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If you have problems falling asleep, you are not alone. Sleep disorders are surprisingly common, particularly amongst the MS community. RLS or restless leg syndrome could be the culprit.

However, one potential cause of your sleep disturbances is a condition known as Restless Leg Syndrome. One may also call this myoclonic jerk.

Restless Leg Syndrome

RLS is a movement disorder where unpleasant sensations in the legs trigger involuntary jerking of the limbs. Research has shown that MS patients are four times more likely to suffer from RLS than the non-MS community.

The feelings or sensations you experience may include:

  • Aching
  • Tingling
  • Jolting or electrical sensations
  • Spiders crawling on, or under, the skin
  • Itching
  • Tightness

As one with first-hand experience, I would confirm all of the symptoms with the tightness and jolting being the most prevalent complaints.

It is also probable that your MS fatigue is being exacerbated by the RLS sleep disturbance.

Anatomy of Restless Leg Syndrome
Anatomy of Restless Leg Syndrome
Source: VerywellHealth

RLS Causes

Abnormalities in the neurotransmitters that control muscle movement are a possible cause. MS disease activity in the parts of the CNS (central nervous system) could affect autonomous movement.

People with more advanced multiple sclerosis or have lesions in their cervical spinal cord have a much higher risk of experiencing Restless Leg Syndrome

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Diagnosing Restless Leg Syndrome

Restless legs syndrome is diagnosed when the following criteria are met:

  • Uncomfortable feelings in the legs cause the urge to keep moving the legs
  • Urges are worse when relaxed, lying down or sitting
  • Moving around eases the discomfort
  • Sensation worsens at night

While these symptoms are indicative of restless leg syndrome which can occur alongside multiple sclerosis. You should be aware that MS, itself, can mimic these symptoms.

  • Extensor Spasms happen when a limb stiffens and the person cannot bend the joint. These muscle spasms usually affect the quadriceps causing the leg to kick out. These are not movement urges, they are wholly involuntary movements. Some extensor spasms can be so severe that the person will fall out of the bed or chair.
  • Parasthesias: include unpleasant sensations that occur primarily in the lower legs and feet. These are often described as tingling, numbness or pins and needles. MS, as opposed to RLS, symptoms tend to be present all day, not just at night.

Willis-Ekbom Disease

Restless Leg Syndrome can also be called Willis-Ekborn Disease and is very prevalent among MS patients.

In fact, a recent study published in PubMed found that of 156 MS patients surveyed, just over 50% met the criteria for RLS.

Restless Leg Syndrome has been shown to have a genetic connection and can run in families.

Furthermore, RLS is connected with nerve damage in the basal ganglia, a part of the brain that uses the neurotransmitter, dopamine, to control muscle activity.

Dopamine neurotransmitter

Dopamine is the messenger between the brain and the areas of the nervous system that regulate movement. If nerve cells become damaged, dopamine levels fall and muscle spasms and involuntary movements are the result.

The natural levels of dopamine, fall toward the end of the day. Which may explain the increased likelihood of restless leg in the evening or at night.

Restless leg syndrome can be a secondary condition to conditions like MS. However, it could also be down to an iron deficiency. Low levels of iron in the blood can lead to a fall in dopamine levels.

However, in MSers restless leg syndrome can be related to abnormalities in the autonomic nervous system.

Restless Leg Syndrome Treatment

In accordance with generic MS health guidelines, you should avoid caffeine, alcohol and nicotine.

Taking regular exercise is an important part of developing a good sleep routine.

Massaging your leg muscles or taking a hot bath can provide some relief. Gentle exercise like yoga and tai chi are very good for relaxing both body and mind.

Benzodiazepines like Valium or Klonopi have been used with some success but, there is a very real danger of addiction with this type of drug.

RLS as an MS Indicator

The sudden onset of RLS symptoms in a patient suggested the possibility of an underlying cause. His diagnostic evaluation excluded other causes of RLS and his clinical course suggested that RLS was due to MS.

MS with the spinal cord involvement is mostly associated with RLS, but any lesion in the hypothalamic-spinal connection may cause disinhibition of lower spinal levels, resulting in RLS.

