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Restless Leg Syndrome

What is Restless Leg Syndrome

Restless leg syndrome (RLS) is a very common problem. It is so common in vein disorders that it is a routine question on our standard patient questionnaire. RLS varies greatly in its intensity over our large patient population. However, it usually responds rapidly and permanently to a specific type of sclerotherapy. I have not seen a patient who did not respond to treatment.

Restless Leg Syndrome Symptoms

RLS is due to the irritation effects of stagnant blood on the leg muscles. In vein disorders, the common denominator is “reflux” (or abnormally reversed blood flow). This produces stagnation, especially when the patient is resting or not walking. During the day, the normal action of the leg muscles (when walking) includes a suction effect on the superficial veins, drawing the blood into the deeper veins. However, in patients with RLS, the blood becomes stagnant in the superficial network (when resting) and irritates the muscles, especially the calf muscles. The body’s reaction to this stimulus is to move the legs with a near-constant urge to move the irritating blood out of that location. Patients rarely recognize this network of problem veins (just under the skin at or just above the calf muscles, but it can be elsewhere) until we point out the components of it to them. This is one of the reasons why the condition has been overlooked, misdiagnosed and mistreated for so long. In some patients, the situation deteriorates further into muscle cramps during the night. This is yet another effect of stagnant blood.

Restless Leg Syndrome Treatment

I hesitate to make generalized statements about a particular form of treatment, especially one like sclerotherapy because there are so many types of sclerotherapy, and some are more effective than others. There are certain target veins that if successfully injected will relieve RLS. We refer to these veins as venules, but they are also called reticular veins or feeder veins. Unlike other veins, they are difficult to inject with precision; they are also easy to undertreat failing. We will not use hypertonic saline because, in our experience, it gives poor results, rather we will use a sclerosant or an irritating solution.

We like to use sodium tetradecyl sulphate in very dilute solutions. Most patients require about four treatments per leg, but more treatments may be required if larger veins are also involved, as in patients with mixed vein disease. Out-of-town patients can receive an accelerated treatment program which is very effective because we can more easily gain control over this diffuse and proliferative disorder. Such treatment is usually completed (or nearly so) in four days. However, yours may take longer, especially if cosmetic considerations become prominent during or after treatment.

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