Curing Restless Legs Syndrome
by Treating Venous Insufficiency
Clint A. Hayes, M.D., F.A.C.S., R.V.T.,
John R. Kingsley, M.D., F.A.C.S., R.V.T.,
Kevin R. Hamby, R.V.S., R.V.T.
John Carlow, Ed.D.
The Vein Center of North Texas, Denison, Texas and
Alabama Vascular and Vein Center, Birmingham, Alabama
Abstract
Background
Restless Legs Syndrome (RLS) is a condition in which patients experience unpleasant sensations in their legs that are accompanied by an irresistible urge to move their legs. These sensations and the chronic sleeplessness they cause can be quite distressing. RLS affects 5-15% of the American and European populations. RLS can be primary (idiopathic) or secondary to another disease process. It is widely recognized that Superficial Venous Insufficiency (SVI) can cause RLS symptoms. We hypothesized that these symptoms are associated with the nightly mobilization of edema fluid that coincides with the onset and duration of symptoms. The purpose of this study was to determine the effect curing SVI had on RLS symptoms.
Methods
Thirty-five patients with RLS as defined by the 2003 NIH criteria (initial IRLS score of ≥ 15) and duplex-proven SVI completed an initial IRLS questionnaire and underwent a standard duplex examination to objectively measure the severity of their conditions. They were separated into non-operative and operative cohorts. The operative cohort underwent successful endovenous ablation of their refluxing superficial veins using the CoolTouch 1320nm laser and ultrasound-guided sclerotherapy of the associated varicose veins with foamed STS. Patients in both cohorts then completed a follow-up IRLS questionnaire. We then compared the baseline and follow-up IRLS scores of both cohorts.
Results
Curing the SVI decreased the mean IRLS score by 21.4 points from 26.9 to 5.5. This corresponds to an 80% improvement in symptoms. We found that 89% of treated patients enjoyed a decrease in their IRLS score of ≥ 15 points. Fifty-three percent had a follow-up score of ≤ 5, and 31% had a follow-up score of zero.
Conclusions
Endovenous ablation of refluxing axial veins with the 1320nm Cool-Touch Laser and STS foam sclerotherapy of associated varicosities alleviates or cures RLS symptoms in patients with moderate to very severe RLS symptoms and Superficial Venous Insufficiency. This supports the proposal that the waning of edema fluid causes RLS symptoms in SVI patients. Superficial Venous Insufficiency should be ruled out in all patients with RLS before initiation or continuation of drug therapy.