muscle Cramps Drawing

04/07/2009

Question:

When I go to bed and slide my feet under the cover if I move them just a little or relax them they start drawing and I have to get up and walk then they stop; as long as I am on my feet they don`t draw; but setting awhile or laying down they seem to start when I relax them. I have had back surgery and it was ok but it has gotten worse I had this before the back surgery but not as bad, had two rods and plates put in. I am just worn out from no sleep and stay up walking the floor. I am taking a muscle relaxing medication but doesn`t help. I can`t take my calcium because I am taking cumin blood thinner for blood clots in my leg that cramps the worse. Any help or suggestions would be greatly apprecaited. Thank you.

Answer:

This sounds very frustrating for you and you are right to seek advice. While there are numerous reasons a person may experience these symptoms, the description you provide makes suggests that you may be suffering from restless legs syndrome (RLS). However, before this diagnosis can be made, a thorough history, physical examination and work up by your physician is needed to rule out other causes of your symptoms, such as neuropathy (nerve disorder), poor circulation, leg cramps and other disorders

RLS is quite common, affecting roughly 10% of the adult population. The diagnosis of RLS truly rests upon the history with 4 key elements necessary to make a diagnosis. These are as follows: 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. Assuming you meet these criteria for the diagnosis, there are a number of treatment options available.

The cause of RLS is unknown in most cases, though a search for potential underlying contributors is always worthwhile. Conditions or factors that may be associated with the onset or worsening of RLS include iron deficiency (this can be quite mild and still affect RLS), kidney failure, pregnancy, neuropathy (disease of the nerves), lack of folate or vitamin B12 or magnesium, excessive caffeine ingestion, and certain medications (such as tricyclic antidepressants and selective serotonin reuptake inhibitor antidepressants). If one of these factors is found, particularly one that may be reversible (such as iron deficiency), then addressing this as the initial treatment strategy may be effective and prevent the need for additional medications.

There are a number medications that can be used for the specific treatment of RLS, though at present only some of the dopaminergic agonist agents (roperinole or Requip, and pramipaxole or Mirapex) are FDA approved. Sinemet, another dopaminergic drug, is less effective and not currently FDA approved for RLS. This class of drugs mimics or helps the release of the chemical dopamine in the brain. Problems with this chemical are thought to be important 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. 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.

* Learn important new information concerning the FDA withdrawal of the medication Propoxyphene(Darvon, 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.

For more information:

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Response by:

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