This week, I have asked my good friend and colleague, Dr Ted King from the USA, to tell us more about how veins may cause symptoms – in particular, the Restless Legs Syndrome (RLS).
“Restless legs syndrome is a condition that is characterized by an irresistible urge to move one’s limbs (almost always legs) to stop uncomfortable or odd sensations. Moving the affected limb lessens the sensations and provides some temporary relief. It seems as though RLS must have been recently discovered because many people have never heard of it or have only recently heard of it for the first time. Interestingly, it was first described in the late 1600’s. It wasn’t until 1945, though, that the term “restless legs” was coined for the first time by Karl-Axel Ekbom. Unfortunately for him, his work was largely ignored until the 1980’s when there was a resurgence of interest into the cause and treatment of RLS. Despite decades of research though, it is still very poorly understood.
Making the diagnosis of RLS requires no testing. Restless legs syndrome has four required clinical criteria. If all four are true for you, you have RLS:
- Do you have a desire to move the extremities due to a discomfort or disagreeable sensations in the extremities?
- Do you have motor restlessness? Patients move to relieve the discomfort, for example walking, or to provide a counter-stimulus to relieve the discomfort, for example, rubbing the legs.
- Are your symptoms worse at rest with at least temporary relief by activity?
- Are your symptoms worse later in the day or at night?
If you can say yes to all four, you should probably see your doctor. He or she isn’t likely to come up with a cause for your RLS, but there are a number of conditions that have been found to be associated with having restless legs. Making sure you don’t have any of them is worthwhile. One very common problem that is not widely recognized but which is commonly associated with RLS is varicose veins. In a study done in 2007 (McDonagh and King), it was found that 36% of 174 patients who came in for a consultation for their veins also met all four criteria for having restless legs syndrome. Only 19% of a control group (age and sex matched) of an equal number of patients who didn’t have varicose veins could be diagnosed with RLS. On statistical analysis, the difference between the 36% and 19% was very significant. Interestingly, in the 19% of the control group who had RLS, 91% of them were found to have varicose veins that they weren’t aware of. Of the remaining 81% of the controls without RLS, only 20% of them were found to have any vein disease. Again, these difference were highly statistically significant. Although, the connection doesn’t prove the cause, there is a clearly a strong connection between RLS and varicose veins.
Fortunately, the story doesn’t end there. There are at least three studies that have been published now that show a marked improvement in varicose vein related RLS symptoms when your veins are treated. Kanter published a 98% success rate in initial relief of RLS symptoms. In 2007, Hayes published a combined complete or significant relief rate of 84% with vein treatment. In 2010, Gibson presented a complete RLS symptom relief rate of 96% in 50 patients whose varicose veins were treated.
So, if your legs are driving you crazy because they hurt and move and twitch, and you can’t relax or sleep because you can’t make them stop, there may be hope. If you have RLS symptoms and you can see veins in your legs, see a vein specialist. If you have RLS that is associated with varicose veins, taking care of your vein problem could very well change your life.“
J. Theodore King, MD, FACPh, National Medical Director of Vein Clinics of America
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