Brief Answer:
Venous insufficiency not a cause to RLS

Detailed Answer:
Good evening Ms. XXXXXXX My name is Dr. Saghafi and I am a neurologist.

At this time we do not know what the underlying cause or mechanism of RLS is other than to say that the best medications used in treating the majority of patients are also used to treat Parkinson's disease. Therefore, the theoretical explanation is that the disorder involves some type of dopamine deficiency but WHERE is the bigger question?

Dopamine is a neurotransmitter found in the central nervous system not in the muscles themselves. There was a time we believed RLS to be some form of peripheral neuropathy (nerves that are not working properly outside the brain and spinal cord) but that notion seems to have given way to the thought that the basic underlying defect is in the brain itself. Again, this is supported by the fact that medications which restore function or at least seem to stimulate brain based receptors improve the symptoms. Serum testing for iron is very popular to support the notion of the peripheral neuropathy but in fact, it proves to be a useful treatment in only a small percentage of patients. Many experts in RLS no longer routinely test for iron levels since treatment with iron has so many other uncomfortable side effects.

Personally, I've stopped routine testing for iron and I simply treat the condition empirically if my clinical index of suspicion is high enough. If that doesn't solve the problem then, I may opt to test more elaborate blood or urine panels and that is where I may order not just iron but all of its storage and transport parameters as well. I also include thyroids, vitamin D, D2, and D3 as well as a screen for Lupus and rheumatoid arthritis.

If what you heard or what was said by this clinic directly implicated venous congestion as an underlying cause to RLS then, it is a grossly misleading ad and should be ignored. The notion that there is a vascular component to RLS and that somehow peripheral vein restructuring, stripping, or ablations will help or cure the problem is simply not a credible idea at this time.

Feel free to send more questions on this topic. However, if you feel that I've provided timely and useful information for your purposes I would appreciate your feedback of our discussion. At the same time, would you do me the favor of CLOSING THE QUERY so as to properly register the case as having satisfactorily been addressed.

This case required 39 min. of dedicated physician time in reviewing, researching, and organizing data into final draft form.

Cheers! Dr D.

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