Wittmaack-Ekbom syndrome

A syndrome characterised by an unpleasant creeping sensation in the lower limbs, occasionally in the thighs or feet, felt deep inside the muscle or bones, when the patient is at rest, inducing an intolerable restlessness and a desire to move the legs to relieve it, with twitching and jumping of the legs. Seldom true pain. Worst in the evening and at night or when the patient rests for some time.

It is associated with iron deficiency, drugs (phenothiazine), barbiturate withdrawal, diabetes, uraemia, neuropathy and chronic respiratory illness as well as following cerebrovascular accident. It is a common complication in pregnancy. Fatigue, anxiety and stress are associated factors. Sudden jerks on falling asleep may be observed also in otherwise normal persons. Probably heterogeneous, but frequently occurs as a familial condition transmitted as an autosomal dominant trait. It is an important cause of severe insomnia.

The syndrome of resless leggs was first described by the English anatomist and physician Thomas Willis (1621-1675) in 1672 and included in a posthumous publication of his collected works. In 1861 Wittmaack described it as «Anxietas tibiarum». Ekbom in 1945 reported his observations in 34 persons and used the term «restless legs». He subsequently observed 70 additional typical cases.

• T. Willis:
  De anima brutorum quæ hominis vitalis ac sensitiva est, excertitationes duæ; prior physiologica ejusdem naturam, partes, potentias et affectiones tradit; altera pathologica morbos qui ipsam, et sedem ejus primarium, nempe ceerebrum et nervosum genus atticiunt, explicat, eorumque therapeias instituit.
  London, R. Davis, 1672.
  English translation by Samuel Pordage, London, 1683: Two Discourses concerning The Soul of Brutes, Which is that of the Vital and Sensitive of Man. The London Practice of Physick: Or the Whole Practical Part of Physick Contained in the Works of Dr. Willis. London, Bassett Crooke, 1685: 404. "Wherefor to some, when being a bed they betake themselves to sleep, presently in the arms and legs, leapings and contractions of the tendons, and so great a restlessness and tossing of their members ensue, that the diseased are no more able to sleep, than if they were in a place of greatest torture" In Germany the disease picture was known as "Anxietas tibiarum", while in France the term "Impatience musculaire" was used.
• T. Wittmaak:
  Pathologie und Therapie des Sensibilitäts-Neurosen.
  In: T. Wittmaak, Lehrbuch der Nervenkrankheiten, Teil 1: Pathologie und Therapie der sensiblen Neurosen. Leipzig, E. Schäfer, 1861. Another early description of the symptoms was made by George Miller Beard (1839-1883). This is probably in:
• G. M. Beard:
  Neurasthenia, or nervous exhaustion.
  Boston Medical and Surgical Journal, 1869, 80: 217-221. It is refferred to in:
• D. R. Mc Leod, R. Hoehn-Saric:
  Anxiety States. In: T. G. Dinan, editor, Principles and Practice of Biological Psychiatry, Vol. 2. Clinical Neuroscience Publishers, London, 1990, pp 43-78 Beard interpreted the symptoms as "one of the myriad results of spinal irritation".
• Hermann Oppenheim (1858-1919):
  Lehrbuch der Nervenkrankheiten. 7th edition, S. Karger, Berlin, 1923, page 1774. "Eine besondere Art subjektiver Empfindungsstörungen ist die Unruhe in den Beinen. Sie kann zum quälenden Übel werden, Jahre und Dezennien bestehen und sich vererben, resp. familiär auftreten".
  From the chapter on neurasthenia.
  Oppenheim considered mental factors to be pathogenetically dominating.
• K. A. Ekbom:
  Asthenia crurum paraesthetica ("irritable legs"): A new syndrome consisting of weakness, sensation of cold and nocturnal paresthesia in legs, responding to certain extent to treatment with priscol and doryl. Note on paresthesis in general.
  Acta Medica Scandinavica, Stockholm, 1944, 118: 197-209. Restless legs. A clinical study of a hitherto overlooked disease in the legs characterized by peculiar paresthesia (“anxietas tibiarum”), pain and weakness and occurring in two main forms, asthenia crurum paraesthetica and asthenia crurum dolorosa. A short review of paresthesia in general.
  Acta Medica Scandinavica, Stockholm, Supplement, 1945; 158: 1-123. Restless Legs. In: P. J. Vinken and G. W. Bruyn, editors: Handbook of Neurology, Vol. 8, Chapt. 19, North Holland Publishing Company, Amsterdam New York, 1970, pp 311-320 Growing pains and restless legs.
  Acta Pædiatrica Scandinavica, Stockholm, 1975, 64: 264-266.
  
  
• J. Huizinga:
  Hereditary acromelalgia (or “restless legs”).
  Acta genetica et statistica medica, Basel, 1957, 7: 121-123.
• I. Oswald:
  Sudden bodily jerks on falling asleep. Brain, Oxford, 1959, 82: 92-103.