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Specific limb: A brief look at ‘restless legs syndrome’

Those that know me well often comment that I have a general inability to sit still and that I am a ‘fidget’. (This is not necessarily a bad thing and in fact there are some positives to fidgeting that I outlined in a previous blog on bad behaviours that are sometimes good for you). There is certainly some truth to the observation that I fidget but sometimes the fidgeting is out of my control. Every few weeks my right lower leg appears to take on a life of its own and I will get strange (uncomfortable) sensations (such as tingling, itching, and aching, and occasionally cramp-like feelings) that force me to move my right leg and foot around. It only happens when I am in a resting and relaxing state and usually lasts about 30 minutes (but can occasionally last much longer). On occasions it disrupts my work and sleep but I find that just getting up and moving around is sometimes enough to alleviate the uncomfortable feelings.

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A few years ago I Googled my ‘symptoms’ and was surprised to find that I am not the only person who appears to experience such effects and that there is a whole medical literature on what has been termed ‘restless legs syndrome’ although in my case it would be in a singular rather than plural form). I’ve had the condition for about 15 years now and it may be related to some of the medication I take for an unrelated chronic degenerative health condition that I have. According to the Wikipedia entry on restless legs syndrome (RLS):

“The first known medical description of RLS was by Sir Thomas Willis in 1672. Willis emphasized the sleep disruption and limb movements experienced by people with RLS…The term ‘fidgets in the legs’ has also been used as early as the early nineteenth century. Subsequently, other descriptions of RLS were published, including those by Francois Boissier de Sauvages (1763), Magnus Huss (1849), Theodur Wittmaack (1861), George Miller Beard (1880), Georges Gilles de la Tourette (1898), Hermann Oppenheim (1923) and Frederick Gerard Allison (1943). However, it was not until almost three centuries after Willis, in 1945, that Karl-Axel Ekbom (1907–1977) provided a detailed and comprehensive report of this condition in his doctoral thesis, Restless legs: clinical study of hitherto overlooked disease. Ekbom coined the term “restless legs” and continued work on this disorder throughout his career. He described the essential diagnostic symptoms, differential diagnosis from other conditions, prevalence, relation to anemia, and common occurrence during pregnancy. Ekbom’s work was largely ignored until it was rediscovered by Arthur S. Walters and Wayne A. Hening in the 1980s. Subsequent landmark publications include 1995 and 2003 papers, which revised and updated the diagnostic criteria”.

As well as being referred to as RLS, it is sometimes referred to as Willis-Ekbom Disease or Willis-Ekbom Syndrome. Since being ‘rediscovered’ in the 1980s, there have been a lot of scientific papers published on the phenomenon although many of these are medical case studies (I don’t think my own experiences are extreme enough or strong enough to appear in any medical textbook. The Wikipedia entry on RLS provides a good summary of what is known medically and empirically:

“Restless legs syndrome (RLS) is a disorder that causes a strong urge to move one’s legs. There is often an unpleasant feeling in the legs that improves somewhat with moving them. Occasionally the arms may also be affected. The feelings generally happen when at rest and therefore can make it hard to sleep. Due to the disturbance in sleep, people with RLS may have daytime sleepiness, low energy, irritability, and a depressed mood. Additionally, many have limb twitching during sleep. Risk factors for RLS include low iron levels, kidney failure, Parkinson’s disease, diabetes, rheumatoid arthritis, and pregnancy. A number of medications may also trigger the disorder including antidepressants, antipsychotics, antihistamines, and calcium channel blockers. There are two main types. One is early onset RLS which starts before age 45 [years], runs in families and worsens over time. The other is late onset RLS which begins after age 45 [years], starts suddenly, and does not worsen. Diagnosis is generally based on a person’s symptoms after ruling out other potential causes… Females are more commonly affected than males and it becomes more common with age…Some doctors express the view that the incidence of restless leg syndrome is exaggerated by manufacturers of drugs used to treat it. Others believe it is an under-recognized and undertreated disorder…An association has been observed between attention deficit hyperactivity disorder (ADHD) and RLS or periodic limb movement disorder. Both conditions appear to have links to dysfunctions related to the neurotransmitter dopamine, and common medications for both conditions among other systems, affect dopamine levels in the brain”.

According to a review by Dr. Richard Allen and Dr. Christopher Earley in the Journal of Clinical Neurophysiology, RLS affects 2.5-15% of the US population. In another review on sleep disorder in the journal American Family Physician, Dr. Kannan Ramar and Dr. Eric Olson reported that RLS is typically characterized by four essential features: These are:

“(1) the intense urge to move the legs, usually accompanied or caused by uncomfortable sensations (e.g., “creepy crawly,” aching) in the legs; (2) symptoms that begin or worsen during periods of rest or inactivity; (3) symptoms that are partially or totally relieved by movements such as walking or stretching; and (4) symptoms that are worse or only occur in the evening or at night”.

