As a Sedelian Professor, Willis lectured on physiology, he also identified
diabetes mellitus, as well as being the first to describe typhoid
fever in 1659. This greatly accomplished man, amongst numerous other
things, also described a case in 1672 in Latin, of what may have been
RLS using the current diagnostic criteria. Willis thought that the
cure for RLS was blood letting, indeed modern understanding can account
for this as anaemia, iron deficiency and/or low ferritin levels can
contribute to RLS. Willis wrote in a chapter entitled ‘Instructions
for curing the Watching evil’ in ‘London practice of Physick
published in 1685:
‘…..Wherefore
to some, when being in bed they betake themselves to sleep, presently
in the arms and legs. Leaping and contractions of the tendons
and so great a restlessness and tossing of the members ensure, that
the diseased are no more able to sleep, than if they were in the place
of the greatest torture!…..’
Willis went on to think
that the diseases originated in the spinal cord and was a product
of spinal irritation and used opiates as his therapy of choice.
Sir Willis wrote:
‘Sometimes
since I was advised with for a lady of quality, who in the night
was hindered from sleep by reason of these spasmodic effects which
came upon her only twice a week; she took afterward daily for almost
three months, receiving no injury thereby, either on the brain or
about any other function, and when while by the use of other remedies;
the dyscrasia of the blood and nervous juice being corrected, the
animal spirits became more benign and mild. She afterward leaving
wholly the opium was able to sleep indifferently well!!’
Current thinking is that the spinal cord may indeed be affected
in RLS although the complement of treatment has changed somewhat!
In the 19th century the term ‘Anxietas Tiabarum’ was the
name given to the condition in Germany and was believed to be a form
of hysteria, whilst in France the name ‘Impatience musculaire’
was adopted.
Descriptions of the disease were also documented by Wittmaak in
Germany in 1861 described as as:
‘A characteristic feeling is that from older anxietan tibiarum:
a strange but descriptive compulsion to move has invaded the legs
of the inflicted person. Every moment see the legs brought into
a different position; drawn up, stretched out, abducted, spread
apart and crossed over one another. However, these movements are
not sudden or violent, rather they are slow, mindful as if it were
of eventually finding the one position that will give the most relief.
In every strange description of the nervous teasin of hysteria one
often also finds this train of involuntary agitation displayed in
the legs and feet. The same thing also occurs however else where
without one being able to find a definite cause…the condition
lasts approximately a quarter of an hour.’
Bread published an article entitled ‘neurasthenia, or nervous
exhaustion’ in the Boston Medical Journal in 1869. Bread described
the disease as ‘one of the myriad results of spinal irritation’,
again highlighting how the spinal cord was though to be involved
from an early stage. In 1923, Openheim was the first to describe
RLS as a neurologic disorder in his ‘Lehrbuch der Nervenkrankheiten’.
His description was also important as the familial component of
the disease was also recognised. His account included:
‘Restlessness in the legs is a special kind of subjective
paralgesia. It can become an agonizing torture, lasting for years
or decades and can be passed on and occur in other members of the
family.’
In 1940, Mussio-Fournier and Rawak described a ‘curious case’
of RLS, entitling the disorder a ‘familial occurance of pruritus,
urticaria and parasthetic hyperkinese syndrome of the lower limbs’.
However this particular analysis failed to identify the difference
between RLS symptoms and an additional allergic disorder which existed
concomitantly in this particular family.
Ekbom himself first described the disease in 1944 as:
‘Asthenia crurum paraesthetica (“irritable legs”).
A new syndrome consisting of weakness, sensation of cold and nocturnal
paraesthesia in legs, responding to certain extent to treatment
with priscol and doryl.’
In his paper published in 1945 he wrote:
‘A clinical study of a hitherto overlooked disease in the
legs characterized by peculiar paraesthesia, pain and weakness and
occurring in two main forms, aestheia crurum paraesthetica and asthenia
dolorosa’.
It is interesting that Ekbom described this disease as ‘overlooked’
as still today there is a lack of awareness of this condition. The
emphasis of description Ekbom gave of this disorder shifted from
the previous preoccupation on the movement abnormality alone to
the sensory aspect of the disease. Ekbom had made the distinction
that the presentation of the disease could vary although we know
that patients will describe a wide variety of sensations other than
the clear-cut ‘two forms’ Ekbom described.
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