RLS as the initial presentation of MS reflects that the pathophysiology of RLS in MS is related to inflammatory demyelination rather than axonal degeneration.

What is Myoclonus

Myoclonus refers to sudden, brief involuntary twitching or jerking of a muscle or musscles. It describes a clinical sign and is not itself a disease.

Myoclonic twitches or jerks are usually caused by sudden muscle contractions (tightening), called positive myoclonus.

In its simplest form, myoclonus consists of a quick muscle twitch followed by relaxation.  Examples of this type of myoclonus are hiccups.

Generally, myoclonus is caused by damage to the brain or spinal cord.

However, very rarely, myoclonus could be caused by an injury to the peripheral nervous system. Anything that disrupts the sensory nerves signals from or to the CNS.

Types of Myoclonus

Categorising the different forms of myoclonus is difficult because the causes and responses vary widely.

  • Sleep myoclonus (also called hypnic myoclonus) occurs during sleep and sleep transitions. Is the type of myoclonus suffered most by the author.
  • Stimulus-sensitive myoclonus is triggered by extraneous events. These events might be loud noises, sudden movement or flashing lights.
  • Essential myoclonus occurs without an underlying brain disorder or idiopathic.
  • Action myoclonus is triggered or made stronger by voluntary movement. For example when trying to position something very precisely.
  • Cortical reflex myoclonus originates in the cerebral cortex. The layer of the brain responsible for information processing.
  • Epileptic myoclonus is the presence of myoclonus in people living with epilepsy.
  • Reticular reflex myoclonus originates in the brain stem, the psrt of the brain controlling the vegetative functions.
  • Palatal myoclonus, also called palatal tremor, is a regular, rhythmic contraction of one or both sides of the palate.
  • Spinal myoclonus originates in the spinal cord. In some instances, the myoclonic jerk involves the whole trunk.
  • Peripheral myoclonus refers to myoclonic jerks that originate from a peripheral nerve (outside of the brain and spinal cord). An example of this is hemifacial spasm.

What causes Myoclonus

Myoclonus may develop on its own or as a result of:

  • Infection
  • Stroke
  • trauma to the spinal cord or head
  • tumours on the brain or spinal cord
  • kidney failure
  • liver failure
  • lipid storage disease
  • adverse effects of drugs or chemicals
  • hypoxia (a condition in which the body, including the brain, is deprived of oxygen)
  • autoimmune inflammatory conditions, such as multiple sclerosis and the malabsorption syndrome celiac disease
  • metabolic disorders

Myoclonus also is a symptom of numerous neurological disorders such as:

  • Epilepsy
  • Encephalitis
  • Coma
  • Parkinson’s disease
  • Lewy body dementia
  • Alzheimer’s disease
  • Creutzfeldt-Jakob disease
  • paraneoplastic syndromes (conditions that affect some cancer patients)
  • corticobasal degeneration
  • frontotemporal dementia
  • multiple system atrophy

Risk of Myoclonus

There is an equal risk of myoclonus for both males and females. The only common risk factor that has been. so far, identified is having a family history.

However, the genetic vulnerability is not clearly understood or accepted.

Myoclonus review

Myoclonus refers to an involuntary muscle jerk. Hiccups are a form of myoclonus, as are the sudden jerks, or “sleep starts,” you may feel just before falling asleep. These forms of myoclonus occur in healthy people and rarely present a problem.

Other forms of myoclonus may occur because of a nervous system (neurological) disorder, such as epilepsy, multiple sclerosis, or a reaction to a medication.

Finally, treating the underlying cause will help control your myoclonus symptoms. If the cause of myoclonus is unknown or can’t be specifically treated, then treatment focuses on reducing the effects of myoclonus on your quality of life.

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References

Overview RLS in Multiple Sclerosis verywellHealth
What is Restless Leg Syndrome MSUK
Restless Leg Syndrome as the initial presentation of Multiple Sclerosis Hindewi
yoclonus Fact Sheet NIH
Myoclonus Causes Healthline
Myoclonus Symptoms Mayo Clinic

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Early Signs of Multiple Sclerosis (MS) First Symptoms
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Restless Leg Syndrome or Myoclonic Jerk