Definition

Restless legs syndrome (RLS) is a neurologic disorder characterized by unpleasant sensations in the legs and an irresistible urge to move them. The sensations are typically worse during periods of inactivity and usually strongest at night. The symptoms are improved with activity. For this reason, people with RLS generally have insomnia , which may be severe.

Causes

The exact cause of RLS is unknown. RLS may occur for no identifiable reason (primary RLS), or may be caused by other medical conditions or use of certain drugs (secondary RLS).

Many people with RLS also have periodic limb movement disorder (PLMD). This is a related motor disorder characterized by involuntary, repetitive, jerking movements that interrupt sleep.

Risk Factors

These factors increase your chance of developing RLS. Tell your doctor if you have any of these risk factors:

• Family members with RLS
• Pregnant—Some women have RLS during pregnancy; the symptoms usually disappear after giving birth.
• Low iron levels (with or without anemia)—This may happen if you give blood frequently.
• Northern European descent
• Chronic disease (which can lead to secondary RLS):
  • Peripheral neuropathy (diabetes)
  • Chronic kidney failure
  • Chronic venous insufficiency (varicose veins)
  • Radiculopathy (nerve problem)
  • Anemia
  • Diabetes
  • Cancer
  • Chronic obstructive pulmonary disease
  • Rheumatoid arthritis
  • Congestive heart failure
• Certain medications (eg, tricyclic antidepressants)
• Withdrawing from certain drugs (eg, selective serotonin reuptake inhibitors [SSRIs], lithium, caffeine, dopamine antagonists, sedating antihistamines)

Symptoms

Symptoms may include:

• Feelings of tingling, creeping, pulling, prickling, "pins and needles," or pain in the legs during periods of rest or inactivity—Half of patients complain of restlessness in the arms as well as legs.
• Symptoms typically get worse at night
• A strong urge to relieve these uncomfortable feelings with movement
• Restlessness, including floor pacing, tossing and turning in bed, and rubbing the legs
• Difficulty falling asleep and staying asleep
• Hypersomnia—recurrent episodes of excessive daytime sleepiness or prolonged nighttime sleep

Symptoms may begin at any age, but are most common in people older than 60 years old. Symptoms usually increase in the evening and during times of rest, relaxation, or inactivity.

Diagnosis

The doctor will ask about your symptoms and medical history, and do a physical and neurologic exam. The diagnosis is based mainly on your symptoms. There is no specific test for RLS, but tests to check for conditions that may trigger RLS include:

• Blood tests to check iron levels
• Monitoring of leg activity during sleep ("sleep study")
• Study of leg muscles, such as electromyography (EMG) and nerve conduction studies

	Nerves of the Leg
	© 2008 Nucleus Medical Art, Inc.

Treatment

There is no cure for this condition. Treatments are aimed at relieving or reducing symptoms.

Treatment for Mild Cases of RLS

Self-care

• Massage your legs.
• Use a heating pad or ice pack.
• Take a hot bath.
• Talk to your doctor about taking supplements that might be helpful, such as folate, iron, magnesium, vitamins B12, C, and E.
• Refrain from using tobacco, alcohol, or caffeine.
• Follow a sleep routine.
• Develop a regular, moderate exercise program.
• Avoid the use of medications that may worsen RLS, such as antidepressants.

Treatment for Conditions That May Trigger RLS

Effective treatment of conditions that may trigger RLS can ease or even eliminate symptoms:

• Anemia
• Diabetes
• Neuropathy
• Kidney failure
• Hypothyroidism

Treatment for Severe Cases of RLS

Medication

• Benzodiazepines
• Dopaminergic agents (ropinirole, pramipexole)—considered the most effective
• Opioids
• Anticonvulsants (gabapentin)
• Clonidine

Transcutaneous Electric Nerve Stimulation

During this treatment, electric stimulation is done to the affected area of the leg. This is usually done 15-30 minutes before bedtime to help reduce leg jerking.

Prevention

There are no guidelines for preventing RLS.

RESOURCES:

National Sleep Foundation
http://www.sleepfoundation.org

Restless Legs Syndrome Foundation
http://www.rls.org

CANADIAN RESOURCES:

BC Health Guide
http://www.bchealthguide.org/

Canadian Sleep Society
http://www.css.to/

References:

Bradley WG, Daroff RB. Neurology in Clinical Practice . Philadelphia, PA: Butterworth Heiemann; 2004.

Current Medical Diagnosis and Treatment . 45th ed. McGraw-Hill; 2006.

National Sleep Foundation website. Available at: http://www.sleepfoundation.org .

Restless legs syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Accessed May 27, 2008.

Restless Legs Syndrome Foundation website. Available at: http://www.rls.org/ .

Shannon, Kathleen. Restless Legs Syndrome In: Gilman S, ed. MedLink Neurology. San Diego, CA: MedLink Corp. Medlink website. Available at: http://www.medlink.com. Accessed May 12, 2008.

Worldwide Education and Awareness for Movement Disorders website. Available at: http://www.wemove.org/.

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