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52-561: Cramp definition is narrower than the definition of muscle spasm : spasms include any involuntary abnormal muscle contractions, while cramps are sustained and painful. True cramps can be distinguished from other cramp-like conditions. Cramps are different from muscle contracture , which is also painful and involuntary, but which is electrically silent. The main distinguishing features of cramps from dystonia are suddenness with acute onset of pain, involvement of only one muscle and spontaneous resolution of cramps or their resolution after stretching

104-404: A health problem . A series of spasms, or permanent spasms, is referred to as a "spasmism". Various kinds of involuntary muscle activity may be referred to as a "spasm". A spasm may be a muscle contraction caused by abnormal nerve stimulation or by abnormal activity of the muscle itself. A spasm may lead to muscle strains or tears in tendons and ligaments if the force of the spasm exceeds

156-440: A "crawling" feeling, or limbs jerking while awake. The sensations typically begin or intensify during quiet wakefulness, such as when relaxing, reading, studying, or trying to sleep. It is a " spectrum disorder " with some people experiencing only a minor annoyance and others having major disruption of sleep and impairments in quality of life. The sensations—and the need to move—may return immediately after ceasing movement or at

208-467: A different statin; however, they should not be ignored if they persist, as they can, in rare cases, develop into more serious problems. Coenzyme Q10 supplementation can be helpful to avoid some statin-related adverse effects, but currently there is not enough evidence to prove the effectiveness in avoiding myopathy or myalgia. Stretching, massage, and drinking plenty of liquids may be helpful in treating simple muscle cramps. The antimalarial drug quinine

260-537: A later time. RLS may start at any age, including childhood, and is a progressive disease for some, while the symptoms may remit in others. In a survey among members of the Restless Legs Syndrome Foundation, it was found that up to 45% of patients had their first symptoms before the age of 20 years. RLS may contribute to higher rates of depression and anxiety disorders in RLS patients. RLS

312-523: A medical description in 1672. Willis emphasized the sleep disruption and limb movements experienced by people with RLS. Subsequently, other descriptions of RLS were published, including by Theodor Wittmaack  [ de ] (1861) (in relation to whom it is sometimes known as Wittmaack-Ekbom syndrome ). In 1945, Karl-Axel Ekbom (1907–1977) provided a detailed and comprehensive report of this condition in his doctoral thesis, restless legs: clinical study of hitherto overlooked disease . Ekbom coined

364-473: A person is exercising or engaging in an activity where the heartbeat rises. Medical conditions associated with leg cramps are cardiovascular disease, hemodialysis, cirrhosis, pregnancy, and lumbar canal stenosis. Differential diagnoses include restless legs syndrome , claudication , myositis , and peripheral neuropathy . All of them can be differentiated through careful history and physical examination. Gentle stretching and massage , putting some pressure on

416-495: A prevalence from 20% to 57%, while those having kidney transplant improve compared to those treated with dialysis. RLS can occur at all ages, although it typically begins in the third or fourth decade. Genome‐wide association studies have now identified 19 risk loci associated with RLS. Neurological conditions linked to RLS include Parkinson's disease , spinal cerebellar atrophy , spinal stenosis , lumbosacral radiculopathy and Charcot–Marie–Tooth disease type 2. In 2013,

468-437: A role in RLS as part as the limbic system modulated by the dopaminergic system which may affect pain perception. Improvement of RLS symptoms occurs in people receiving low-dose dopamine agonists . There are no specific tests for RLS, but non-specific laboratory tests are used to rule out other causes such as vitamin deficiencies. Five symptoms are used to confirm the diagnosis: The symptoms below are not essential, like

520-703: A role in the prevalence of this syndrome. RLS diagnosed at an older age runs a more severe course. RLS is even more common in individuals with iron deficiency , pregnancy, or end-stage kidney disease . The National Sleep Foundation 's 1998 Sleep in America poll showed that up to 25 percent of pregnant women developed RLS during the third trimester. Poor general health is also linked. There are several risk factors for RLS, including old age, family history, and uremia . The prevalence of RLS tends to increase with age, as well as its severity and longer duration of symptoms. People with uremia receiving renal dialysis have

