San Antonio Express-News (Sunday)
Texas woman finds relief from restless leg syndrome
A good night’s sleep is only a recent phenomenon for Leslie McKelfresh.
The 63-year-old Montrose resident started dealing with restless leg syndrome as a teenager. The condition is characterized by an uncomfortable sensation in the legs that is relieved by movement.
“It’s an irresistible urge to move my legs or feet,” McKelfresh said. “It feels sort of like a tingling or burning sensation.”
At first, her symptoms were off and on. By her 30s, it was nearly a constant struggle.
For years, restless leg syndrome-induced sleepless nights were her reality. Sometimes, the condition would disturb her sleep several evenings in a row.
The feeling typically wakes her up about 15 or 20 minutes after she has fallen asleep. She gets up and starts to stretch.
She walks around for a while and then tries to go back to bed.
“I feel like it’s gone, but I lay down, and it comes back again,” she said. “I go back downstairs and start walking. Sometimes, it’s so bad, I’m up for six or seven hours.”
The next day, McKelfresh is completely exhausted. As a Pilates teacher and private trainer at her home studio, Fit By Leslie, she needs her energy.
The interrupted sleep is bad enough, but over the years, McKelfresh said, her restless leg syndrome symptoms started appearing earlier and earlier in the day.
For instance, she would try to get a pedicure — and then her leg would start to twitch, smearing the nail polish on her feet.
“I couldn’t sit for any length of time,” McKelfresh said.
She could not go out to dinner with her husband and friends because she was scared that her symptoms would start up and she would have to pace around.
McKelfresh had excruciating plane rides. “I had to walk up and down the aisles,” she said.
She has even had to pull over while driving to wait until her leg stopped moving.
“I wouldn’t be able to drive,” she said. “I’d take deep breaths. I’d pray a lot. I would cry. It was just so frustrating.”
Over the years, McKelfresh saw several different doctors, who placed her on medications that did not work. Even after her dosages were raised, her symptoms only seemed to worsen.
She also tried other remedies — like hot baths and compresses. Nothing seemed to make a difference.
In 2019, her internal medicine doctor recommended Dr. Aparajitha Verma, sleep medicine specialist with McGovern Medical School at UTHealth Houston.
“She’s the first person in all those years who helped,” McKelfresh said.
Restless leg syndrome
Verma explained that restless leg syndrome is a clinical diagnosis, one that does not require any studies. Between 3 to 15 percent of the general population is affected, and the sensation can vary for different patients, affecting the legs or sometimes the arms.
“For some, it’s like ants crawling on their feet, and some say it’s pain,” Verma said.
“Some can’t describe it. It’s just an unpleasant feeling.”
Regardless, the only way patients can find relief is through movement.
“It can cause significant sleep interruption,” Verma said. “And as we get older, any condition disrupting sleep can interfere with memory or cause cardiovascular issues, hypertension and metabolic issues. There’s a whole host of negative results.”
Sometimes, restless leg syndrome is misdiagnosed — or patients think they are suffering from insomnia.
“It definitely needs to be addressed,” Verma said.
Treatment requires a thorough analysis. First, she has to determine if it is “primary restless leg syndrome,” which is genetic and occurs for unknown reasons. These instances tend to have an earlier onset, milder symptoms and less rapid progression.
Or, it could be “secondary restless leg syndrome,” associated with certain conditions like anemia, kidney failure or even pregnancy.
Verma looks at the patient’s medical history and current prescriptions that might increase the likelihood of restless leg syndrome. For instance, there are antidepressants and anti-nausea medications that exacerbate the condition.
Verma also assesses lifestyle triggers, including consumption of caffeine and management of stress.
Iron metabolism is also key. Iron is necessary for the synthesis of dopamine, and restless leg syndrome results from a decreased amount of dopamine, Verma explained.
The first-line treatment, she said, often centers on dopamine agonists, which increase the level of dopamine.
“The problem is that when you increase the dose too rapidly, it saturates the receptors in the brain and can be counterproductive,” Verma said. “There are newer medications that give us more options.”
Getting a good night’s sleep
When McKelfresh started seeing Verma in 2019, the dosage of dopamine agonists was exactly the problem.
Often, the medications work well for a couple of weeks at a lower dosage, Verma said. The effectiveness fades with time and doctors prescribe a higher dose. “The receptors get saturated, and you need more and more of the medication,” she said.
The higher dose, however, can cause more intense bouts of restless leg syndrome that come earlier in the day.
“It’s miserable,” Verma said. “People cannot sit still, and they get embarrassed. It’s very sad. Those patients go through a lot.”
McKelfresh was a case in point. Verma placed her on a 24-hour dopamine agonist patch called Neupro and added two other medications: Klonopin, used for seizures and anxiety, and Horizant, an anticonvulsant and nerve pain medication prescribed for restless leg syndrome.
She also helped McKelfresh remove triggers from her diet, like red wine and gluten. Verma stressed the importance of monitoring stress and making time for self-care.
Following the doctor’s orders, McKelfresh experienced a really good night’s sleep. “I had so much energy,” she said. “It was basically like night or day for me.”
Finally, she can sit at a restaurant and enjoy dinner — or treat herself to a pedicure.
McKelfresh still experiences restless leg syndrome, but it’s more of an exception, not the rule.
She continues to see Verma once every four months. And she can dial her for help if she’s experiencing more stress or needs to adjust her medications
“Dr. Verma sits down with me for however long I need,” McKelfresh said. “She’s very meticulous. If I didn’t have her, I would still be dealing with this every day.”
She hopes others with restless leg syndrome will also seek a doctor who can make a difference. “Get immediate help,” she said. “Don’t wait.”