Acta Pzdiatr Scand 64: 264-266, 1975
GROWING PAINS AND RESTLESS LEGS KARL-AXEL EKBOM From the Department of Neurology, Unitlersity Hospital, Uppsala. Snieden
ABSTRACT. Ekbom, K. A. (Department of Neurology, University Hospital, Uppsala, Sweden). Growing pains and restless legs. Acta Paediatr Scand, 64: 264, 1975.-Growing pains is a common and distressing symptom in children, hut has aroused little interest. There is a similarity between growing pains and the painful form of restless legs, but it is not known if these two conditions are identical. I have recently observed a family in which the mother has growing pains since her childhood. The pain persists in adult age, which is unusual. She also has typical restless legs. Her three sons have severe growing pains. The study of this family has convinced me that growing pains and restless legs are different conditions. KEY WORDS: Growing pains, restless legs, Ekbom’s syndrome
Growing pains in children are common and cause much suffering. Little has been written on this subject, however. For a review of the literature I refer to Jbster ( 5 ) . Growing pains and restless legs (Ekbom’s syndrome) resemble each other. Wersall (4) and Brenning ( 1 ) considered that the two conditions are identical or related. I discussed this question in my monograph on restless legs (2) but did not come to any definite conclusion. Twenty-five years later I was still in doubt. I then wrote that growing pains resembled the painful form of restless legs, but added that the intensity of pain is probably greater in growing pains (3). Most patients with restless legs have only disagreeable creeping sensations in their legs, but some have real pain. No pathological signs are found in either disease. I have seen several hundred patients with restless legs, but until recently no adult with growing pains. I have now, however, observed a woman who has suffered from growing pains since her childhood. She also Acra Prediatr Scand 64
has restless legs, and so has been able to compare the two conditions.
CASE REPORTS Case I A married schoolteacher, 37 years old, has for several years had periods of creeping sensations in her legs between the knee and ankle. There is no pain. The discomfort usually appears an hour after she has gone to bed and wakes her up from sleep. She must then move her legs but does not leave the bed. After half an hour or at most one hour she falls asleep again. The creeping sensations have never appeared during the day or the evening, hut only when she is in bed. They are provoked by exertion during the day. Two years ago she went on a cycling tour during her holiday. Then she had creeping sensations at night, but they ceased when the tour was over. She has three sons and is now pregnant again. She has not had restless legs during her pregnancies. As long as she can remember she has suffered from growing pains. It is a constant aching pain like toothache of “unbelievable” intensity. The pain is felt deep inside the calves and usually only on one side at the time. A few times it has appeared in both legs simultaneously and this was utterly disagreeable. The pain occurs after two or three hours of sleep and wakes her up. It is accompanied by a general distress. She tosses about in bed, but she is not compelled to move her legs. She takes an aspirin (acetylsalicylic acid)
Growing pains and restless legs
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also in the arms. They cause an irresistible need to move the legs. The symptoms appear during the afternoon when the legs are kept still, as at the cinema, in front of the television and in bed before or during sleep. In mild cases they last 10-30 minutes. In severe cases they last with interruptions almost the whole night. Even then they usually disappear after 4 or 5 in the morning. They hinder sleep and force the patients to move their legs or to walk around in the bedroom. The sensations then disappear quickly. As a rule there is no pain. A few patients, however, have real pain with the same localization as the creeping sensations, most often between the knee and ankle. It is a constant, slight to moderate aching pain, which may appear alone, or combined with creeping sensations. It is disagreeable but not of great intensity. The creeping sensation or pain in restless legs is as a rule felt on both sides ‘symmetrically. The