572-480: A symptom or complication of pregnancy ; kidney disease; thyroid disease; hypokalemia , hypomagnesemia , or hypocalcaemia (as conditions); restless legs syndrome ; varicose veins ; and multiple sclerosis . As early as 1965, researchers observed that leg cramps and restless legs syndrome can result from excess insulin , sometimes called hyperinsulinemia . Under normal circumstances, skeletal muscles can be voluntarily controlled. Skeletal muscles that cramp

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624-551: A vibratory counter-stimulation device has been found to help some people with primary RLS to improve their sleep. There is some evidence that intravenous iron supplementation moderately improves restlessness for people with RLS. For those whose RLS disrupts or prevents sleep or regular daily activities, medication may be useful. Evidence supports the use of dopamine agonists including pramipexole , ropinirole , rotigotine , cabergoline , and pergolide . They reduce symptoms, improve sleep quality and quality of life. Levodopa

676-458: Is a neurological disorder , usually chronic, that causes an overwhelming urge to move one's legs. There is often an unpleasant feeling in the legs that improves temporarily by moving them. This feeling is often described as aching, tingling, or crawling in nature. Occasionally, arms may also be affected. The feelings generally happen when at rest and therefore can make it hard to sleep . Sleep disruption may leave people with RLS sleepy during

728-452: Is a medication associated with a high incidence of leg cramps. Additional factors, which increase the probability for these side effects, are physical exercise, age, history of cramps, and hypothyroidism . Up to 80% of athletes using statins experience significant adverse muscular effects, including cramps; the rate appears to be approximately 10–25% in a typical statin-using population. In some cases, adverse effects disappear after switching to

780-518: Is a sudden involuntary contraction of a muscle , a group of muscles, or a hollow organ , such as the bladder. A spasmodic muscle contraction may be caused by many medical conditions, including dystonia . Most commonly, it is a muscle cramp which is accompanied by a sudden burst of pain. A muscle cramp is usually harmless and ceases after a few minutes. It is typically caused by ion imbalance or muscle overload . There are other causes of involuntary muscle contractions, and some of these may cause

832-419: Is a traditional treatment that may be slightly effective for reducing the number of cramps, the intensity of cramps, and the number of days a person experiences cramps. Quinine has not been shown to reduce the duration (length) of a muscle cramp. Quinine treatment may lead to haematologic and cardiac toxicity. Due to its low effectiveness and negative side effects, its use as a medication for treating muscle cramps

884-493: Is also a commonly acknowledged circadian rhythm explanatory mechanism associated with it, clinically shown simply by biomarkers of circadian rhythm, such as body temperature . The interactions between impaired neuronal iron uptake and the functions of the neuromelanin -containing and dopamine-producing cells have roles in RLS development, indicating that iron deficiency might affect the brain dopaminergic transmissions in different ways. Medial thalamic nuclei may also have

936-402: Is also effective. However, pergolide and cabergoline are less recommended due to their association with increased risk of valvular heart disease. Ropinirole has a faster onset with shorter duration. Rotigotine is commonly used as a transdermal patch which continuously provides stable plasma drug concentrations, resulting in its particular therapeutic effect on patients with symptoms throughout

988-1152: Is approved by regulatory authorities for the treatment of RLS, whereas gabapentin and pregabalin are used off-label . Data on gabapentinoids in the treatment of RLS are more limited compared to dopamine agonists. However, based on available evidence, gabapentinoids are similarly effective to dopamine agonists in the treatment of RLS. Low doses of opioids are used in the treatment of severe and treatment-resistant cases and are recommended by multiple reputable medical guidelines . The most commonly used agents are prolonged-release oxycodone and methadone , but other opioids, including tramadol , codeine , morphine , and hydrocodone , may also be considered. Opioids are only indicated in severe cases that do not respond to other measures due to their very high abuse liability and high rate of side effects , which may include constipation , fatigue, and headache . However, opioids are said to be highly effective for severe and refractory RLS, and can be helpful in well-selected individuals. Benzodiazepines , such as diazepam or clonazepam , are not generally recommended, and their effectiveness

