SUNDAY, April 17, 2005 (HealthDay News) -- For Dr. David Rye, the personal and professional truly overlap.
Rye is a professor of neurology and director of the Health Care Program in Sleep Medicine at Emory University in Atlanta.
He also has restless legs syndrome (RLS).
A central nervous system disorder, RLS produces uncomfortable sensations in the legs that usually peak in the evening or nighttime. But, people like Rye often complain of daytime symptoms, too.
"Bad times for me are when there's a lull where I've been sitting for too long," Rye said. "On an airplane, for example -- that's where it really gets me."
Like many with this disorder, Rye went for years without understanding that his condition wasn't just "jittery legs." "I wasn't really cognizant of it," he said.
Now, as chairman of the medical advisory board for the Restless Legs Syndrome Foundation, much of Rye's work at Emory focuses on the causes and treatment of RLS, especially as it pertains to sleep.
Dr. Cheryl Waters, a professor of neurology at Columbia University in New York City, said that "many patients that have this disorder also have an associated disorder where their legs move spontaneously while they are sleeping."
Besides frequently waking themselves up, "they may also kick their bed partner, causing them to wake up, too," she said. "Of course, they're exhausted throughout the following day."
Waters estimated that about one in every 10 adults has some form of RLS, although for most, symptoms are manageable. "That percentage may include the guy that keeps kicking his legs under the table at your board meeting," she said. "It doesn't necessarily mean that everyone needs to be treated."
About 10 percent of people with severe RLS do require treatment, Rye said. Because some cases of RLS are triggered by another condition -- such as iron deficiency, kidney disease or even pregnancy -- sometimes when that condition ends or eases, the person's RLS does, too.
In other cases, drug therapy can help. "Some of the most favored drugs right now are those already approved for Parkinson's disease," Rye said. Last August, for example, a study from John Hopkins University found that the Parkinson's drug ropinirole (Requip) reduced involuntary leg movements from 49 per hour to just 12 per hour in people with RLS.
Ropinirole is one of a family of medicines called dopamine agonists, which alter levels of the important brain chemical dopamine.
"We use very low doses of these dopamine drugs, much lower than what we'd use for Parkinson's," Rye said. "It's usually just one-fifth to one-tenth of the dose."
Despite the effectiveness of drugs like ropinirole, RLS researchers still aren't sure how the medicines reduce symptoms. "It could be shutting dopamine down for a while," Rye said, "but we really don't know right now."
These drugs aren't the only pharmaceutical option available, he added. Mild narcotics, such as Percocet, help many people, as do anticonvulsants.
Better therapies will come with a better understanding of the causes of the disease, he said. RLS clusters in families, so genes definitely play some role, Rye said.
But so might a neurological nighttime "rehearsal" of repetitive daytime movements, he speculated.
"One emerging theory is that there's a lot of motor learning that might get replayed while you're asleep," Rye said. This phenomenon could explain why the legs of people with RLS are more prone to involuntary movements than their arms, for example.
"If we were quadrupeds, we might have both arms and legs being restless," Rye said. "But perhaps because we are bipeds, it only affects our legs. You bear more weight there, and more work is being done by your legs every day than your arms."
He pointed to "one of the worst cases" of RLS his clinic has seen, occurring in an Olympic marathon speed-walker. "You ask yourself, is it bad because he's a marathon runner? Or, because he has RLS, does he need to walk a lot? We don't know the answer to that," Rye said.
In the meantime, Rye encourages people bothered by jittery, restless legs to seek help -- and to not stop until someone adequately diagnoses their condition.
"RLS is often not taught in med school, and I've had patients who are classic cases that have been seeing psychiatrists for years, undiagnosed," he said. In fact, one study found that when people went to doctors and described symptoms typical of the condition, the doctors diagnosed it correctly just 25 percent of the time.
"Obviously, a lot of education has to occur both at the physician and patient level," Rye said.
More information
To learn more about the symptoms and treatment of RLS, visit the Restless Legs Syndrome Foundation.