growing pains in my cases were seldom felt in both legs at the same time. The intensity of the ache seems to be much greater than in restless legs. Both conditions have a predilection for the first hours of the night. Restless legs usually appear night after Case 2 The patient’s eldest son, 12 years old, says that it is night, but growing pains with greater intervals. Restless legs are relieved by diazepam, a severe ache deep inside the calf, usually only on one side but sometimes in both legs at the same time. growing pains by acetylsalicylic acid. GrowIt appears only after a few hours of sleep. He wakes ing pains diminish and disappear when the up and tosses in bed and moves his legs but that does children grow up. Restless legs may last for not help. He does not walk about on the floor. At last he takes an aspirin, and then the pain disappears after decades. 15-30 minutes. The pain occurs 2-3 times a month, I have seen a few adults with onset of especially when he has been playing football or running. restless legs in their childhood. This is His two younger bi-others describe their pains in the same way. Their mother says that her youngest son unusual. The wrong diagnosis of growing cries of pain. The frequency is the same in summer pains had been made in these cases. and winter. The tather. who i5 a physician, thought that The cause of restless legs and growing the children consumed roo many tablets. He tried placebo, but that did not help. Paracetamol gave quick relief. pains is still obscure. Heredity seems to be important in both conditions. N o strict genetic investigation has been made, however. DISCUSS I O N Restless legs are made worse by pregnancy, In restless legs there are disagreeable creep- iron deficiency and some drugs (promethaing sensations deep inside the legs, mostly zine). They disappear during fever. Growing between the knee and ankle, occasionally pains are not mused by growth but nothing also in the feet and thighs. in rare cases is known about their origin.
and then the Dain disamears in 15 minutes. She has .. always taken a tablet and for this reason does not know how long the ache would last if untreated. When the pain ceases, at first its intensity diminishes. Then it disappears for a while (not more than one minute) and then recurs though less severely. Then it disappears again and recurs, still weaker. In this way it continues until the ache is completely gone. On rare occasions the pain occurs in the day but then ,it is rather mild. She has now the pain about once a month, often the day before her menstruation. It is often provoked by exenion, for instance a stressing day in school or cycling. When she was a child, the pain appeared more frequently, at least a few times every month. During her first three pregnancies she did not have growing pains more often than usual. During her fourth pregnancy (now in her eight month) she has had growing pains only once. In her opinion the creeping sensations (restless legs) are quite different from the ache (growing pains). She never has these symptoms at the same time. The growing pains are also different from cramp. Both her parents had growing pains. The paternal grandmother did not suffer from growing pains but her five sisters had much ache in their legs during childhood. When the patient was a child they used to say: “It is only growing pains. When we were children we also had such pains and there is nothing to do but to take an aspirin.” The patient’s only brother had severe growing pains and so had her husband and his two brothers. Only the patient herself has growing pains in adult age. In all her relatives the pain disappeared after childhood. The patie-‘ has three sons, 12, 10 and 7 years old, and they ha all had intense growing pains since the age of one year. The pain now seems to be milder than earlier.
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Actu Padiulr Scund 63
266
Karl-Axel Ekbom
In my opinion growing pains and restless legs are two different conditions. In clinical work the first step is always a correct diagnosis. An effective therapy based on an understanding of the pathogenesis often has to wait for many years (as for instance in pernicious anemia). Much,research remains to be done concerning the two conditions discussed in this paper.
REFERENCES 1 . Brenning, R . : ‘Growing pains’. Actu Upsul. 65: 185, 1960.