1040-808: Is categorized as either primary or secondary. While the cause is generally unknown, it is believed to be caused by changes in the neurotransmitter dopamine resulting in an abnormal use of iron by the brain. RLS is often due to iron deficiency (low total body iron status) and could be a sign of anemia caused by internal bleeding or bone marrow issues. Other associated conditions may include end-stage kidney disease and hemodialysis , folate deficiency , magnesium deficiency , sleep apnea , diabetes , peripheral neuropathy , Parkinson's disease , and certain autoimmune diseases , such as multiple sclerosis . RLS can worsen in pregnancy, possibly due to elevated estrogen levels. Use of alcohol, nicotine products, and caffeine may be associated with RLS. A 2014 study from

1092-514: Is much more serious and is permanent unless treated. In this case, the hypertonic muscle tone is excessive, and the muscles are unable to relax. A subtype of spasm is colic . This is an episodic pain caused by spasm of smooth muscle in a particular organ (e.g., the bile duct ). A characteristic of colic is the sensation of having to move about, and the pain may induce nausea or vomiting . Restless legs syndrome Restless legs syndrome (RLS) , (also known as Willis–Ekbom disease (WED) ,

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1144-558: Is not linked to an underlying cause, its frequency may be reduced by lifestyle modifications such as adopting improving sleep hygiene , regular exercise, and stopping smoking . Medications used may include dopamine agonists and gabapentinoids in those with daily restless legs syndrome. In severe or refractory cases, opioids have been used. Treatment of RLS should not be considered until possible medical causes are ruled out. Secondary RLS may be cured if precipitating medical conditions ( anemia ) are managed effectively. Stretching

1196-1030: Is not recommended by the FDA. Magnesium is commonly used to treat muscle cramps. Moderate quality evidence indicates that magnesium is not effective for treating or preventing cramps in older adults. It is not known if magnesium helps cramps due to pregnancy, liver cirrhosis , other medical conditions, or exercising. Oral magnesium treatment does not appear to have significant major side effects, however, it may be associated with diarrhea and nausea in 11–37% of people who use this medicine. With exertional heat cramps due to electrolyte abnormalities (primarily potassium loss and not calcium, magnesium, and sodium), appropriate fluids and sufficient potassium improves symptoms. Vitamin B complex , naftidrofuryl , lidocaine , and calcium channel blockers may be effective for muscle cramps. Adequate conditioning, stretching, mental preparation, hydration, and electrolyte balance are likely helpful in preventing muscle cramps. Spasm A spasm

1248-444: Is not well established. Loss of sleep due to RLS could cause the conditions, or medication used to treat a condition could cause RLS. More than 60% of cases of RLS are familial and are inherited in an autosomal dominant fashion with variable penetrance . Research and brain autopsies have implicated both dopaminergic system and iron insufficiency in the substantia nigra . Iron is well understood to be an essential cofactor for

1300-445: Is outdated usage, as the unambiguous names (WED or RLS) are preferred for clarity. Some doctors express the view that the incidence of restless legs syndrome is exaggerated by manufacturers of drugs used to treat it. Others believe it is an underrecognized and undertreated disorder. Further, GlaxoSmithKline (GSK) ran advertisements that, while not promoting off-licence use of their drug ( ropinirole ) for treatment of RLS, did link to

1352-509: Is unknown or contradictory. They, however, are sometimes still used as a second-line treatment, as add-on agents. Other treatments have also been explored, such as valproate , carbamazepine , perampanel , and dipyridamole , but are either not effective or have insufficient data to support their use. Placebos provide a large benefit in terms of reduction of RLS symptoms. This is thought to be due to positive expectancy effects and conditioning, which activate dopamine and opioid pathways in

