The torture of restless legs
Initially thought of as a neurological curiosity, it is surprisingly common
The startling news reported last week that those troubled by restless legs are three times more likely to attempt or commit suicide is a salutary reminder of the morale sapping torture of this enigmatic affliction. “Some say they never have a moment’s peace,” noted Swedish physician Karl-axel Ekbom half a century ago. He likened the most unpleasant sensation, typically occurring when lying in bed at night or sitting for any length of time, to “ants running up and down the bones” or “a leg full of small worms” and described how “the discomfort forces them to walk up and down continuously like a caged bear”.
Though initially thought of as a neurological curiosity, it is surprisingly common – and remained untreatable until the chance observation of several patients with Parkinson’s disease who found that the drugs they were taking to boost the level of the neurotransmitter dopamine also markedly alleviated their restless legs. At the time this seemed an amazing breakthrough but despairingly, after a few months’ blessed relief, the drugs tend to
become gradually less effective or paradoxically worsen those creeping and crawling sensations – known as augmentation. Over the years, readers of this column have written to tell of the several ways they have found to ameliorate their symptoms – notably heat, in the form of a hot bath late at night, or, conversely, pouring icy water over the legs. “When I feel this infernal irritation is about to start up,” wrote one long term sufferer, “I pull on my calf muscle so tightly so as to induce a cramp, then letting go find it has almost disappeared.”
The disappointments of drug treatment in the long term has prompted renewed interest in such methods – presumed to work by “drowning out” the unpleasant nerve signals from the brain – summarised as “Nonpharmacological Treatments for Restless Legs” in the journal Sleep Review, available to read online. They include graded exercise, and a range of medical devices such as a Tens machine and the compressive Restiffic that wraps around the foot and is reputed to be “superior to drug treatment”, reducing the intensity of symptoms from “severe” to “mild”.
More faint theories
The conundrum of the gentleman who, to his and his hairdresser’s alarm, has collapsed twice this year when having a “trim” has prompted considerable interest with several ramifications. The most likely explanation would be impaired blood flow, as ophthalmologist William Coddington describes: “When I have my hair cut I invariably flex my neck so the barber can more easily get to the back of my head,” he writes. For those with arthritis in the cervical spine, this manoeuvre can compress the two vertebral arteries running up the back of the neck, reducing the blood flow to the posterior part of the brain to cause transient loss of consciousness.
A similar sequence of events occurs more commonly following the reverse manoeuvre of extending the neck backwards to have the hair shampooed. Here the blood flow through the vertebral arteries is reduced still further by their being compressed by the lip of the basin to cause the signs and symptoms of a mini stroke.
Nor is that the end of it – there are two further forms of hairdressing related fainting. The first, “hairdryer syncope”, occurs in older women who have sat under a hood hairdryer for some time and is attributed to the heat generated by the dryer dilating the blood vessels to cause a fall in blood pressure. Then, at the other end of the age spectrum, there is “hair-grooming syncope” in adolescent girls who have been standing still for some time having their hair combed or braided. Here the action of pulling on the scalp stimulates the vagus nerve, leading to a reflex slowing of the heart rate. The predisposition of hairdressing to cause fainting in these diverse ways, though interesting, might be a bit esoteric. On the contrary, recognising the link is vital in sparing the unfortunate fainter a panoply of intrusive investigations for disturbances of heart rhythm, epilepsy and other possible causes of loss of consciousness.