Actu Pzdiatr Scatid 64
Soc
Med
2. Ekbom, K. A.: Restless legs. Actu Med Scand, Suppl. 158: I, 1945. 3. Ekbom, K . A.: Restless legs. I n P. J. Vinken & G. W. Bruyn (eds.): Handbook of clinical neurology. North-Holland Publishing Company, Amsterdam 1970, vol. 8, part 11, pp. 311-320. 4. Wersall, J . : Restless legs. Liikartidningen, 49: 2032, 1952. 5. gster, J . : Growing pains. A symptom and its significance. Dun Med Bull, 19: 72, 1972. Submitted April 1, 1974 Accepted May 29, 1974 Department of Neurology University Hospital S-750 14 Uppsala Sweden
GROWING PAINS AND RESTLESS LEGS KARL-AXEL EKBOM From the Department of Neurology, Unitlersity Hospital, Uppsala. Snieden
ABSTRACT. Ekbom, K. A. (Department of Neurology, University Hospital, Uppsala, Sweden). Growing pains and restless legs. Acta Paediatr Scand, 64: 264, 1975.-Growing pains is a common and distressing symptom in children, hut has aroused little interest. There is a similarity between growing pains and the painful form of restless legs, but it is not known if these two conditions are identical. I have recently observed a family in which the mother has growing pains since her childhood. The pain persists in adult age, which is unusual. She also has typical restless legs. Her three sons have severe growing pains. The study of this family has convinced me that growing pains and restless legs are different conditions. KEY WORDS: Growing pains, restless legs, Ekbom’s syndrome
Growing pains in children are common and cause much suffering. Little has been written on this subject, however. For a review of the literature I refer to Jbster ( 5 ) . Growing pains and restless legs (Ekbom’s syndrome) resemble each other. Wersall (4) and Brenning ( 1 ) considered that the two conditions are identical or related. I discussed this question in my monograph on restless legs (2) but did not come to any definite conclusion. Twenty-five years later I was still in doubt. I then wrote that growing pains resembled the painful form of restless legs, but added that the intensity of pain is probably greater in growing pains (3). Most patients with restless legs have only disagreeable creeping sensations in their legs, but some have real pain. No pathological signs are found in either disease. I have seen several hundred patients with restless legs, but until recently no adult with growing pains. I have now, however, observed a woman who has suffered from growing pains since her childhood. She also Acra Prediatr Scand 64
has restless legs, and so has been able to compare the two conditions.
CASE REPORTS Case I A married schoolteacher, 37 years old, has for several years had periods of creeping sensations in her legs between the knee and ankle. There is no pain. The discomfort usually appears an hour after she has gone to bed and wakes her up from sleep. She must then move her legs but does not leave the bed. After half an hour or at most one hour she falls asleep again. The creeping sensations have never appeared during the day or the evening, hut only when she is in bed. They are provoked by exertion during the day. Two years ago she went on a cycling tour during her holiday. Then she had creeping sensations at night, but they ceased when the tour was over. She has three sons and is now pregnant again. She has not had restless legs during her pregnancies. As long as she can remember she has suffered from growing pains. It is a constant aching pain like toothache of “unbelievable” intensity. The pain is felt deep inside the calves and usually only on one side at the time. A few times it has appeared in both legs simultaneously and this was utterly disagreeable. The pain occurs after two or three hours of sleep and wakes her up. It is accompanied by a general distress. She tosses about in bed, but she is not compelled to move her legs. She takes an aspirin (acetylsalicylic acid)
Growing pains and restless legs
265
also in the arms. They cause an irresistible need to move the legs. The symptoms appear during the afternoon when the legs are kept still, as at the cinema, in front of the television and in bed before or during sleep. In mild cases they last 10-30 minutes. In severe cases they last with interruptions almost the whole night. Even then they usually disappear after 4 or 5 in the morning. They hinder sleep and force the patients to move their legs or to walk around in the bedroom. The sensations then disappear quickly. As a rule there is no pain. A few patients, however, have real pain with the same localization as the creeping sensations, most often between the knee and ankle. It is a constant, slight to moderate aching pain, which may appear alone, or combined with creeping sensations. It is disagreeable but not of great intensity. The creeping sensation or pain in restless legs is as a rule felt on both sides ‘symmetrically. The growing pains in my