On the air

Questions, Questions - BBC Radio 4

6th November 2008

Stewart Henderson of Radio 4 interviewed Professor K. Ray Chaudhuri on the subject of Restless Legs Syndrome:

Henderson: We perhaps know someone who finds it difficult to keep their legs still when, say, watching television or having a quiet drink in the pub, but when does nervous fidgeting become a definable medical condition? The term “Restless Legs Syndrome” was first used by Karl Axel Ekbom, a Swedish neurologist, in 1944. However, the first description of it appears to date back to the 17th Century. A physician to Charles II, Thomas Willis, was treating patients with reflex actions and noticed that: "Some, when being in bed, presently in the legs had leaping and contractions of the tendons, and so great a restlessness that they are no more able to sleep." For a contemporary examination of Restless Legs Syndrome I went to meet Professor K. Ray Chaudhuri, consultant neurologist at the University College Hospital in Lewishham in South London. I began by getting him to explain the differences between excesses of nervous energy and a specific medical condition.

Chaudhuri: I think it is a very important distinction that needs to be made. Often people have the problem of the legs being fidgety and that's simply because the legs become achey and suffer discomfort when you put them in one position for a while and this goes by the name akathisia which means restlessness but that is quite different to the other condition which is known as Restless Legs Syndrome which involves a specific condition where people have restlessness in the leg, an urge to move their legs only when they're resting and typically occurring in the evening or at night. So the two conditions are quite different.

Henderson: Before we come to Restless Legs then, why is it that some people fidget their legs; it's referred to loosely as nervous energy?

Chaudhuri: The underlying cause of restlessness or this restless energy is unclear. We know that in some conditions that it can occur for instance if some people are taking medications in relation to a mental health disorders, that can sometimes cause this as a side effect, and in some children for instance attention deficit hyperactivity disorder - ADHD - or growing pains, all these conditions might manifest itself as restless energy, but in many others it just happens, there is no defined neurological or psychiatric cause for it.

Henderson: Turning to Retless Legs Syndrome, what are people experiencing when it strikes?

Chaudhuri: The commonest problem is lack of sleep. These patients do not sleep sometimes for months and years and they are not taken seriously when they go to their doctors or to their other health care professionals and they describe their lack of sleep; usually it is thought to be due to insomnia or to some sort of problem such as depression so they are given anti-depressants or sleeping pills, and some of it makes the Restless Legs Syndrome worse, so the typical problem that these patients experience is lack of sleep. But the other major problem they experience is some very horrible and uncomfortable feeling in the legs, and that's described in various ways, one of them is "Coca Cola bubbling though my veins" is the description from one of our patients, or creepy crawlies in the legs, or severe pain in the legs could be a manifestation.

Henderson: And why isn't it recognised as a serious condition?

Chaudhuri: It is not recognised as a serious condition for two reasons, one is the name of the condition implies a slightly trivial nature of the illness perhaps, you know restless legs, fidgety legs, if you don't accept the two are different, and the second is general under-recognition of this condition particularly in the UK compared to the rest of the European countries.

Henderson: Is there a specific time or are there particular conditions when it manifests itself?

Chaudhuri: Restless Legs Syndrome is a condition that can either come on its own at any time at any age, or in some people, particularly women, where it is very common, it can unmask itself during pregnancy. In the last half of the trimester of the pregnancy patients might develop Restless Legs Syndrome, and often after the delivery of the child the RLS disappears, but in some it remains. Also sometimes if people have problems with thyroid gland, diabetes, nervous problems such as inflammation of the nerves, that also can result in Restless Legs Syndrome.

Henderson: What, then, would you suggest to a person who seems to be showing symptoms of Restless Legs Syndrome; is the treatment available?

Chaudhuri: The treatments are available, they are licenced, and they have gone through international clinical trials and they are very robust. Treatment can be issued by the general practitioner themselves, it doesn't need to be referred to secondary care, but again, should the need arise, that can also be arranged.

Henderson: K Ray Chaudhuri, thank you very much.