*Restless leg syndrome (RLS* ☝ *Today about*☝ Definition Restless leg syndrome (RLS) or Willis-Ekbom disease(WED) is a common cause of painful legs. The leg pain of restless leg syndrome typically eases with motion of the legs and becomes more noticeable at rest. Restless leg syndrome also features worsening of symptoms and leg pain during the early evening or later at night. Restless leg syndrome Restless leg syndrome is often abbreviated RLS; it has also been termed shaking leg syndrome. Night time involuntary jerking of the legs during sleep is also known as periodic leg/limb movement disorder. History 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. Initially published in Latin (De Anima Brutorum, 1672) but later translated to English (The London Practice of Physick, 1685), 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. Epidemiology Except perhaps in Asian populations, RLS is a common disorder, occurring in about 10% of the population. The age-adjusted prevalence of RLS determined by telephone interviews in a random population of 1803 adults in Kentucky was 10%. A Canadian survey of 2019 adults estimated the prevalence of RLS symptoms at 17% for women and 13% for men. A population-based survey in West Pomerania, Germany, of 4107 subjects found an overall 10.6% prevalence. Using standardized questions in face-to-face interviews, Rothdach et al. reported an overall prevalence of 9.8% in 369 participants ages 65-83 years in Augsburg, Germany. In a study from Japan, 4612 participants living in urban residential areas were assessed for a single symptom of RLS by a self-administered questionnaire of the following two items: (1) Have you ever been told you jerk your legs or kick sometimes and (2) have you ever experienced sleep disturbance due to a creeping sensation or hot feeling in your legs? The prevalence of RLS ranged from 3% in women ages 20-29 years to 7% in women ages 50-59 years and correlated with age. In contrast to the first three studies, RLS had a higher prevalence in men than women, with the difference reaching significance in those 40-49 years old; in men there was no positive correlation with age. Face-to-face interviews of 157 consecutive individuals ages 55 years and older participating in a health screening program and 1000 consecutive individuals ages 21 years and older from a primary health care center in Singapore yielded much lower prevalence data. Using IRLSSG criteria, the prevalence of RLS in this predominantly Asian population was 0.6% in the older (1 male) and 0.1% (1 female) in the younger cohorts. In the Kentucky and Singapore studies, there was no gender difference; however, in the two German studies, the prevalence was higher in women and in the Japanese study it was higher in men. The Canadian study reported a significantly higher occurrence of bedtime leg restlessness in women. Types Restless legs syndrome (RLS) can be either primary or secondary, and the causes vary. Primary RLS is a neurological disorder. Although the majority of people with RLS begin to experience symptoms in their middle years, some may have signs of the problem in childhood. Their symptoms may slowly progress for years before becoming a regular occurrence. Secondary RLS tends to be more severe than the primary type and stems from another underlying condition, including the following: Anemia or low blood-iron levels Folate deficiency Nerve damage due to diabetes or other conditions Kidney disease or dialysis Attention deficit disorder (ADD) Attention deficit/hyperactivity disorder (ADHD) Pregnancy Rheumatoid arthritis Parkinson’s disease Risk factors RLS/WED can develop at any age, even during childhood. The disorder is more common with increasing age and more common in women than in men. Restless legs syndrome usually isn’t related to a serious underlying medical problem. However, RLS/WED sometimes accompanies other conditions, such as: Peripheral neuropathy: This damage to the nerves in your hands and feet is sometimes due to chronic diseases such as diabetes and alcoholism. Iron deficiency: Even without anemia, iron deficiency can cause or worsen RLS/WED. If you have a history of bleeding from your stomach or bowels, experience heavy menstrual periods or repeatedly donate blood, you may have iron deficiency. Kidney failure: If you have kidney failure, you may also have iron deficiency, often with anemia. When kidneys don’t function properly, iron stores in your blood can decrease. This, with other changes in body chemistry, may cause or worsen RLS/WED. Causes The cause of restless leg syndrome is unknown in most people. However, restless leg syndrome has been associated with Pregnancy, Obesity, Smoking, Iron deficiency and anemia, Nerve disease, Polyneuropathy (which can be associated with hypothyroidism, heavy metal toxicity, toxins, and many other conditions), Other hormone diseases such as diabetes, and Kidney failure (which can be associated with vitamin and mineral deficiency). Some drugs and medications have been associated with restless leg syndrome including: Caffeine, Alcohol, H2-histamine blockers (such as ranitidine [Zantac] and cimetidine [Tagamet]), and certain antidepressants (such as amitriptyline [Elavil, Endep]). Occasionally, restless leg syndrome run in families. Recent studies have shown that restless leg syndrome appears to become more common as a person ages. Also, poor venous circulation of the legs (such as with varicose veins) can cause restless leg syndrome. Symptoms The International Restless Legs Syndrome Study Group described the following symptoms of restless legs syndrome (RLS): Strange itching, tingling, or “crawling” sensations occurring deep within the legs; these