DEAR MAYO CLINIC: My child moves around a lot at bedtime and has trouble falling asleep. She describes "bugs" on her legs. As someone who was diagnosed with restless legs syndrome, I am wondering if children can develop restless legs syndrome, too?

ANSWER: Yes, children can have restless legs syndrome. You also may hear it called Willis Ekbom disease, based on the names of the physicians who first described this condition.

Just like adults, children can have sensations in their legs that makes it hard for them to fall or stay asleep. If the sensation happens regularly, they may have restless legs syndrome, which is considered a sleep disorder.

Restless legs syndrome can occur in about 2% of school-aged children. It also can run in families. Children with symptoms may have a parent who has restless legs syndrome.

Similar to adults, restless legs syndrome can make it difficult for children to get a good night's sleep. It does not lead to other health problems in children. Treatments are available that often can reduce or eliminate restless legs syndrome.

At first, it can be challenging to diagnose children with restless legs syndrome, which is characterized by an unpleasant or uncomfortable urge to move their legs. Some people describe it as a crawling, pulling or burning sensation in the thighs, calves or feet. Children may describe "bugs" or use other such descriptors.

The sensation is temporarily relieved when they get up and move around, or when they shift or stretch their legs. Children also can have "growing pains," which typically wax and wane, and are not associated with the need for movement.

Symptoms of restless legs syndrome typically begin at night after a person has been sitting or lying down for some time. These symptoms can occur during the day, too, when a person is sitting, but they typically are worse at night. Children may sometimes have these feelings while sitting in a car or classroom.

Many people have mild leg twitches as they drift off to sleep. These movements, called "hypnic starts," are a normal part of falling asleep. They are not associated with restless legs syndrome. Restless legs syndrome is much more uncomfortable, and it often makes it hard to fall sleep and stay asleep.

Sometimes muscle and ligament strain can be misinterpreted as restless legs syndrome, too. Usually, however, a strain is relieved by rest; whereas, the symptoms of restless legs syndrome worsen when limbs are kept still.

Health care providers usually can diagnose restless legs syndrome based on symptoms. In children, symptoms can start as early as 5 to 6 years of age. Attention deficit hyperactivity disorder can coexist in about 30% of children who experience restless legs syndrome.

Sleep studies are not necessary unless children cannot accurately describe their symptoms. Based on how old children are developmentally, it can be difficult for them to describe the unusual feelings in their legs, so it is important to speak with a health care provider about options.

Treatment for restless legs syndrome focuses on relieving its symptoms. Taking a warm bath, massaging the legs, or applying warm or cool packs can calm symptoms of restless legs syndrome. Stretching, followed by exercise at a moderate level regularly and establishing good sleep habits also can make a difference. Caffeine, alcohol or tobacco consumption can trigger or worsen symptoms.

Research shows that too little iron in a person's diet can contribute to restless legs syndrome. Some young children or toddlers have a high consumption of cow's milk, which can lead to low iron. You may want to speak to your pediatrician about checking their blood iron level.

If the blood iron level is low, eating more iron-rich foods can help. Examples include red meat; dark green leafy vegetables; beans; and iron-fortified breads, cereals and pastas. Your health care provider also might recommend an iron supplement, which is usually the first choice to treat children.

No medications have been approved by the Food and Drug Administration for children with restless legs syndrome. Certain medications may be considered by a sleep medicine physician if children have not responded to other measures to manage symptoms.

For adults, if lifestyle changes are not enough, medications are available to reduce symptoms related to restless legs syndrome. Medications that have been shown to help include several that affect a chemical in your brain called dopamine. Dopamine's job is to send messages from your brain to your body that control muscle movement. Researchers suspect that restless legs syndrome may be linked to insufficient activity of dopamine in the nervous system.

Be aware that certain medications can worsen symptoms of restless leg syndrome, including over-the-counter sleep aids that contain diphenhydramine, selective serotonin reuptake inhibitors and anti-nausea drugs. Review current medications with your health care provider. He or she may recommend substitutes, as needed, to manage restless legs syndrome. — Dr. Julie Baughn, Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota

The post Mayo Clinic Q and A: Restless legs syndrome in children appeared first on Mayo Clinic News Network.

