I have a husband who was recently diagnosed to have Restless Legs Syndrome. It affects his quality of life in a very negative way; he sleeps poorly and can be very moody as a result. Can my children inherit this condition?
Restless Legs Syndrome (RLS) is a neurological problem which was first described in adults in 1672. Yet, only recently has awareness of this condition in children and youth somewhat improved.
The condition may indeed be inherited; it is thought to be an autosomal dominant condition. RLS genes have been identified on chromosome 12 in French Canadian families; on chromosome 14 for Italian families; and on chromosome 9 for American families.
About 38% of adults with RLS give a history that their symptoms started before age 20. According to the Sleep Disorder Program at the Mayo Clinic, the condition occurs in close to 6% of patients under the age of 18 years. This figure of 6% was also confirmed in Canadian children 11 to 13 years old. But overall, the French Canadian population has a RLS prevalence estimated at 15-20%.
In a review paper on RLS - the first of its kind - published in August 2007 in Pediatrics (Vol. 120: pp. 253-266), Dr. Daniel Picchetti and his colleagues reported that it is more common than epilepsy or diabetes. There are no significant gender differences for Restless Legs Syndrome in children, but in adults there is a 2:1 female to male ratio.
Unfortunately, RLS is still significantly under-diagnosed and misdiagnosed. In 2003, the National Institutes of Health published consensus criteria for diagnosing RLS in children and adolescents specifically (For more information, see www.nih.gov).
This condition is important to identify because it can easily be misdiagnosed as tics, growing pains, muscle cramps, and even depression, anxiety, and attention deficit disorder (ADD). It may adversely affect a child´s sleep, leading to a lack of energy, extreme moodiness, and poor cognitive functioning, thus affecting a child´s education.
RLS is characterized by an urge to move, associated with an unpleasant sensation in the legs. The symptoms are worse at rest, or while lying or sitting in a cramped space. Symptoms are also typically more common in the evening or at night, resulting in many patients not being able to sit still at these times. For example, it may be more common while sitting during a long airline flight or during the confinement of watching a movie in a cramped theater at night. These uncontrolled movements and unpleasant sensations are relieved by movement, walking, or stretching.
Given RLS can be associated with poor and disturbed sleep, the majority of patients report significant distress. Patients struggle to fall asleep and few can stay asleep through the night. Parents of 8-11 year olds report that in an average week, at least two of the nights their child sleeps less and is woken up more often as a result of RLS. In adolescents, the number of nights where the patient cannot sleep well is higher (at least three nights per week). As a result, 21-33% of patients report daytime sleepiness, and an inability to concentrate and focus in the classroom.
In older children (aged 8 to 11 years) who can describe their symptoms, these comments were obtained: “My legs need to stretch”, “It feels like ants crawling on my legs and I need to walk”, “My legs tingle and hurt”, My legs have too much energy and that is why I kick myself at night”, “My legs feel like electricity flowing”, “I feel like I need to shake my leg like my dad does”, “It feels like there are bugs in my bones”.
According to the authors of a review paper on RLS (Pediatrics, August 2007), children in North America with RLS were more likely to have received a diagnosis for ADD, depression, and anxiety than children with RLS in the United Kingdom. Due to a misdiagnosis, these patients may end up with the wrong medication.
The treatment of RLS in children and adolescents is still uncertain. Few experts agree on what truly works. Medications such as clonidine, benzodiazepines, ropinirole, and medications which raise the dopamine levels in the central nervous system have been tried with variable success. The consensus among sleep experts is that there needs to be more randomized placebo controlled studies done.
In some cases, RLS has been linked to a low iron level; if this is diagnosed, treatment with iron may be helpful. Sleep hygiene - such as enforcing a regular sleep-wake schedule and avoiding heavy meals, fluids or exercise within a few hours of bedtime - should also be tried. It is also wise to avoid watching TV or playing games near bedtime. The treatment still needs to be refined, but good sleep hygiene can be helpful until the best medications are determined.
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