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HindustanTimes Fri,22 Aug 2014

Shaken and stirred

Jaya Shroff Bhalla, Hindustan Times   January 19, 2013
First Published: 23:42 IST(19/1/2013) | Last Updated: 01:42 IST(20/1/2013)

Do you also have sleepless nights? Does acute pain in your legs keep you up and aching? If your answers are yes, then it is time you met up a neurologist, instead of trying endless home remedies or resorting to sleeping pills.

At least one in 100 people in India suffer from Restless Leg Syndrome (RLS), but in most cases, the condition is mild and does not need treatment. Abnormal sensation in the legs, which prohibits one from sleeping peacefully, is a typical symptom of the disease. Even when one abnormally shakes his leg in a rhythm, while seated, it is associated with the disorder.

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Primary RLS has no known cause. There is no specific age when the problem begins but scientific data suggests that it worsens as you grow older. Secondary RLS, which is more severe in nature and needs medication, is associated with specific medical conditions such as severe deficiencies of iron, magnesium or folate, varicose veins, sleep apnea, diabetes or peripheral neuropathy. In 80% of the cases, the problem is misdiagnosed at the outset.

Nandita Rai, 24, (name changed on request) says she had not slept peacefully in more than three years because she developed acute pain in both her legs each time she lay down. To beat her pain, she would sometimes pile heavy pillows on her legs; sometimes tie them up tight, and her use of balms and pain killers  was endless. "I took sleeping pills and anti-depressants to fight the pain, but nothing worked. Then a friend suggested I meet a neurologist, who told me that I suffered from Restless Leg Syndrome. Now I take one prescription each night and sleep well," said Rai.

"I can't say how I developed the problem, but it grew over the years, till it became unmanageable. The strangest thing was that I had no trouble walking. So mostly, when I went to the doctor, I was always confused as all my complaints would vanish as there was no pain during the daytime," she added.

"The medicines prescribed are dopaminergic drugs, which are also used to treat Parkinson's," said Dr Sumit Singh, senior consultant neurology at Medanta, The Medicity in Gurgaon, and former AIIMS neurologist.

The pill is to be taken for as long as the problem persists. "Sometimes, the problem is life-long. But the pill works like magic. People who haven't slept in years start sleeping again," said Singh, who gets an average of 2-3 such cases daily. The medicine costs between R10 and R20 a day.

The real problem is that in most cases, the condition stays undiagnosed. Bad lifestyle, iron and vitamin deficiencies and stress are adding to growing cases of RLS.

Kshitij Rawat, 41, also developed a problem but he was quick to take measures. "For about two months, I did not sleep well. I would wake up tired and would be groggy all day, as most nights were sleep deprived, thanks to the horrible pain in my legs all through sleep," he said.

"Then by chance, I happened to read about abnormal pain in the legs on the internet and after due research, I met up with a neurologist. After tests, he told me that I was deficit in vitamin and iron. Some changes in my diet, exercises during the day and a one pill in the night before sleep - all together, the prescription worked like magic and I got better," says Rawat.

"I have a new patient with RLS almost every day. It is a fairly unknown syndrome. The challenge is that it cannot be clinically diagnosed and all tests come out to be normal," said Dr Praveen Gupta, senior consultant, neurology at Artemis Hospital, Gurgaon.

"The hallmark of this syndrome is that the patient will feel immense pain while lying down, however the pain completely goes away when the patient walks. Also a person with involuntary movement of legs while sitting is also likely to be suffering from the condition," he said.

"RLS patients come to us from all specialities, including medicine sleep disorder and neurology, as there is no defined doctor to diagnose the problem. Sometimes the patients have been taking wrong medicines for decades because of misdiagnosis," said Dr Garima Shukla, additional professor, Department of neurology, AIIMS.

"There is no specific test for RLS.  The only way to find the problem is by way of clinical diagnosis that is why it is difficult to pin-point the problem. We study the symptoms and signs along with history and pattern of the problem to determine whether a patient suffers from the disorder," she said, who has over 300 patients undergoing treatment for RLS.


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