For the first four years of her life, Savannah Brock didn't sleep more than a few hours at a time. Though desperately tired, the child couldn't fall or stay asleep due to an unrelenting urge to move her legs. While Savannah's parents knew something was wrong, medical tests didn't reveal the cause. Then they met a Mayo Clinic pediatric sleep specialist who listened to the family's story and pinpointed the problem.

Savannah Brock loves to dance. The 11-year-old is on a dance team and performs in jazz, hip-hop and lyrical dance competitions. For Savannah's mother, Kelly, watching her child gracefully move her legs and arms in choreographed, rhythmic expression is an experience that stands in stark contrast to the girl's difficult early years.

From the time she was born until she was 4, Savannah's legs twitched and jerked incessantly any time she tried to rest. The movements made it hard for her to sleep more than a few hours at a time. "In order for her to get quality rest, we would sacrifice our own sleep and massage her legs for hours during the night," Kelly says. "It got to the point where we were all so sleep-deprived. I started hallucinating."

Kelly and her husband, Joey, who live in Madison, Mississippi, received medical guidance from local doctors, but the answers they received never added up to a solution. They consistently were told that Savannah had "growing pains," and she would outgrow the symptoms. They sought help from a local neurologist who recommended the toddler receive mood-altering medication to get her to sleep. He also suggested a sleep study.

Kelly says the mood-altering medication was not the solution for Savannah, and the sleep study yielded few answers. But the exam put her parents in contact with a physician who offered to help, and he provided them his personal cellphone number. After a particularly trying Saturday witnessing her exhausted toddler unable to be still during nap time, Kelly called the doctor.

"I was at a level of complete distress watching my little girl suffer as she fought for sleep, and I needed help," Kelly says. "Nothing was working, and none of the doctors knew what to do, so I called him crying."

The doctor told Kelly he had found a specialist at Mayo Clinic who might be able to help: Suresh Kotagal, M.D., in the Department of Neurology.

Savannah, Kelly and Kelly's mother traveled to Mayo Clinic in Rochester to meet Dr. Kotagal in the Mayo Clinic Center for Sleep Medicine. It didn't take him long to identify the problem and come up with a solution. Following a physical exam and a blood test, Dr. Kotagal told Kelly that Savannah had restless leg syndrome, and what she needed to jump-start treatment for the condition was an iron supplement. A short time later, Savannah received an IV iron infusion. 

"As soon as they performed that iron infusion, Savannah slept through the night for the first time in her entire life, and she was symptom-free for weeks afterward," Kelly says. "It was like a miracle from heaven."

Disruptive, underdiagnosed condition

It is not unusual for children with restless leg syndrome to go untreated for years, says Dr. Kotagal. "Restless leg syndrome is underrecognized and underdiagnosed in children. It's often dismissed as a sort of muscle or tendon issue, or that the discomfort in the legs is from dermatitis."

According to a large study involving 10,000 families in the United States and United Kingdom, the prevalence of restless leg in children is about 2%. One reason the condition is underdiagnosed is that very young children lack vocabulary to explain their symptoms. "Children are not able to express in words the discomfort that they're feeling in their bodies," Dr. Kotagal says. "They may just appear irritable or cry excessively for no obvious reason, so it's a little harder to diagnose."

"At one point, she said she had fire ants in her bones. It was utterly heartbreaking."

Kelly Brock

When Savannah started forming words and sentences, she described her legs as having bugs in them or birds flapping their wings. "At one point, she said she had fire ants in her bones," Kelly recalls. "It was utterly heartbreaking."

Although the condition affects the limbs, restless leg syndrome is a neurological disorder triggered by iron deficiency in certain parts of the brain. "The discomfort that develops in the arms, back and legs is related to brain malfunction," Dr. Kotagal says. "It is not a musculoskeletal condition. The discomfort that occurs is due to the malfunctioning of brain sensory systems."

Restless leg syndrome is not life-threatening, but it can severely impede childhood development. "When children don't sleep well at night, they have a lot of daytime behavior difficulties," Dr. Kotagal says. "For instance, they may be inattentive in school, get diagnosed as having attention deficit hyperactivity disorder, have mood swings or oppositional behavior."