1404-548: Is variable, with cramps lasting anywhere from a few seconds to several minutes. Muscle soreness may remain after the cramp itself ends. These cramps are more common in older people. They happen quite frequently in teenagers and in some people while exercising at night. Besides being painful, a nocturnal leg cramp can cause much distress and anxiety . The precise cause of these cramps is unclear. Potential contributing factors include dehydration , low levels of certain minerals ( magnesium , potassium , calcium , and sodium , although

1456-648: The idiopathic form of RLS than for people who also have an associated medical condition. Current therapies can control the disorder, minimizing symptoms and increasing periods of restful sleep. In addition, some people have remissions, periods in which symptoms decrease or disappear for days, weeks, or months, although symptoms usually eventually reappear. Being diagnosed with RLS does not indicate or foreshadow another neurological disease, such as Parkinson's disease . RLS symptoms can worsen over time when dopamine -related drugs are used for therapy, an effect called augmentation which may represent symptoms occurring throughout

1508-565: The American Academy of Neurology also found that reduced leg oxygen levels were strongly associated with restless legs syndrome symptom severity in untreated patients. An association has been observed between attention deficit hyperactivity disorder (ADHD) and RLS or periodic limb movement disorder . Both conditions appear to have links to dysfunctions related to the neurotransmitter dopamine , and common medications for both conditions among other systems, affect dopamine levels in

1560-667: The Ekbom Support Group website. That website contained statements advocating the use of ropinirole to treat RLS. The Association of the British Pharmaceutical Industry (ABPI) ruled against GSK in this case. Different measurements have been used to evaluate treatments in RLS. Most of them are based on subjective rating scores, such as IRLS rating scale (IRLS), Clinical Global Impression (CGI), Patient Global Impression (PGI), and Quality of life (QoL). These questionnaires provide information about

1612-503: The Restless Legs Syndrome Foundation renamed itself the Willis–Ekbom Disease Foundation; however, it reverted to its original name in 2015 “to better support its mission”. A point of confusion is that RLS and delusional parasitosis are entirely different conditions that have both been called "Ekbom syndrome", as both syndromes were described by the same person, Karl-Axel Ekbom . Today, calling WED/RLS "Ekbom syndrome"

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1664-793: The affected leg by walking or standing, or taking a warm bath or shower may help to end the cramp. If the cramp is in the calf muscle, dorsiflexing the foot (lifting the toes back toward the shins) will stretch the muscle and provide almost immediate relief. There is limited evidence supporting the use of magnesium, calcium channel blockers , carisoprodol , and vitamin B 12 . Quinine is no longer recommended for treatment of nocturnal leg cramps due to potential fatal hypersensitivity reactions and thrombocytopenia . Arrhythmias , cinchonism , and hemolytic uremic syndrome can also occur at higher dosages. Various medications may cause nocturnal leg cramps: Statins may sometimes cause myalgia and cramps among other possible side effects. Raloxifene (Evista)

1716-792: The affected muscle. Restless leg syndrome is not considered the same as muscle cramps and should not be confused with rest cramps. Skeletal muscle cramps may be caused by muscle fatigue or a lack of electrolytes such as sodium (a condition called hyponatremia ), potassium (called hypokalemia ), or magnesium (called hypomagnesemia ). Some skeletal muscle cramps do not have a known cause. Motor neuron disorders (e.g., amyotrophic lateral sclerosis ), metabolic disorders (e.g., liver failure ), some medications (e.g., diuretics and inhaled beta‐agonists ), and haemodialysis may also cause muscle cramps. Causes of cramping include hyperflexion , hypoxia , exposure to large changes in temperature, dehydration, or low blood salt . Muscle cramps can also be

