Restless legs syndrome

Restless legs syndrome (RLS) is a disorder of the part of thenervous system that causes an urge to move the legs. Because it usually interferes with sleep, it also is considered a sleep disorder.

Symptoms of Restless Legs Syndrome

People with restless legs syndrome have uncomfortable sensations in their legs (and sometimes arms or other parts of the body) and an irresistible urge to move their legs to relieve the sensations. The condition causes an uncomfortable, “itchy,” “pins and needles,” or “creepy crawly” feeling in the legs. The sensations are usually worse at rest, especially when lying or sitting.

The severity of RLS symptoms ranges from mild to intolerable. Symptoms can come and go and severity can also vary. The symptoms are generally worse in the evening and at night. For some people, symptoms may cause severe nightly sleep disruption that can significantly impair their quality of life.

Who Gets Restless Legs Syndrome?

Restless legs syndrome may affect up to 10% of the U.S. population. It affects both sexes, but is more common in women and may begin at any age, even in young children. Most people who are affected severely are middle-aged or older.

RLS is often unrecognized or misdiagnosed. This is especially true if the symptoms are intermittent or mild. Once correctly diagnosed, RLS can often be treated successfully.

Causes of Restless Legs Syndrome

In most cases, doctors do not know the cause of restless legs syndrome; however, they suspect that genes play a role. Nearly half of people with RLS also have a family member with the condition.

Other factors associated with the development or worsening of restless legs syndrome include:

  • Chronic diseases. Certain chronic diseases and medical conditions, including iron deficiency, Parkinson’s disease, kidney failure,diabetes, and peripheral neuropathy often include symptoms of RLS. Treating these conditions often gives some relief from RLS symptoms.
  • Medications. Some types of medications, including antinausea drugs, antipsychotic drugs, some antidepressants, and cold and allergymedications containing sedating antihistamines, may worsen symptoms.
  • Pregnancy. Some women experience RLS during pregnancy, especially in the last trimester. Symptoms usually go away within a month after delivery.

Other factors, including alcohol use and sleep deprivation, may trigger symptoms or make them worse. Improving sleep or eliminating alcohol use in these cases may relieve symptoms.

Treatment for Restless Legs Syndrome

Treatment for RLS is targeted at easing symptoms. In people with mild to moderate restless legs syndrome, lifestyle changes, such as beginning a regular exercise program, establishing regular sleep patterns, and eliminating or decreasing the use of caffeine, alcohol, and tobacco, may be helpful. Treatment of an RLS-associated condition also may provide relief of symptoms.

Other non-drug RLS treatments may include:

Leg massages

Hot baths or heating pads or ice packs applied to the legs
Good sleep habits
A vibrating pad called Relaxis
Medications may be helpful as RLS treatments, but the same drugs are not helpful for everyone. In fact, a drug that relieves symptoms in one person may worsen them in another. In other cases, a drug that works for a while may lose its effectiveness over time.

Drugs used to treat RLS include:

Dopaminergic drugs, which act on the neurotransmitter dopamine in the brain. Mirapex, Neupro, and Requip are FDA-approved for treatment of moderate to severe RLS. Others, such as levodopa, may also be prescribed.
Benzodiazepines, a class of sedative medications, may be used to help with sleep, but they can cause daytime drowsiness.
Narcotic pain relievers may be used for severe pain.
Anticonvulsants, or antiseizure drugs, such as Tegretol, Lyrica, Neurontin, and Horizant.
Although there is no cure for restless legs syndrome, current treatments can help control the condition, decrease symptoms, and improve sleep.

Anxiety

Anxiety disorders are different, though. They can cause such distress that it interferes with your ability to lead a normal life.

This type of disorder is a serious mental illness. For people who have one, worry and fear are constant and overwhelming, and can be disabling. But with treatment, many people can manage those feelings and get back to a fulfilling life.

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How Are Anxiety Disorders Treated?

Fortunately, much progress has been made in the last two decades in the treatment of people with mental illnesses, including anxiety disorders. Although the exact treatment approach depends on the type of disorder, one or a combination of the following therapies may be used for most anxiety disorders:

  • Medication : Drugs used to reduce the symptoms of anxiety disorders include many antidepressants, certain anticonvulsant medicines and low-dose antipsychotics, and other anxiety-reducing drugs.
  • Psychotherapy : Psychotherapy (a type of counseling) addresses the emotional response to mental illness. It is a process in which trained mental health professionals help people by talking through strategies for understanding and dealing with their disorder.
  • Cognitive-behavioral therapy: This is a particular type of psychotherapy in which the person learns to recognize and change thought patterns and behaviors that lead to troublesome feelings.
  • Dietary and lifestyle changes
  • Relaxation therapy

How can I manage anxiety?