The condition caused Savannah to be extremely tired and often weepy at bedtime. "She was a wonderful, adorable, loving child, but you could tell the lack of sleep was affecting her, as it would anyone," Kelly says. "If Dr. Kotagal hadn't intervened when he did, it could have affected her behaviorally."

Simple, effective treatment

Treating patients with restless leg syndrome involves providing enough iron supplementation to cross the blood-brain barrier to correct the neurodeficiency. Iron is given in the form of an oral pill, liquid solution or IV infusion. For Savannah, who had a severe case of the illness, IV infusion therapy was required to provide an adequate amount of iron, while avoiding gastrointestinal side effects that are typically seen with oral iron treatment. Dr. Kotagal also prescribed Savannah the nerve medication gabapentin.

Not only did Savannah's first infusion allow her to sleep for sustained periods, but as a result of the treatment, Savannah became less emotional, more focused and better at managing relationships, Kelly says.

Following the iron infusion at Mayo Clinic, the family returned to Mississippi. At home, under the guidance of her local pediatrician — who'd been given literature from Dr. Kotagal on the condition and how to manage it — Savannah began taking a liquid iron supplement, as well as daily gabapentin. Every six weeks, she received a blood test. The results were sent to Dr. Kotagal who closely monitored her iron levels to ensure that she didn't develop an iron excess.

"Dr. Kotagal took us seriously and gave us hope for our precious girl."

Kelly Brock

Two years ago, when Savannah was 9, her medical team began decreasing the iron supplements. "Extremely slowly, with bated breath, we weaned her off," Kelly says. "And amazingly, she was OK. As of today, she's on no medicine at all, and she's doing great. I guess you could say that we're in a remission period for as long as it's going to last. But the fact is, even if it comes back, we know how to treat it."

Although Savannah doesn't require follow-up visits with Dr. Kotagal, the support he provided continues to give the family comfort and assurance. "Dr. Kotagal recognized this was a severe case of RLS that required immediate treatment," Kelly says. "And he had a way out. It was like divine intervention, meeting him. Dr. Kotagal took us seriously and gave us hope for our precious girl. The fact that he knew exactly how to handle her condition, and his treatment plan worked, I was like: 'My gosh. He's our hero. He's our family's hero.'"

But according to Dr. Kotagal, Kelly had just as much a hand in Savannah's recovery as he did. "I think she's just been an amazing mother," he says. "She knew her child was ill. She wasn't satisfied with the answers she was getting locally, and she sought help at Mayo Clinic. I think a lot of credit for Savannah's recovery goes not as much to me as to her."

HELPFUL LINKS

• Learn more about restless leg syndrome.
• Check out the Department of Neurology.
• Connect with others talking about nerve diseases on Mayo Clinic Connect.
• Explore Mayo Clinic.
• Request an appointment.

The post Sharing Mayo Clinic: From restless legs to dancing feet appeared first on Mayo Clinic News Network.

ANSWER: The sensations you describe may be caused by restless legs syndrome (RLS), also called Willis-Ekbom disease. The symptoms can range from mildly annoying to incapacitating. A key secondary symptom is difficulty getting good sleep. Combined, these can have a damaging effect on energy, vitality, thinking and mood.

Diagnosing RLS is based on identifying tell-tale symptoms. These include an urge to move the legs along with an uncomfortable sensation in the thighs, calves or feet — or occasionally the arms — that may be described as creeping, jittery, tingling, electric, burning or aching. Sometimes, the urge to move the legs can occur without these sensations. Restless legs syndrome usually causes sensations that begin or worsen during rest or inactivity, such as lying down or sitting, and worsen in the evening or at night. These sensations are typically only relieved by movement, such as walking or stretching, until they go away.

It’s common for people with RLS to have difficulty sleeping or to feel that sleep isn’t restorative. About 80 percent of those with RLS also have periodic limb movements of sleep. This consists of nighttime leg jerking or kicking while asleep that can disturb sleep quality, often without you knowing it.

