Q: Most nights I experience a crawling sensation in my legs that is relieved by walking. I'm told I have restless legs syndrome. What is it and what can I do about it?

A: Restless legs syndrome exists in about 10% of the population. Patients describe a creepy-crawly, itching or pulling sensation in their legs. This is better with movement, usually walking. It is especially bothersome at night and can interfere with sleep.

Restless legs syndrome was first described thusly by the English physician Thomas Willis in 1685: "Wherefore to some, when being abed they betake themselves to sleep, presently in arms and legs, leapings and contractions of the tendons, and so great a restlessness and tossing of their members ensure, that the diseased are no more able to sleep than if they were in a place of greatest torture."

In about 80% of the patients this syndrome is associated with periodic limb movements during sleep. These are jerks recurring at 20 to 40 second intervals throughout the night. These often prevent restful sleep.

Serum iron and ferritin levels should be checked, since iron deficiency may cause this syndrome. If serum ferritin is below 30, consider a 2 to 3 month trial of supplemental iron. Serum ferritin measures stored iron and is a more reliable measure of your body's iron stores.

I recommend iron gluconate or a more easily handled iron glycinate found in Solgar's Gentle Iron. An effective, easily tolerated but pricey iron tonic from Germany is Floradix Iron plus Herbs. Iron is better absorbed with some Vitamin C, so have a glass of OJ at the same time. Check levels again in 2 to 3 months.

Other treatments are low dose levodopa, the same drug used for Parkinson's disease. This is usually quite effective but can cause a rebound effect with worsening symptoms requiring higher doses. As a result, the so-called dopamine agonists - pergolide, pramipexole and ropinirole - are generally preferred, since they do not cause rebound. Gabapentin, also known as Neurontin, can be effective. It's main side effect is desirable - healthy sleep. Klonopin, a benzodiazapene tranquilizer from the same class as Valium is also effective, but can become habit forming.

Your doctor may order an overnight sleep test to better measure the extent of your leg movements at night.

If you wish to avoid powerful drugs, consider tonic water. Quinine sulfate, an old treatment for malaria is used by some doctors with success. This is an unofficial, "off label" treatment. Tonic water has some quinine in it - enough to calm down some folk's symptoms. Try a seven ounce bottle one hour before bedtime.

What else? A good homeopath may find an effective remedy. If successful, you've avoided going on a drug. Homeopathy is safer and cheaper than any drug. How does it work? Who cares…as long as it works!

Other descriptive terms for restless legs syndrome that may be applied include creepy-crawlies, ants crawling, worms moving, soda bubbles in veins, electric current, the "gotta moves", jimmy legs, heebie-jeebies, tearing, throbbing, burning and jitteryness.

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