Various online articles and papers report a variety of potential treatments based on the notion that RLS might be caused by a dopamine imbalance in the body. Some medics advise a regular sleep routine (such as that advised for those with insomnia), and cutting out the drinking of alcohol and the smoking of cigarettes. Pharmacological treatments include the use of drugs that are also used in the treatment of Parkinson’s disease such as L-DOPA and pramipexole, and the use of magnesium sulphate therapy (as reported in a 2006 paper in the Journal of Clinical Sleep Medicine – magnesium is known to be a natural muscle relaxant). In a 2011 issue of the journal Sleep Medicine, In an online article about RLS, Dr Michael Platt, author of the 2014 book Adrenalin Dominance, claims that RLS sufferers can be treated using a progesterone cream:

“Excess adrenalin during the night can cause restless leg syndrome. People often have associated symptoms also resulting from elevated adrenalin, such as teeth grinding, the need to urinate, and tossing and turning, and they often awaken in the morning with low back pain. Characteristically, RLS patients have an excess of adrenaline, may toss and turn all night, be quick to anger, might be workaholics, will usually have fibromyalgia (aches and pains – low back, side of the hips, and grind their teeth), they might drink too much, and will be hypoglycemic (sleepy between 3-4 p.m. or when in a car), and so on. There is an associated over-production of insulin and an under-production of progesterone…[By using a progesterone cream] I have had 100% success with eliminating RLS by getting hormones into balance, often within the first week. Patients feel more relaxed, they can sleep at night, rage disappears, and they can focus more easily”.

Dr. Luis Marin and his colleagues reported a different treatment for RLS altogether. They reported the case of a 41-year-old male RLS sufferer who after being on medication for RLS discovered his own solution – having sex. Following sex, the man reported that all RLS symptoms would disappear. Marin and colleagues speculated that the release of dopamine following orgasm might alleviate RLS symptoms. This appears to be a reasonable speculation given the findings of research published in the Journal of Neuroscience by Dr. Gert Holstege and his colleagues who examined brain activation at the point of ejaculation. In their paper they reported the similarity between ejaculation and using heroin in terms of brain activation:

“We used positron emission tomography to measure increases in regional cerebral blood flow during ejaculation compared with sexual stimulation in heterosexual male volunteers. Manual penile stimulation was performed by the volunteer’s female partner. Primary activation was found in the mesodiencephalic transition zone, including the ventral tegmental area, which is involved in a wide variety of rewarding behaviors. Parallels are drawn between ejaculation and heroin rush”.

It could well be that the increase in dopamine following ejaculation acts in a similar way to the medications that are given to RLS sufferers. Of all the treatments for RLS that I have read about, I think I know which one I would prefer!

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Allen, R.P., & Earley, C.J. (2001). Restless legs syndrome: A review of clinical and pathophysiologic features. Journal of Clinical Neurophysiology, 18(2), 128-147.

Bartell S1, Zallek S. Intravenous magnesium sulfate may relieve restless legs syndrome in pregnancy. Journal of Clinical Sleep Medicine, 15, 187-188.

Chaudhuri, K.R., Appiah-Kubi, L.S., & Trenkwalder, C. (2001). Restless legs syndrome. Journal of Neurology, Neurosurgery & Psychiatry, 71(2), 143-146.

Ekbom, K., & Ulfberg, J. (2009). Restless legs syndrome. Journal of Internal Medicine, 266(5), 419-431.

Holstege, G., Georgiadis, J. R., Paans, A. M., Meiners, L. C., van der Graaf, F. H., & Reinders, A. S. (2003). Brain activation during human male ejaculation. Journal of Neuroscience, 23(27), 9185-9193

Leschziner, G., & Gringras, P. (2012). Restless legs syndrome. British Medical Journal, 344, e3056.

Marin, L.F., Felicio, A.C., & Prado, G.F. (2011). Sexual intercourse and masturbation: Potential relief factors for restless legs syndrome? Sleep Medicine, 12(4), 422.

Ondo, W. G. (2009). Restless legs syndrome. Neurologic Clinics, 27(3), 779-799.

Ramar, K; Olson, EJ (Aug 15, 2013). Management of common sleep disorders. American Family Physician, 88, 231–238.

Satija, P., & Ondo, W. G. (2008). Restless legs syndrome. CNS Drugs, 22(6), 497-518.

Tales of the unexpected: 10 bad habits that sometimes do us good (Part 1)

All of us have bad habits, and all of us from time to time feel guilty about these habits. But there are some bad habits – at least when carried out in moderation – that might actually have benefits for psychological and/or physical wellbeing. Most bad habits help change our mood state and reduce stress (at least in the very short-term) but tend to become less helpful the more they are engaged in. Some of these bad habits turn into addictions where the short-term benefits are outweighed by the long-term costs. However, there are many activities that can sometimes have unexpected benefits and five of these are outlined in this blog. The next five bad habits will be in my next blog.