If you have milder RLS symptoms that occur intermittently and aren’t impacting your life much, you may be able to calm the sensation by massaging your legs, stretching leg muscles, walking or taking a warm bath. To prevent symptoms, keep the mind occupied in the evening, such as with crossword puzzles, conversation, knitting or other activities that may help. Try stopping any afternoon or evening caffeine intake, as this can sometimes contribute to the problem.

If symptoms aren’t manageable on your own, the first step is to test for insufficient iron levels with a blood test called a serum ferritin test. Even serum ferritin measurements that are within the typical normal range may be low enough to contribute to RLS symptoms. If the iron levels are low, iron replacement with a supplement is typically recommended, although intravenous iron replacement may be considered in some cases.

Another early step is having your health care provider or pharmacist look at any prescription or non-prescription drugs or supplements you take to assess whether any of them might be contributing to symptoms.

If none of these changes are enough to relieve your symptoms, your health care provider may prescribe medication to reduce leg restlessness. Several prescription medications — most of which were developed to treat other diseases — may reduce the restlessness in your legs. These include medications that increase dopamine in the brain, opioids, muscle relaxants and sleep medications. It may take several trials for you and your health care provider to find the right medication or combination of medications that works best for you.

Sometimes these drug options aren’t effective, they decline in effectiveness or side effects become intolerable. In these cases, it’s often worthwhile to go back to the basics and thoroughly review iron levels or other factors that may be hampering efforts to control symptoms, such as a sleep disorder or medication. (adapted from Mayo Clinic Health Letter) — Dr. Vichaya Arunthari, Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, Florida

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Related Articles

• Mayo Clinic Minute: Sleep spoilers — tips for a good night’s rest published 11/2/18
• Mayo Clinic Minute: Signs of a sleep disorder published 10/1/18
• Mayo Clinic Minute: Does your child have restless legs syndrome? published 8/10/18

The post Mayo Clinic Q and A: Understanding restless legs syndrome appeared first on Mayo Clinic News Network.

Dr. Suresh Kotagal, a Mayo Clinic pediatric neurologist and sleep specialist, says some young patients describe it as feeling like bugs are crawling on their legs while lying in bed, and moving their legs is the only relief. The end result is a lack of good, quality sleep, which can have negative side effects at home or in school.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (1:00) is in the downloads. Read the script.

"Sometimes kids will say that 'I feel like I have to kick my legs' or 'I feel like I have to move my legs to get comfortable,'" says Dr. Kotagal.

That's restless legs syndrome, a genetic disorder that Dr. Kotagal says is more common in children than you might think. Studies show that 1 in 50 kids have the condition, a discomfort that can prevent a child from falling asleep and repeatedly wake a child during sleep.

"They are tired in the daytime and frequently have troubles with attention span," says Dr. Kotagal.

It often can be related to low levels of iron, which helps make dopamine, a chemical that helps in neurotransmission in the brain and learning.

"So if we don't have enough dopamine, one is likely to have disturbed sleep," he says.

Dr. Kotagal says children with restless legs syndrome may go undiagnosed because there is a lack of awareness of the condition, and it can be attributed to attention deficit hyperactivity disorder instead. He says the first step is to talk about sleep disorders with your primary care provider or pediatrician.

The post Mayo Clinic Minute: Does your child have restless legs syndrome? appeared first on Mayo Clinic News Network.

Dr. Suresh Kotagal, a Mayo Clinic pediatric neurologist and sleep specialist, says some young patients describe it as feeling like bugs are crawling on their legs while lying in bed, and moving their legs is the only relief. The end result is a lack of good, quality sleep, which can have negative side effects at home or in school.

Jason Howland has more in this Mayo Clinic Minute.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (1:00) is in the downloads. Read the script.

"Sometimes kids will say that 'I feel like I have to kick my legs' or 'I feel like I have to move my legs to get comfortable,'" says Dr. Kotagal.

That's restless legs syndrome, a genetic disorder that Dr. Kotagal says is more common in children than you might think. Studies show that 1 in 50 kids have the condition, a discomfort that can prevent a child from falling asleep and repeatedly wake a child during sleep.

"They are tired in the daytime and frequently have troubles with attention span," says Dr. Kotagal.