sensations may also occur in the arms. A compelling urge to move the limbs to relieve these sensations Restlessness — floor pacing, tossing and turning in bed, rubbing the legs Symptoms may occur only with lying down or sitting. Sometimes, persistent symptoms worsen while lying down or sitting and improve with activity. In very severe cases, the symptoms may not improve with activity. Other symptoms of RLS include the following: Sleep disturbances and daytime sleepiness Involuntary, repetitive, periodic, jerking limb movements that occur either in sleep or while awake and at rest; these movements are called periodic leg movements of sleep or periodic limb movement disorder. Up to 90% of people with RLS also have this condition. In some people with RLS, the symptoms do not occur every night but come and go. These people may go weeks or months without symptoms (remission) before the symptoms return again. Complications Restless legs syndrome rarely results in any serious consequences. However, in some cases severe and persistent symptoms can cause considerable mental distress, chronic insomnia, and daytime sleepiness. In addition, since restless legs syndrome (RLS) is worse when resting, people with severe RLS may avoid daily activities that involve long periods of sitting, such as going to movies or traveling long distances. Diagnosis and test There’s no single test for diagnosing restless legs syndrome. A diagnosis will be based on your symptoms, your medical and family history, a physical examination, and your test results. Your GP should be able to diagnose restless legs syndrome, but they may refer you to a neurologist if there’s any uncertainty. There are four main criteria your GP or specialist will look for to confirm a diagnosis. These are: an overwhelming urge to move your legs, usually with an uncomfortable sensation such as itching or tingling your symptoms occur or get worse when you’re resting or inactive your symptoms are relieved by moving your legs or rubbing them your symptoms are worse during the evening or at night Blood tests Your GP may refer you for blood tests to confirm or rule out possible underlying causes of restless legs syndrome. For example, you may have blood tests to rule out conditions such as anaemia, diabetes and kidney function problems. It’s particularly important to find out the levels of iron in your blood because low iron levels can sometimes cause secondary restless legs syndrome. Low iron levels can be treated with iron tablets. Sleep tests If you have restless legs syndrome and your sleep is being severely disrupted, sleep tests such as a suggested immobilisation test may be recommended. The test involves lying on a bed for a set period of time without moving your legs while any involuntary leg movements are monitored. Occasionally, polysomnography may be recommended. This is a test that measures your breathing rate, brain waves and heartbeat throughout the course of a night. The results will confirm whether you have periodic limb movements in sleep (PLMS). Treatment and medications Treatment for RLS is targeted at easing symptoms. In people with mild to moderate restless legs syndrome, lifestyle changes, such as beginning a regular exercise program, establishing regular sleep patterns, and eliminating or decreasing the use of caffeine, alcohol, and tobacco, may be helpful. Treatment of an RLS-associated condition also may provide relief of symptoms. Other non-drug RLS treatments may include: Leg massages Hot baths or heating pads or ice packs applied to the legs Good sleep habits A vibrating pad called Relaxis Medications may be helpful as RLS treatments, but the same drugs are not helpful for everyone. In fact, a drug that relieves symptoms in one person may worsen them in another. In other cases, a drug that works for a while may lose its effectiveness over time. Drugs used to treat RLS include: Dopaminergic drugs, which act on the neurotransmitter dopamine in the brain. Mirapex, Neupro, and Requip are FDA-approved for treatment of moderate to severe RLS. Others, such as levodopa, may also be prescribed. Benzodiazepines, a class of sedative medications, may be used to help with sleep, but they can cause daytime drowsiness. Narcotic pain relievers may be used for severe pain. Anticonvulsants, or antiseizure drugs, such as Tegretol, Lyrica, Neurontin, and Horizant. Although there is no cure for restless legs syndrome, current treatments can help control the condition, decrease symptoms, and improve sleep. Lifestyle and home remedies Making simple lifestyle changes can help alleviate symptoms of RLS/WED. Try baths and massages: Soaking in a warm bath and massaging your legs can relax your muscles. Apply warm or cool packs: Use of heat or cold, or alternating use of the two, may lessen your limb sensations. Try relaxation techniques: such as meditation or yoga. Stress can aggravate RLS/WED. Learn to relax, especially before bedtime. Establish good sleep hygiene: Fatigue tends to worsen symptoms of RLS/WED, so it’s important that you practice good sleep hygiene. Ideally, have a cool, quiet, comfortable sleeping environment; go to bed and rise at the same time daily; and get adequate sleep. Some people with RLS/WED find that going to bed later and rising later in the day helps in getting enough sleep. Exercise: Getting moderate, regular exercise may relieve symptoms of RLS/WED, but overdoing it or working out too late in the day may intensify symptoms. Avoid caffeine: Sometimes cutting back on caffeine may help restless legs. Try to avoid caffeine-containing products, including chocolate and caffeinated beverages, such as coffee, tea and soft drinks, for a few weeks to see if this helps.

