Restless Legs Syndrome
(RLS)
Definition
Restless legs syndrome (RLS) is a neurologic disorder. It is characterized by:
- Unpleasant sensations in the legs
- An irresistible urge to move your legs
Causes
The cause of primary RLS is unknown. In some cases, RLS may be genetic. Or, it may be caused by other conditions or certain drugs. This is called 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
- Interrupted sleep because of periodic leg movements
Risk Factors
These factors increase your chance of developing RLS:
- Family members with RLS
- Pregnancy—Some women have RLS during pregnancy. The symptoms usually go away after giving birth.
- Low iron levels—with or without anemia —may happen if you give blood a lot.
- Northern European descent
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Chronic disease, which can lead to secondary RLS:
- Peripheral neuropathy
- Chronic kidney failure
- Chronic venous insufficiency —varicose veins
- Radiculopathy—nerve problem
- Anemia
- Diabetes
- Cancer
- Chronic obstructive pulmonary disease
- Rheumatoid arthritis
- Congestive heart failure
- Certain medicines, including tricyclic antidepressants, selective serotonin reuptake inhibitors [SSRIs], lithium, caffeine, dopamine antagonists, and 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—may also occur in the arms
- Symptoms typically get worse at night
- A strong urge to relieve uncomfortable sensations 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, they are most common in people older than 60 years old. Symptoms usually increase in the evening and during times of rest, relaxation, or inactivity. For this reason, people with RLS generally have insomnia, which may be severe.
Diagnosis
The doctor will ask about your symptoms and medical history. A physical and neurologic exam will be done. The diagnosis is based mainly on your symptoms. There is no specific test for RLS.
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Tests to check for conditions that may trigger RLS include:
- Blood tests
- Monitoring of leg activity during sleep
- Study of leg muscles, such as electromyography (EMG) and nerve conduction studies
Nerves of the Leg
Copyright © Nucleus Medical Media, Inc.
Treatment
There is no cure for RLS. 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.
- Avoid using tobacco, alcohol, or caffeine.
- Follow a sleep routine.
- Begin a safe exercise program with the advice of your doctor.
- Avoid the use of medicines that may worsen RLS.
Treatment for Conditions That May Trigger RLS
Effective treatment of conditions that may trigger RLS can ease or resolve your symptoms:
- Anemia
- Diabetes
- Neuropathy
- Kidney failure
- Hypothyroidism
Treatment for Severe Cases of RLS
Medication
Dopamine agonists are the only drugs that are FDA approved to treat restless leg syndrome. They are often considered the most effective type of medicine for this condition.
Other medications may be used to help control symptoms of restless leg syndrome. Some medication options include clonidine, anticonvulsants, and opioids. Your doctor will select the medication based on your symptoms and medical history.
RESOURCES:
National Sleep Foundation
http://www.sleepfoundation.org
Willis-Ekbom Disease Foundation
http://www.rls.org
CANADIAN RESOURCES:
Canadian Sleep Society
http://www.css.to
Health Canada
http://www.hc-sc.gc.ca/index-eng.php
REFERENCES:
Bradley WG, Daroff RB. Neurology in Clinical Practice . Philadelphia, PA: Butterworth Heiemann; 2004.
Cui Y, Wang Y, Liu Z. Acupuncture for restless legs syndrome. Cochrane Database of Systematic Reviews . 2008;CD006457.
Current Medical Diagnosis and Treatment . 45th ed. McGraw-Hill; 2006.
Restless legs syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated December 19, 2012. Accessed February 19, 2013.
Salas RE, Gamaldo CE, Allen RP. Update in restless legs syndrome. Curr Opin Neurol . 2010;23(4):401-6.
What is restless legs syndrome? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/rls/ . Updated November 1, 2010. Accessed February 19, 2013.
What is Willis-Ekbom disease (WED)/RLS? Willis-Ekbom Disease Foundation website. Available at: http://www.rls.org/page.aspx?pid=477 . Accessed February 19, 2013.
11/26/2012 DynaMed Systematic Literature Surveillance http://www.dynamicmedical.com/what.php : Aurora R, Kristo D, Bista S, et al. The Treatment of Restless Legs Syndrome and Periodic Limb Movement Disorder in Adults—An Update for 2012: Practice Parameters with an Evidence- Based Systematic Review and Meta-Analyses. Sleep . 2012;35(8):1039-1062.
Last reviewed March 2013 by Michael Woods, MD
Last Updated: 03/15/2013