(1) Fidgeting helps burn calories

While fidgeting might be annoying for individuals and those around them, it is an activity that expends energy and burns calories. Fidgeting is one of a number of activities (along with walking, gardening, typing, tidying up, etc.) that are known as non-exercise activity thermogenesis (NEAT). In basic terms, NEAT is any activity that is not eating, sleeping, or sporting exercise. A number of studies carried out by obesity expert Dr. James Levine at the US Mayo Clinic (Arizona, US) have shown that individuals who fidget burn up about 350kcal a day. This is because fidgeting speeds up an individual’s metabolism by stimulating neurochemicals in the body thus increasing the ability to convert body fat into energy. So, if you are a compulsive foot tapper, an excessive thumb twiddler, or a restless doodler, just remember that all of these activities burn calories.

(2) Chewing gum helps boost thinking and alertness

Watching people chew gum is not a pretty site but if English football managers are anything to go by, chewing gum appears to be a stress relieving activity. In fact, there appear to appear to be many cognitive benefits of chewing gum. Dr. Kin-ya Kubo and colleagues in the book Senescence and Senescence-Related Disorders noted that chewing gum immediately before performing a cognitive task increases blood oxygen levels in the prefrontal cortex and hippocampus (important brain structures involved in learning and memory), thereby improving task performance. Dr. Kubo argues that chewing gum may therefore be a drug-free and simple method of helping those with senile dementia and stress-related disorders that are often associated with cognitive dysfunction. Another study by Dr. Yoshiyuki Hirano and colleagues showed that chewing gum boosts thinking and alertness, and that reaction times among chewers were 10% faster than non-chewers. The research team also reported that up to eight areas of the brain are affected by chewing (most notably the areas concerning attention and movement). As Professor Andy Smith (Cardiff University, UK) neatly summed up: “The effects of chewing on reaction time are profound. Perhaps football managers arrived at the idea of chewing gum by accident, but they seem to be on the right track”. 

(3) Playing video games helps relieve pain

Many individuals that do not play video games view the activity as a complete waste of time and potentially addictive. While excessive video game playing may cause problems in a minority of individuals, there is lots of scientific evidence that playing video games can have many beneficial effects. For instance, a number of studies have shown that children with cancer who play video games after chemotherapy take less pain killing medication. Video games have also been used as pain relieving therapy for other medical conditions such as burns victims and those with back pain. This is because playing video games is an engaging and engrossing activity that means the player cannot think about anything else but playing the game (and is what psychologists refer to as a ‘cognitive distractor task’). Pain has a large psychological component and individuals experience less pain if the person is engaged in an activity that takes up all their cognitive mind space. As well as being a pain reliever, there are also many studies showing that playing video games increase hand-eye co-ordination, increase reaction times, and have educational learning benefits.

(4) Eating snot helps strengthen the immune system (maybe)

How does it make you feel when you see someone picking their nose and then eating what they have found? Disgust? Contempt? Amused? In 2008, Dr Friedrich Bischinger, an Austrian lung specialist, claimed that picking your nose and eating it was good for you. He claimed that people who pick their noses with their fingers were healthy, happier and probably better in tune with their bodies than those who didn’t. Dr. Bischinger believes that eating the dry remains of what you pull out of your nose is a great way of strengthening the body’s immune system. He explained that in terms of the immune system, the nose is a filter in which a great deal of bacteria are collected, and when this mixture arrives in the intestines it works just like a medicine. He said that “people who pick their nose and eat it get a natural boost to their immune system for free. I would recommend a new approach where children are encouraged to pick their nose. It is a completely natural response and medically a good idea as well”. He went on to suggest that if anyone was worried about what other people think, they should pick their noses privately if they want to get the benefits.  This view is also shared by Dr. Scott Napper, a biochemist at the University of Saskatchewan. He theorises that hygiene improvement has led to the increase in allergies and auto-immune disorders and that eating snot may boost the immune system by ingesting small and harmless amounts of germs into the body. The same theory has also been applied to another bad habit – biting fingernails – because again, the act of biting nails introduces germs directly into a person’s orifices.