12 Amazing Health Benefits Of Manganese stylecraze.com Oct 17, 2017 11:20 AM Manganese is an essential mineral that is needed by our body in little amounts, and hence, it is often referred to as one of the trace minerals. Our body contains, at most, 20 mg of manganese. It is mainly concentrated in the liver, pancreas, kidneys, and bones. This mineral is needed for the proper functioning of our brain and nervous system. There are several other important benefits of manganese that have been included in this article. Keep reading to know more about them. Manganese – A Brief  Image: Shutterstock Manganese, an active component of the enzyme manganese superoxide dismutase, is necessary for the proper functioning of enzymes, absorption of nutrients, wound healing, and development of bones in the body. The deficiency of manganese can cause joint pains, poor bone health, and fertility problems. Studies have shown that one needs to take almost 12 mg of manganese on a daily basis for optimum health. This trace mineral is a strong antioxidant that scavenges the free radicals in the body. Now, the important question that arises is, what are the sources of manganese? This trace mineral is found in variable quantities in spices, herbs, cloves, saffron, wheat germ, bran, nuts, mussels, oysters, clams, cocoa powder, dark chocolate, roasted pumpkin, squash seeds, flax, sesame seeds, sesame butter, chili powder, roasted soybeans, and sunflower seeds. How Manganese Is Beneficial Strengthens BonesScavenges Free RadicalsControls Sugar LevelsTreats EpilepsyControls Metabolism RateTreats Inflammation And SprainsPrevents OsteoporosisGood For Thyroid HealthAlleviates PMS SyndromeAids Vitamin AbsorptionGood For Brain HealthIncreases Energy And Functional Efficiency In The Body Health Benefits Of Manganese Let’s take a look at the spectrum of health benefits manganese has to offer. 1. Strengthens Bones  Image: Shutterstock Manganese is vital for the normal development of the human bone structure (1). It helps to boost the mineral density of the spine (2). It has also proved to be beneficial for post-menopausal women. Manganese deficiency in women after menopause can increase the amount of trace minerals and cause minor fractures. Research is going on to establish a concrete evidence that manganese can help prevent osteoporosis and many other diseases. 2. Scavenges Free Radicals Manganese has antioxidant properties, which help it to monitor the activity of free radicals in our body (3). These free radicals can damage human cells and lead to cancer and other harmful diseases. Hence, it is vital to add manganese-rich food sources or supplements to your diet to avert the risk of many diseases. 3. Controls Sugar Levels  Image: Shutterstock Manganese can control the blood sugar levels in our body and help prevent diabetes. Manganese can normalize the synthesis and secretion of insulin in the blood to control the level of sugar. This also helps to regulate unpredictable drops in the blood sugar, which makes life easier for diabetics (4). 4. Treats Epilepsy Epilepsy is a troublesome disorder, and the deficiency of manganese can trigger epileptic seizures. Manganese can act as a vasodilator and plays a key in treating seizures due to its anti-epileptic qualities (5). You can use manganese supplements to control minor and major epileptic seizures. Regulating our body’s metabolism is an essential function of manganese. Manganese-activated enzymes are useful to metabolize cholesterol, amino acids, carbohydrates, and vitamins such as vitamin E and vitamin B1. It also helps in proper functioning of the liver. Manganese can help in the metabolism of glutamine (amino acid) and is an integral part of DNA polymerase (6). 6. Treats Inflammation And Sprains  Image: Shutterstock Manganese cures sprains and inflammation by increasing the superoxide dismutase level (7). This happens due to its antioxidant properties. Superoxide dismutase (SOD) deficiency can be observed in patients with arthritis. SOD has anti-inflammatory properties that can alleviate arthritis. Manganese can help to increase the synthesis and functioning of SOD, thus helping reduce the symptoms of the condition. 7. Prevents Osteoporosis Manganese supplements can give you relief from osteoporosis and osteoarthritis since this essential mineral can add to the bone density and mineral density. However, further research is needed to specifically explore the impact of manganese on the bone health (8). 