  • Go to counseling as directed. Cognitive behavioral therapy can help you understand and change how you react to events that trigger your symptoms.
  • Find ways to manage your symptoms. Activities such as exercise, meditation, or listening to music can help you relax.
  • Practice deep breathing. Breathing can change how your body reacts to stress. Focus on taking slow, deep breaths several times a day, or during an anxiety attack. Breathe in through your nose and out through your mouth.
  • Do not smoke. Nicotine can increase your anxiety. Do not use e-cigarettes or smokeless tobacco in place of cigarettes or to help you quit. They still contain nicotine. Ask your healthcare provider for information if you currently smoke and need help quitting.
  • Do not have caffeine. Caffeine can make your symptoms worse. Do not have foods or drinks that are meant to increase your energy level.
  • Limit or do not drink alcohol. Ask your healthcare provider if alcohol is safe for you. You may not be able to drink alcohol if you take certain anxiety or depression medicines. Limit alcohol to 1 drink per day if you are a woman. Limit alcohol to 2 drinks per day if you are a man. A drink of alcohol is 12 ounces of beer, 5 ounces of wine, or 1½ ounces of liquor.

Call 911 if:

  • You have chest pain, tightness, or heaviness that may spread to your shoulders, arms, jaw, neck, or back.
  • You feel like hurting yourself or someone else.

Diabetic Peripheral Neuropathy

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Peripheral neuropathy is nerve damage caused by chronically high blood sugar and diabetes. It leads to numbness, loss of sensation, and sometimes pain in your feet, legs, or hands. It is the most common complication of diabetes.

About 60% to 70% of all people with diabetes will eventually develop peripheral neuropathy, although not all suffer pain. Yet this nerve damage is not inevitable. Studies have shown that people with diabetes can reduce their risk of developing nerve damage by keeping theirblood sugar levels as close to normal as possible.

What causes peripheral neuropathy? Chronically high blood sugar levels damage nerves not only in your extremities but also in other parts of your body. These damaged nerves cannot effectively carry messages between the brain and other parts of the body.

This means you may not feel heat, cold, or pain in your feet, legs, or hands. If you get a cut or sore on your foot, you may not know it, which is why it’s so important to inspect your feet daily. If a shoe doesn’t fit properly, you could even develop a foot ulcer and not know it.
The consequences can be life-threatening. An infection that won’t heal because of poor blood flow causes risk for developing ulcers and can lead to amputation, even death.

This nerve damage shows itself differently in each person. Some people feel tingling, then later feel pain. Other people lose the feeling in fingers and toes; they have numbness. These changes happen slowly over a period of years, so you might not even notice it.

Because the changes are subtle and happen as people get older, people tend to ignore the signs of nerve damage, thinking it’s just part of getting older.

But there are treatments that can help slow the progression of this condition and limit the damage. Talk to your doctors about what your options are, and don’t ignore the signs because with time, it can get worse.

Drugs associated with Diabetic Peripheral Neuropathy

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Alcohol Withdrawal

Alcohol withdrawal syndrome is a potentially life-threatening condition that can occur in people who have been drinking heavily for weeks, months, or years and then either stop or significantly reduce their alcohol consumption.

Alcohol withdrawal symptoms can begin as early as two hours after the last drink, persist for weeks, and range from mild anxiety and shakiness to severe complications, such as seizures and delirium tremens (also called DTs). The death rate from DTs — which are characterized by confusion, rapid heartbeat, and fever — is estimated to range from 1% to 5%.

If you have mild to moderate withdrawal symptoms, your doctor may prefer to treat you in an outpatient setting, especially if you have supportive family and friends. Outpatient detoxification is safe, effective, and less costly than inpatient detoxification at a hospital or other facility.

However, you may require inpatient treatment if you don’t have a reliable social network, are pregnant, or have a history of any of the following:

Severe withdrawal symptoms
Withdrawal seizures or DTs
Multiple previous detoxifications
Certain medical or psychiatric illnesses
The goals of treatment are threefold: reducing immediate withdrawal symptoms, preventing complications, and beginning long-term therapy to promote alcohol abstinence.