(5) Daydreaming helps problem solving

Daydreaming is something that can occupy up to one-third of our waking lives and is often viewed as a sign of laziness, inattentiveness and/or procrastination. However, scientific research has shown that the ‘executive network’ in our brain is highly active when we daydream. A study carried out by Professor Kalina Christoff and colleagues and published in the Proceedings of the National Academy of Sciences found activity in numerous brain regions while daydreaming including areas associated with complex problem solving. These brain regions were more active while daydreaming compared to routine tasks. It is believed that when an individual uses conscious thought they can become too rigid and limited in their thinking. The findings suggest that daydreaming is an important cognitive state where individuals turn their attention from immediate tasks to unconsciously think about problems in their lives. Christoff says that “when you daydream, you may not be achieving your immediate goal – say reading a book or paying attention in class – but your mind may be taking that time to address more important questions in your life, such as advancing your career or personal relationships”. In addition to this, Dr. Eric Klinger of the University of Minnesota has argued that daydreaming also serves an evolutionary purpose. When individuals are engaged on one task, daydreaming can trigger reminders of other, concurrent goals so that they do not lose sight of them.

Part 2 of this article will be in the next blog.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Christoff, K., Gordon, A.M., Smallwood, J., Smith, R., & Schooler, J.W. (2009). Experience sampling during fMRI reveals default network and executive system contributions to mind wandering. Proceedings of the National Academy of Sciences, 106, 8719-872

Fox, K.C., Nijeboer, S., Solomonova, E., Domhoff, G.W., & Christoff, K. (2013). Dreaming as mind wandering: evidence from functional neuroimaging and first-person content reports. Frontiers in Human Neuroscience, 7, 42. doi: 10.3389/fnhum.2013.00412.

Griffiths, M.D. (2005). The therapeutic value of videogames. In J. Goldstein & J. Raessens (Eds.), Handbook of Computer Game Studies (pp. 161-171). Boston: MIT Press.

Griffiths, M.D., Kuss, D.J., & Ortiz de Gortari, A. (2013). Videogames as therapy: A review of the medical and psychological literature. In I. M. Miranda & M. M. Cruz-Cunha (Eds.), Handbook of research on ICTs for healthcare and social services: Developments and applications (pp.43-68). Pennsylvania: IGI Global.

Hirano, Y., Obata, T., Takahashi, H., Tachibana, A., Kuroiwa, D., Takahashi, T., … & Onozuka, M. (2013). Effects of chewing on cognitive processing speed. Brain and Cognition, 81, 376-381.

Kato, P. M., Cole, S. W., Bradlyn, A. S., & Pollock, B. H. (2008). A video game improves behavioral outcomes in adolescents and young adults with cancer: A randomized trial. Pediatrics, 122, E305-E317.

Klinger, E. (2009). Daydreaming and fantasizing: Thought flow and motivation. In Markman, K. D., Klein, W.P., & Suhr, J.A. (Eds.), Handbook of Imagination and Mental Simulation (pp. 225-239). New York: Psychology Press.

Klinger, E., Henning, V. R., & Janssen, J. M. (2009). Fantasy-proneness dimensionalized: Dissociative component is related to psychopathology, daydreaming as such is not. Journal of Research in Personality, 43, 506-510.

Kubo, K. Y., Chen, H., & Onozuka, M. (2013). The relationship between mastication and cognition. In Wang, Z. & Inuzuka (Eds.), Senescence and Senescence-Related Disorders. InTech. Located at: http://www.intechopen.com/books/senescence-and-senescence-related-disorders

Levine, J.A. (2004). Nonexercise activity thermogenesis (NEAT): environment and biology. American Journal of Physiology-Endocrinology And Metabolism, 286, E675-E685.

Levine, J.A., Melanson, E. L., Westerterp, K. R., & Hill, J.O. (2001). Measurement of the components of nonexercise activity thermogenesis. American Journal of Physiology-Endocrinology and Metabolism, 281, E670-E675.

Levine, J.A., Schleusner, S. J., & Jensen, M.D. (2000). Energy expenditure of nonexercise activity. American Journal of Clinical Nutrition, 72, 1451-1454.

Redd, W.H., Jacobsen, P.B., DieTrill, M., Dermatis, H., McEvoy, M., & Holland, J.C. (1987). Cognitive-attentional distraction in the control of conditioned nausea in pediatric cancer patients receiving chemotherapy. Journal of Consulting and Clinical Psychology, 55, 391-395.

Reichlin, L., Mani, N., McArthur, K., Harris, A.M., Rajan, N., & Dacso, C.C. (2011). Assessing the acceptability and usability of an interactive serious game in aiding treatment decisions for patients with localized prostate cancer. Journal of Medical Internet Research, 13, 188-201.

Vasterling, J., Jenkins, R.A., Tope, D.M., & Burish, T.G. (1993). Cognitive distraction and relaxation training for the control of side effects due to cancer chemotherapy. Journal of Behavioral Medicine, 16, 65-80.

Wighton, K. (2013). From biting your nails to burping and even eating in bed: The bad habits that can be GOOD for you! Daily Mail, April 8. Located at: http://www.dailymail.co.uk/health/article-2305953/Bad-habits-From-biting-nails-burping-eating-bed-The-bad-habits-GOOD-you.html