Restless Legs Syndrome

Definition

Restless legs syndrome (RLS) is a neurological disorder. It is characterized by:

• Unpleasant sensations in the legs
• An irresistible urge to move the legs

Causes

The cause of primary RLS is unknown. RLS may have some genetic components. In some cases, it may be caused by other conditions or certain medications. 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

Factors that may increase your chance of getting RLS include:

• Family history
• Pregnancy
• Certain medications, such as antidepressants, antipsychotics, caffeine, theophylline, dopamine antagonists, and sedating antihistamines

Certain chronic diseases may lead to secondary RLS. These include:

• Peripheral neuropathy
• Chronic kidney failure
• Anemia or iron deficiency
• Diabetes
• Chronic obstructive pulmonary disease (COPD)

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

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 neurological exam will be done. The diagnosis is based mainly on your symptoms. There is no specific test for RLS.

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

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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 medications 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 More 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 medication 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.

Prevention

There are no current guidelines to prevent RLS because the cause is unknown.