1768-577: The brain. A 2005 study suggested that up to 44% of people with ADHD had comorbid (i.e. coexisting) RLS, and up to 26% of people with RLS had confirmed ADHD or symptoms of the condition. Certain medications may cause or worsen RLS, or cause it secondarily, including: Both primary and secondary RLS can be worsened by surgery of any kind; however, back surgery or injury can be associated with causing RLS. The cause vs. effect of certain conditions and behaviors observed in some patients (ex. excess weight, lack of exercise, depression or other mental illnesses)

1820-433: The brain. Both dopamine agonists and opioids are used in and effective for the treatment of RLS, which is thought to be related to the effectiveness of placebos for the condition. More than half of the benefit of RLS medications such as pramipexole and gabapentin enacarbil appears to be due to the placebo component based on clinical trial data. RLS symptoms may gradually worsen with age, although more slowly for those with

1872-658: The day and affect movements of all limbs. There is no cure for RLS. RLS affects an estimated 2.5–15% of the American population. A minority (around 2.7% of the population) experience daily or severe symptoms. RLS is twice as common in women as in men, and Caucasians are more prone to RLS than people of African descent. RLS occurs in 3% of individuals from the Mediterranean or Middle Eastern regions, and in 1–5% of those from East Asia , indicating that different genetic or environmental factors, including diet, may play

1924-537: The day, with low energy, and irritable or depressed . Additionally, many have limb twitching during sleep, a condition known as periodic limb movement disorder . RLS is not the same as habitual foot-tapping or leg-rocking . Diagnosis of RLS is generally based on a person's symptoms after ruling out other potential causes. Risk factors include low iron levels , kidney failure , Parkinson's disease , diabetes mellitus , rheumatoid arthritis , pregnancy and celiac disease . A number of medications may also trigger

1976-437: The day. A 2008 meta-analysis found pramipexole to be better than ropinirole. There are, however, issues with the use of dopamine agonists including augmentation. This is a medical condition where the drug itself causes symptoms to increase in severity and/or occur earlier in the day. Dopamine agonists may also cause rebound when symptoms increase as the drug wears off. In many cases, the longer dopamine agonists have been used,

2028-399: The disorder including antidepressants , antipsychotics , antihistamines , and calcium channel blockers . RLS may either be of early onset, occurring before age 45, or of late onset, occurring after age 45. Early-onset cases tend to progress more slowly and involve fewer comorbidities, while cases in older patients may progress suddenly and alongside other conditions. RLS may resolve if

2080-669: The dopamine agonist treatment has an impact on the resolution or at least improvement of the impulse-control disorder, even though some people can be particularly exposed to dopamine agonist withdrawal syndrome. Gabapentinoids (α 2 δ ligands), including gabapentin , pregabalin , and gabapentin enacarbil , are also widely used in the treatment of RLS. They are used as first-line treatments similarly to dopamine agonists, and as of 2019, guidelines have started to recommend gabapentinoids over dopamine agonists as initial therapy for RLS due to higher known risks of symptom augmentation with long-term dopamine agonist therapy. Gabapentin enacarbil

2132-431: The entire limb that contains the "locked-up" muscle group. It may take up to a week for the muscle to return to a pain-free state, depending on the person's fitness level, age, and several other factors. Nocturnal leg cramps are involuntary muscle contractions that occur in the calves , soles of the feet, or other muscles in the body during the night or (less commonly) while resting. The duration of nocturnal leg cramps

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2184-843: The evening and at night, not be triggered by other medical or behavioral conditions, and should impair one's quality of life. Generally, both legs are affected, but in some cases there is an asymmetry. The most common conditions that should be differentiated with RLS include leg cramps, positional discomfort, local leg injury, arthritis, leg edema , venous stasis , peripheral neuropathy , radiculopathy , habitual foot tapping/leg rocking, anxiety , myalgia , and drug-induced akathisia . Peripheral artery disease and arthritis can also cause leg pain but this usually gets worse with movement. There are less common differential diagnostic conditions included myelopathy , myopathy , vascular or neurogenic claudication , hypotensive akathisia , orthostatic tremor , painful legs, and moving toes . If RLS