Prescription drugs of choice include benzodiazepines, such asdiazepam (Valium), chlordiazepoxide (Librium), lorazepam (Ativan), andoxazepam (Serax). Such medications can help control the shakiness, anxiety, and confusion associated with alcohol withdrawal and reduce the risk of withdrawal seizures and DTs. In patients with mild to moderate symptoms, the anticonvulsant drug carbamazepine(Tegretol) may be an effective alternative to benzodiazepines, because it is not sedating and has low potential for abuse.

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To help manage withdrawal complications, your doctor may consider adding other drugs to a benzodiazepine regimen. These may include:

  • An antipsychotic drug, which can help relieve agitation and hallucinations
  • A beta-blocker, which may help curb a fast heart rate and elevatedblood pressure related to withdrawal and reduce the strain of alcohol withdrawal in people with coronary artery disease
  • Clonidine (Catapres), another blood pressure drug
  • Phenytoin (Dilantin), an anticonvulsant which doesn’t treat withdrawal seizures but may be useful in people with an underlying seizure disorder

If you have severe vomiting, seizures or delirium tremens, the safest place for you to be treated is in a hospital. For delirium tremens, treatment in an intensive care unit (ICU) is often required. In an ICU, your heart rate, blood pressure, and breathing can be monitored closely in case emergency life-support (such as artificial breathing by a machine) is needed.

Medicines called benzodiazepines can lessen alcohol withdrawal symptoms. Commonly used medicines in this group include chlordiazepoxide (Librium) and lorazepam (Ativan).

Most alcohol abusers who are having withdrawal symptoms have a shortage of several vitamins and minerals and can benefit from nutritional supplements. In particular, alcohol abuse can create a shortage of folate,thiamine, magnesium, zinc and phosphate. It also can cause low blood sugar.

What is the most important information I should know about Gabapentin?

Do not stop taking NEURONTIN without first talking to your healthcare provider. Stopping NEURONTIN suddenly can cause serious problems.

NEURONTIN can cause serious side effects including:

1. Suicidal Thoughts. Like other antiepileptic drugs, NEURONTIN may cause suicidal thoughts or actions in a very small number of people, about 1 in 500.

Call a healthcare provider right away if you have any of these symptoms, especially if they are new, worse, or worry you:

  • thoughts about suicide or dying
  • attempts to commit suicide
  • new or worse depression
  • new or worse anxiety
  • feeling agitated or restless
  • panic attacks
  • trouble sleeping (insomnia)
  • new or worse irritability
  • acting aggressive, being angry, or violent
  • acting on dangerous impulses
  • an extreme increase in activity and talking (mania)
  • other unusual changes in behavior or mood

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How can I watch for early symptoms of suicidal thoughts and actions?

  • Pay attention to any changes, especially sudden changes, in mood, behaviors, thoughts, or feelings.
  • Keep all follow-up visits with your healthcare provider as scheduled.

Call your healthcare provider between visits as needed, especially if you are worried about symptoms.

Do not stop taking NEURONTIN without first talking to a healthcare provider.

  • Stopping NEURONTIN suddenly can cause serious problems. Stopping a seizure medicine suddenly in a patient who has epilepsy can cause seizures that will not stop (status epilepticus).
  • Suicidal thoughts or actions can be caused by things other than medicines. If you have suicidal thoughts or actions, your healthcare provider may check for other causes.

2. Changes in behavior and thinking –Using NEURONTIN in children 3 to 12 years of age can cause emotional changes, aggressive behavior, problems with concentration, restlessness, changes in school performance, and hyperactivity.

3. NEURONTIN may cause serious or life-threatening allergic reactionsthat may affect your skin or other parts of your body such as your liver or blood cells. This may cause you to be hospitalized or to stop NEURONTIN. You may or may not have a rash with an allergic reaction caused by NEURONTIN. Call a healthcare provider right away if you have any of the following symptoms:

  • skin rash
  • hives
  • difficulty breathing
  • fever
  • swollen glands that do not go away
  • swelling of your face, lips, throat, or tongue
  • yellowing of your skin or of the whites of the eyes
  • unusual bruising or bleeding
  • severe fatigue or weakness
  • unexpected muscle pain
  • frequent infections

These symptoms may be the first signs of a serious reaction. A healthcare provider should examine you to decide if you should continue taking NEURONTIN.