Restless Legs Syndrome

What is Restless Legs Syndrome (RLS)?

It's late in the evening. You lie in bed, ready for sleep. What's that? A burning, creeping sensation inside your legs. It feels as if bugs are crawling inside them! You must move your legs...it's the only way to stop these feelings.

This is a description of restless legs syndrome (RLS), a common neurological disorder that affects 5-15% of the population (approximately 12 million people in the United States). The unpleasant sensations usually occur when people are resting or ready to go to sleep. This may cause people with RLS to have trouble falling asleep and staying asleep. Insomnia and sleepiness during the day can lead to depression and anxiety.

Signs and Symptoms of RLS

People with RLS have uncomfortable feelings in their legs, especially when they are lying down or resting. Most people are not bothered by RLS when they are moving around. The sensations can also occur when a person is sitting for a long period of time, for example on a plane or car trip or watching a movie. The uncomfortable feelings cause an urge to move and this movement often relieves the discomfort. The exact location of the sensations varies from person to person and occasionally, the unpleasant feelings can occur in the hands and arms. RLS can start anytime, even in childhood. Approximately one-third of people with RLS had their first symptoms before they were 20 years old.

Causes of RLS

For many people, the cause of RLS is unknown. However, RLS does appear to run in families, but how RLS might be inherited is not known. RLS is associated with several conditions including:

  • Low levels of iron: people with an iron deficiency or anemia are more likely to develop RLS. Iron supplements can sometimes eliminate the symptoms of RLS. Decreased iron levels may lead to abnormalities in the dopamine neurotransmitter system.

  • Diseases: kidney disease, diabetes, Parkinson's disease, nerve disorders and spinal cord injuries increase the risk for RLS. Treating these conditions sometimes reduces the symptoms of RLS.

  • Pregnancy: women who are pregnant have a higher incidence of RLS than women who are not pregnant. RLS symptoms are most severe during the last three months of the pregnancy and usually disappear a few weeks after the baby is delivered.

  • Drug use: some medications, including tricyclic antidepressants, antinausea drugs, lithium, antiseizure drugs, antipsychotic drugs, caffeine and cold medicines, can make RLS symptoms worse.

  • Dopamine deficiency: medications that increase levels of the neurotransmitter dopamine may relieve RLS symptoms.

Diagnosis of RLS

There is no blood test or brain scan that can diagnose RLS. Rather, doctors speak with a person to get a better understanding of the symptoms. For example, a doctor might ask about the uncomfortable feelings in a person's legs (when do the feelings occur? how are the sensations relieved?). The doctor might also ask about a person's medications, medical history and daytime sleepiness. Blood tests and nerve studies can be used to rule out other causes of the symptoms.

The International Restless Legs Study Group defines RLS as having the following symptoms:

  • An urge to move, mostly in the legs. This urge is usually caused by uncomfortable sensations in the legs.
  • Motor restlessness (movement) relieves the urge to move.
  • When a person rests or relaxes, the symptoms get worse.
  • The symptoms are worse in the evening or night.

Treatment of RLS

Medications

  1. Dopaminergic drugs: chemicals that increase dopamine neurotransmitter levels in the brain often relieve symptoms of RLS. For example, levodopa, the chemical from which dopamine is formed, relieves many RLS symptoms. Drugs that act directly on dopamine receptors in the brain can also reduce RLS symptoms; includes drugs such as praminpexole (Mirapex), pergolide (Permax) and ropinirole (Requip).

  2. Benzodiazepines: may improve sleep and can reduce leg movements, but have little or no effect on unpleasant sensations; includes drugs such as clonazepam (Klonopin), diazepam (Valium) and triazolam (Halcion). Unfortunately, these drugs may increase sleep apnea.

  3. Opiates: may improve sleep and reduce leg movements; includes drugs such as codeine and oxycodone. There is the risk of addiction to these drugs if the dose is too high.

  4. Anticonvulsants (antiepileptics): may reduce the unpleasant sensations of RLS; includes drugs such as carbamazepine (Tegretol) and gabapentin (Neurontin).

Different patients with RLS benefit from different drugs: what works in one person may not work in another person. Some drugs that are effective for one person may even make RLS symptoms worse in other people. Unpleasant side effects of some drugs may make the medications less desirable. Also, some drugs may lose their effectiveness and the dosage of a drug or a new drug may have to be used.

Other Treatments

RLS symptoms are sometimes relieved without the use of drugs by:
  1. Moderate (not excessive) exercise
  2. Hot baths
  3. Massage, heating pads or ice packs for the legs
  4. Elimination of products that contain caffeine, alcohol and nicotine from diet
  5. Regular sleep routine

Did You Know?
  • In 1685, English physician Sir Thomas Willis was the first to associate restless legs and sleep problems.
  • In 1945, Swedish neurologist Karl A. Ekbom introduced the term "restless legs syndrome." RLS is sometimes called "Ekbom's Syndrome."

References and Further Information:

  1. Restless Legs Syndrome - National Institute of Neurological Disorders and Stroke
  2. Restless Legs Syndrome - WEMOVE
  3. Restless Legs Syndrome - Talkaboutsleep.com
  4. Facts about RLS - National Health, Lung and Blood Institute
  5. Restless Legs Syndrome Foundation
  6. International Restless Legs Study Group
  7. Allen, R.P. and Earley, C.J. Restless legs syndrome. A review of clinical and pathophysiological features. J. Clinical Neurophysiol., 18:128-147, 2001.
  8. Ray Chaudhuri, K., Odin, P. and Olanow, C.W. (editors), Restless Legs Syndrome, London: Taylor & Francis, 2004.


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