1- Its said that RLS affects approximately 10% of people in the United States (American College of Phlebology "Healthy Veins Healthy Legs - A Patient's Guide to Phlebology).
2- Chronic Venous Disease (CVD) may occur without visible varicosities. Deep vein insufficiency, perforant vein insufficiency and saphenous insufficiency may be misdiagnosed by duplex ultrasound scanning (DUS). False negative are common and a physician without experience with phlebology may receive a negative DUS and conclude that there is no CVD.
3- But then why would the patient improve symptoms when they start to loose weight, return to do physical activities and use compression stockings?
4- We've been doing our own DUS since 2003 and the amount of patients that did a DUS and had false negative result is alarming.
5- Other interesting data we collected in our clinic. We do DUS in 100% of the patients and 33% of the asymptomatic patients have at least one segment of long reflux on the saphenous vein. Clinica Miyake is a private clinic in Brazil devoted 100% fo Phlebology since 1962. More than 90% of the patients have aesthetic concern on the legs).
6- Why would an asymptomatic patient have a long saphenous reflux and no symptoms? They normally are not overweight, exercise frequently, and have a good quality of life. Then the calf pumping compensate the reflux.
7- a careful clinical history may detect that an "asymptomatic" patient have heavy legs and/or swelling in a long flight or long standing day. When finally resting the legs, the better circulation may cause symptoms known as RLS.
8- Vein diagnosis is still improving. A perforant vein with 2mm diameter and no reflux detected by ultrasound may cause pain during palpation and we have seen for many years improvement after proper surgical ligation.
9- patients with no reflux on the saphenous veins, no painful perforant vein but with telangiectasias and feeder veins may be diagnosed as RLS as well. Augmented Reality (Veinviewer) may help detect the feeder veins. After treating the telangiectasias and feeder veins, we've also seen symptoms such as aching, burning, heaviness and itching disappear after CLaCS treatment.
http://www.ncbi.nlm.nih.gov/pubmed/18467618
http://www.ncbi.nlm.nih.gov/pubmed/18265529
http://www.ncbi.nlm.nih.gov/pubmed/11195857
Roberto: Pain due to palpitation seems to indicate muscle overuse injury - the hyper tonus muscle tissue likely the product of overactive muscle spindle cells.
http://www.sciencedaily.com/releases/2010/06/100624091755.htm
The by product of the chronic tense muscle and resulting edema would disable capillary circulation and lymph function further creating a higher pressure inside of the muscle body which is restricted in volume by the fascia covering. Nerve irritation by way of this increased pressure may also cause a sensory nerve to signal, a pain neuron to fire, a motor nerve to function poorly and result in weak muscle function or to cause extreme muscle spasms.
The compromised muscle may regain competence by exercise - stretching - massage - acupuncture - application of heat or all of the above, - response will vary by injury, injury location, length of injured status, tendency to maintain the injured status or re-injure the tissue ( due to overloading or systemic disease ).
It appears that restless leg syndrome is the same result ( for the most part ) as are carpal tunnel, anterior compartment syndrome, many back, shoulder, and neck problems, false sciatica ( piriformis syndrome ), and quad and hamstring overuse injury ( often a reflection as to how an individual stands ) - locking out one or the other muscle group. It is informative to observe how the stride length of many people - especially the elderly is restricted by hamstring muscles shortened by overactive muscle spindle cells.
I would also postulate that Pre-Eclampsia is a condition of overuse and muscle spindle cell over activation - ( the same as restless legs syndrome ) - with the likely addition of epigenetic changes which are now under greater investigation. I would like to suggest a trial of intense deep tissue massage to at risk women.
Further investigation as to elevated BP readings in elderly with RLS type muscle overuse injury and reduced stride length may provide some insight as to cause and effect. Current projects to investigate de-nervation of the kidney artery sensor to treat elevated BP not amenable to medication suggests the possible cause may be due to reduced leg circulation from hyper tonus, - and treatment by high pressure - deep tissue massage could improve stride length and reduce elevated BP readings by improving circulation.
We might need to ask if joint problems start with muscle overuse - overloading the joint unevenly and compromising blood and lymph circulation.
I am not a researcher in this area, I am a patient with severe RLS and I am also moderator of an international discussion board for patients. As a result, I have read quite a few publications of the available treatments for RLS, research into the causes and have received feedback from many patients about what works and what does not.
First off, although RLS has been designated a disease, it is also subdivided into primary, idiopathic RLS and secondary RLS that is a result of conditions such as renal failure, late stage pregnancy, MS and several other diseases. Secondary RLS is usually best resolved by treating the primary condition. Idiopathic RLS is usually best treated through various medications and has been shown to have a genetic correlation with six genes identified so far.
If we ignore the secondary patients, RLS is not limited to just the legs. As it becomes more severe, it can also occur in the arms, neck and torso. Treatment with dopamine agonist drugs will always resolve the symptoms over the short term, but these drugs usually result in augmentation over the long term. It is partly for this reason that neurochemical research has concentrated on dopamine levels in the hypothalamus as a potential cause. Iron levels in the hypothalamus have also been shown to have a correlation, which makes sense because iron is associated with dopamine production. These iron levels are not always associated with anemia, but are better measured by tests such as ferritin levels that correlate with total iron and not hemaglobin.
Another feature of severe RLS is severe insomnia. For some, the insomnia is associated with the need to move the affected limbs. However, for many of us who are still receiving dopamine agonist treatments, the need to move when attempting to relax may go away, but the severe insomnia does not. It is for this reason that Johns Hopkins is currently studying the association between glutamate levels in the hypothalamus and RLS severity.
Finally, treatments based upon resolving or improving the flow of blood through the veins of the legs does help some, but by no means has it helped everyone who has tried it. I think that this is yet another illustration of how complicated the disease really is and how much more research is needed to identify the cause(s) and identify additional treatments.
I truly believe that Research Gate will improve medicine Worldwide! Uncountable patients will benefit. Thank you for your clarification Stephen N Smith!
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