8. Good For Thyroid Health You may not be aware of many other mineral supplements for thyroid disorder other iodine, right? But, manganese is also very much essential for thyroid health. Manganese is an essential co-factor for various enzymes like thyroxine, a vital hormone in the thyroid gland. It is important to maintain proper functioning of the thyroid gland to avoid health issues. This can be useful to maintain proper appetite, metabolism, weight, and organ system efficiency (9). 9. Alleviates PMS Syndrome  Image: Shutterstock Many women can suffer from premenstrual syndrome (PMS). Manganese helps to manage mood swings and reduce headaches, depression, and irritability. Women who suffer from severe PMS symptoms are advised to consume manganese supplements (10). 10. Aids Vitamin Absorption Manganese can be useful in the absorption of essential vitamins such as vitamin B, vitamin E, and minerals. It plays an important role in enzymatic reactions required for the absorption and utilization of vitamins obtained from food (11). 11. Good For Brain Health Manganese is found to be very essential in treating many nervous disorders. This property of manganese is due to the availability of superoxide dismutase, which scavenges free radicals from the neural pathways. Manganese also binds with neurotransmitters, thus regulating the transmission of electrical impulses throughout the body and enhancing the cognitive function (12). 12. Increases Energy And Functional Efficiency In The Body Manganese can also provide instant energy and ensure proper working of the body. It regulates glucose metabolism, thus ensuring proper energy distribution in each and every cell of the body. It also ensures proper absorption of glucose in the muscles and organs (13). A Word Of Caution Though manganese offers a lot of health benefits, you need to limit its consumption and be aware of its side effects. Listed below are a few things you need to keep in mind: Make sure you consume the amount prescribed by your health care provider. Overdose can be fatal.Don’t consume manganese supplements within an hour or two of taking an antacid. This is because antacids are known to lower the absorption of manganese in the body.People who receive nutrition through IV should avoid consuming manganese supplements altogether.Kids under the age of five can be badly affected if they inhale manganese.Using manganese supplements with quinolone antibiotics can be fatal.Manganese makes up the trio of toxic trace minerals in the body, and their deficiency or overuse can cause serious damage. Make sure that you never inhale it over a long period as it may lead to a number of fatal disorders like Parkinson’s.Those with liver disorders should avoid taking manganese supplements as they can lead to tremors or mental disorders.People suffering from iron-deficiency anemia should totally avoid its consumption as their body tries to absorb as much of manganese as possible. Public Health Recommendations The dietary intakes recommended by the National Academy of Sciences for common masses are as follows. Age/Life Stage Adequate Intake (Per day) 0-6 months0.003 mg7-12 months0.6 mg1-3 years1.2 mg4-8 years1.5 mg 9-13 years, female 9-13 years, male 1.6 mg 1.9 mg 14-18 years, female 14-18 years, male 1.6 mg 2.2 mg 19+ years, female 19+ years, male 1.8 mg 2.3 mg Pregnant women2.0 mgLactating women2.6 mg It is evident from the above-mentioned benefits that manganese can contribute to your overall wellness in a variety of ways. We hope you found this information useful. Let us know if you know any other ways of incorporating this essential mineral in your diet. Report a problem 194dislike

40y/f c/o multiple joints pain mainly both hand and ankle joints for last 10 yrs. A k/c/o Hypothyroidism, hypertension on medication well controlled. o/e Tep 98.6 BP 130/80 HR 76 bpm. R R 20/m chest b/l clear.no additional heart sounds. CVS,CNS NAD. joints tenderness++ swelling++. investigation uric acid, BSR, CXR PA view,kft,lft, lipid profile normal.joints x Ray are awaited. vit b12 >2000 pg/ml.some blood reports are as follows. PL adv further investigation and diagnosis and treatment.

45 yrs female...weight...40 kg...severe back pain..knee pain...weak....anemic..loss of appetite since 2 month...no htn.dm....due to weakness she can't able to walk...2 min....BP 110.70.....she walk with support.....pt conditions economically very poor....pls suggest how can manage this case.@Dr. Shivraj Agarwal

a 48 year female complaint with 1.vertigo during standing up. 2.Severe headache with body weakness body weakness may be due to Anemia But what will cause of Headache with vertigo *History* H/o Rheumatic Arthritis H/o steroid from 20 year (predinsalone10mg) *Vitals* B.p-110/70 *Management* please suggest diagnosis & management?