cases were seldom felt in both legs at the same time. The intensity of the ache seems to be much greater than in restless legs. Both conditions have a predilection for the first hours of the night. Restless legs usually appear night after Case 2 The patient’s eldest son, 12 years old, says that it is night, but growing pains with greater intervals. Restless legs are relieved by diazepam, a severe ache deep inside the calf, usually only on one side but sometimes in both legs at the same time. growing pains by acetylsalicylic acid. GrowIt appears only after a few hours of sleep. He wakes ing pains diminish and disappear when the up and tosses in bed and moves his legs but that does children grow up. Restless legs may last for not help. He does not walk about on the floor. At last he takes an aspirin, and then the pain disappears after decades. 15-30 minutes. The pain occurs 2-3 times a month, I have seen a few adults with onset of especially when he has been playing football or running. restless legs in their childhood. This is His two younger bi-others describe their pains in the same way. Their mother says that her youngest son unusual. The wrong diagnosis of growing cries of pain. The frequency is the same in summer pains had been made in these cases. and winter. The tather. who i5 a physician, thought that The cause of restless legs and growing the children consumed roo many tablets. He tried placebo, but that did not help. Paracetamol gave quick relief. pains is still obscure. Heredity seems to be important in both conditions. N o strict genetic investigation has been made, however. DISCUSS I O N Restless legs are made worse by pregnancy, In restless legs there are disagreeable creep- iron deficiency and some drugs (promethaing sensations deep inside the legs, mostly zine). They disappear during fever. Growing between the knee and ankle, occasionally pains are not mused by growth but nothing also in the feet and thighs. in rare cases is known about their origin.
and then the Dain disamears in 15 minutes. She has .. always taken a tablet and for this reason does not know how long the ache would last if untreated. When the pain ceases, at first its intensity diminishes. Then it disappears for a while (not more than one minute) and then recurs though less severely. Then it disappears again and recurs, still weaker. In this way it continues until the ache is completely gone. On rare occasions the pain occurs in the day but then ,it is rather mild. She has now the pain about once a month, often the day before her menstruation. It is often provoked by exenion, for instance a stressing day in school or cycling. When she was a child, the pain appeared more frequently, at least a few times every month. During her first three pregnancies she did not have growing pains more often than usual. During her fourth pregnancy (now in her eight month) she has had growing pains only once. In her opinion the creeping sensations (restless legs) are quite different from the ache (growing pains). She never has these symptoms at the same time. The growing pains are also different from cramp. Both her parents had growing pains. The paternal grandmother did not suffer from growing pains but her five sisters had much ache in their legs during childhood. When the patient was a child they used to say: “It is only growing pains. When we were children we also had such pains and there is nothing to do but to take an aspirin.” The patient’s only brother had severe growing pains and so had her husband and his two brothers. Only the patient herself has growing pains in adult age. In all her relatives the pain disappeared after childhood. The patie-‘ has three sons, 12, 10 and 7 years old, and they ha all had intense growing pains since the age of one year. The pain now seems to be milder than earlier.
-
Actu Padiulr Scund 63
266
Karl-Axel Ekbom
In my opinion growing pains and restless legs are two different conditions. In clinical work the first step is always a correct diagnosis. An effective therapy based on an understanding of the pathogenesis often has to wait for many years (as for instance in pernicious anemia). Much,research remains to be done concerning the two conditions discussed in this paper.
REFERENCES 1 . Brenning, R . : ‘Growing pains’. Actu Upsul. 65: 185, 1960.
Actu Pzdiatr Scatid 64
Soc
Med
2. Ekbom, K. A.: Restless legs. Actu Med Scand, Suppl. 158: I, 1945. 3. Ekbom, K . A.: Restless legs. I n P. J. Vinken & G. W. Bruyn (eds.): Handbook of clinical neurology. North-Holland Publishing Company, Amsterdam 1970, vol. 8, part 11, pp. 311-320. 4. Wersall, J . : Restless legs. Liikartidningen, 49: 2032, 1952. 5. gster, J . : Growing pains. A symptom and its significance. Dun Med Bull, 19: 72, 1972. Submitted April 1, 1974 Accepted May 29, 1974 Department of Neurology University Hospital S-750 14 Uppsala Sweden