2236-412: The evidence has been mixed), and reduced blood flow through muscles attendant in prolonged sitting or lying down. Nocturnal leg cramps (almost exclusively calf cramps) are considered "normal" during the late stages of pregnancy. They can, however, vary in intensity from mild to extremely painful. A lactic acid buildup around muscles can trigger cramps; however, they happen during anaerobic respiration when

2288-406: The formation of L-dopa , the precursor of dopamine. Six genetic loci found by linkage are known and listed below. Other than the first one, all of the linkage loci were discovered using an autosomal dominant model of inheritance. Three genes, MEIS1 , BTBD9 and MAP2K5 , were found to be associated to RLS. Their role in RLS pathogenesis is still unclear. More recently, a fourth gene, PTPRD

2340-517: The higher the risk of augmentation and rebound as well as the severity of the symptoms. Patients may also develop dopamine dysregulation syndrome , meaning that they can experience an addictive pattern of dopamine replacement therapy. A 2007 study indicated that dopamine agonists used in restless legs syndrome can lead to an increase in compulsive gambling . Patients may also exhibit other impulse-control disorders such as compulsive shopping and compulsive eating. There are some indications that stopping

2392-422: The leg muscles can bring temporary relief. Walking and moving the legs, as the name "restless legs" implies, brings temporary relief. In fact, those with RLS often have an almost uncontrollable need to walk and therefore relieve the symptoms while they are moving. Unfortunately, the symptoms usually return immediately after the moving and walking ceases. Counter-stimulation from massage, a hot or cold compress, or

2444-474: The most often are the calves , thighs , and arches of the foot , and in North America are sometimes called a " Charley horse " or a "corky". Such cramping is associated with strenuous physical activity and can be intensely painful; however, they can even occur while inactive and relaxed. Around 40% of people who experience skeletal cramps are likely to endure extreme muscle pain, and may be unable to use

2496-484: The ones above, but occur commonly in RLS patients: According to the International Classification of Sleep Disorders (ICSD-3), the main symptoms have to be associated with a sleep disturbance or impairment in order to support RLS diagnosis. As stated by this classification, RLS symptoms should begin or worsen when being inactive, be relieved when moving, should happen exclusively or mostly in

2548-412: The tensile strength of the underlying connective tissue. This can occur with a particularly strong spasm or with weakened connective tissue. A hypertonic muscle spasm is a condition of chronic, excessive muscle tone (i.e., tension in a resting muscle). This is the amount of contraction that remains when a muscle is not working. A true hypertonic spasm is caused by malfunctioning feedback nerves. This

2600-416: The term "restless legs". Ekbom's work was largely ignored until it was rediscovered by Arthur S. Walters and Wayne A. Hening in the 1980s. Subsequent landmark publications include 1995 and 2003 papers, which revised and updated the diagnostic criteria. RLS sensations range from pain or an aching in the muscles, to "an itch you can't scratch", a "buzzing sensation", an unpleasant "tickle that won't stop",

2652-523: The underlying problem is addressed. Otherwise treatment includes lifestyle changes and medication. Lifestyle changes that may help include stopping alcohol and tobacco use, and sleep hygiene . Medications used to treat RLS include dopamine agonists like pramipexole and gabapentinoids (α 2 δ ligands) like gabapentin . RLS affects an estimated 2.5–15% of the American population. Females are more commonly affected than males, and RLS becomes increasingly common with age. Sir Thomas Willis provided

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2704-461: Was found to be associated with RLS. There is also some evidence that periodic limb movements in sleep (PLMS) are associated with BTBD9 on chromosome 6p21.2, MEIS1, MAP2K5/SKOR1, and PTPRD. The presence of a positive family history suggests that there may be a genetic involvement in the etiology of RLS. Although it is only partly understood, pathophysiology of restless legs syndrome may involve dopamine and iron system anomalies. There

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