It often can be related to low levels of iron, which helps make dopamine, a chemical that helps in neurotransmission in the brain and learning.

"So if we don't have enough dopamine, one is likely to have disturbed sleep," he says.

Dr. Kotagal says children with restless legs syndrome may go undiagnosed because there is a lack of awareness of the condition, and it can be attributed to attention deficit hyperactivity disorder instead. He says the first step is to talk about sleep disorders with your primary care provider or pediatrician.

The post Mayo Clinic Minute: Restless legs syndrome in kids appeared first on Mayo Clinic News Network.

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DEAR MAYO CLINIC:

ANSWER: If the sensation in your legs is making it hard for you to fall asleep, and it’s happening on a regular basis, you may have restless legs syndrome, or RLS. You may hear it called Willis Ekbom disease, too, based on the names of the physicians who first described this condition. RLS doesn’t lead to other health problems. But it can make it difficult to get a good night’s sleep. See your doctor to have your condition evaluated. Treatments are available that can often reduce or even eliminate RLS.

Restless legs syndrome is characterized by an unpleasant or uncomfortable urge to move your legs. Some people describe it as a crawling, pulling or burning sensation in the thighs, calves or feet. The sensation is temporarily relieved when you get up and move around or when you shift or stretch your legs. RLS symptoms typically begin in the evening or at night after you have been sitting or lying down for some time.

Many people have mild leg twitches as they drift off to sleep. Called hypnic starts, they are a normal part of falling asleep and are not associated with restless legs syndrome. RLS is much more uncomfortable and often makes it hard to get to sleep and stay asleep. Sometimes muscle and ligament strain can be misinterpreted as RLS. Usually, however, a strain is relieved by rest whereas RLS gets worse when you keep your limbs still.

Doctors can usually diagnose RLS based on your symptoms. Symptoms can start as early as five to six years of age. Attention deficit hyperactivity disorder may co-exist in about 30 per cent of children with RLS. Sleep studies are not necessary unless the patient is a child who is unable to describe the symptoms accurately.

Treatment for RLS focuses on relieving the symptoms. A number of steps you can take at home may help. Taking a warm bath, massaging your legs, and applying warm or cool packs can all be useful in calming RLS. Stretching, followed by exercise at a moderate level on a regular basis, and establishing good sleep habits can also make a difference. Caffeine, alcohol and tobacco may trigger RLS symptoms or make them worse. Try cutting back on these substances to see whether that decreases your symptoms.

Your diet may have an effect on RLS. Research shows that too little iron in your diet can contribute to restless legs syndrome. If your doctor suspects this may be the case for you, he or she will likely check your blood-iron level. If it is low, eating more iron-rich foods can help. Examples include red meat, dark green leafy vegetables, beans and iron-fortified breads, cereals and pastas. Your doctor might also recommend you take an iron supplement.

If lifestyle changes are not enough, your doctor may prescribe medication to reduce leg restlessness. Medications that have been shown to be helpful for RLS include several that affect a chemical in your brain called dopamine. Dopamine’s job is to send messages from your brain to your body that control muscle movement. Researchers suspect that RLS may be linked to insufficient activity of dopamine in the nervous system.

Oral iron is generally the first treatment of choice for children with RLS. Certain medications used to treat pain conditions, such as gabapentin, may also effectively treat childhood RLS. Use of dopamine agonist drugs, such as ropinirole, pramipexole or rotigotine, may be considered when oral iron and gabapentin have not proven effective.

Be aware that certain medications can make RLS symptoms worse, including over-the-counter sleep aids that contain diphenhydramine, selective serotonin reuptake inhibitors and anti-nausea drugs. Review your current medications with your doctor. He or she may recommend substitutes, as needed, to help manage RLS. — Suresh Kotagal, M.D., Center for Sleep Medicine, Mayo Clinic, Rochester, Minn.

The post Mayo Clinic Q and A: Without treatment, RLS can make it difficult to get a good night’s sleep appeared first on Mayo Clinic News Network.

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Myth or Matter-of-Fact: Wearing compression stockings is often the first approach to try before moving to other treatments for varicose veins.

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Follow #MayoClinicRadio and tweet your questions.

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