Restless Legs Syndrome (RLS), a condition characterized by an overwhelming urge to move the legs, can be particularly challenging for pregnant individuals, especially during hot weather. While often described as an uncomfortable, shuddering, or electric sensation, RLS can manifest as a burning, itching, tingling, or pins-and-needles feeling, primarily affecting the legs but sometimes extending to the arms and torso.
Understanding Restless Legs Syndrome
RLS, also known as Willis-Ekbom disease, affects an estimated 10% of the UK population. Symptoms typically worsen at night, disrupting sleep and potentially leading to a cycle of exhaustion, insomnia, anxiety, and depression. Dr. Julian Spinks, a GP and chairman of RLS-UK, notes that the exact causes of RLS are not fully understood due to limited research. Historically, it was thought to be linked to low dopamine levels, but prolonged use of dopamine-agonist medications can exacerbate symptoms. Current understanding suggests that insufficient iron in specific brain regions may be a primary cause, affecting brain function and dopamine pathways. Other contributing factors can include genetic predisposition, kidney disease, magnesium and calcium deficiencies, arthritis, Parkinson's disease, and hormonal changes.
Heatwaves can also trigger or worsen RLS symptoms. "Heat is a surprisingly common trigger for my affliction: restless legs syndrome (RLS)," wrote one individual experiencing the condition during a heatwave. "The UK going through its hottest June on record is bad news for many sufferers."
Treatment Challenges and Solutions
Standard treatments for RLS, such as dopamine receptor agonists (pramipexole, ropinirole) or alpha-2-delta ligands (pregabalin, gabapentin), are generally not considered safe during pregnancy. The author of the newsletter exclusive recounted seeking help from multiple healthcare professionals, including GPs, midwives, consultants, a psychiatrist, and a neurologist, but received little more than advice for hot baths.
Professor Guy Leschziner, a neurologist specializing in sleep disorders, suggested codeine as a potential treatment for severe or unmanageable RLS, particularly in situations like pregnancy or long journeys. Codeine, an opioid painkiller, is considered safe in pregnancy but is not recommended for long-term use due to dependency risks. It works by blocking pain signals and RLS sensations in the central nervous system and brain.
"I wouldn't recommend it widely, but it can be helpful for some people," Professor Leschziner stated. "I prescribe it for individuals who have very intermittent RLS or when a situation would be unmanageable for them, such as during pregnancy or a long-haul flight or car journey."
The author found that a 15mg dose of codeine significantly reduced RLS symptoms, allowing for better sleep and a return to a sense of well-being. The dose was later increased to 30mg as the pregnancy progressed. After giving birth, the RLS symptoms disappeared within three weeks of discontinuing codeine.
Other Management Strategies
While medication can be effective, Professor Leschziner indicated that a majority of RLS patients manage the condition through other means. These include testing for and treating low iron levels with supplements or infusions, discontinuing medications that worsen symptoms, and employing exercise and massage during flare-ups. The sensory input from exercise or massage might disrupt the neural signals causing RLS discomfort.
Dr. Spinks also highlighted that a GP's knowledge of RLS can vary, as it is not a standard part of medical training, leading to a "degree of luck" in whether patients receive informed advice.