Restless legs syndrome

Overview

Restless Legs Syndrome (RLS), also known as Willis-Ekbom Disease, is a neurological disorder characterized by an uncontrollable urge to move the legs, usually due to uncomfortable sensations. This urge is most often experienced during periods of rest or inactivity, especially in the evening or at night, and is temporarily relieved by movement such as walking or stretching.

RLS can interfere with sleep, leading to daytime fatigue, difficulty concentrating, and a decreased quality of life. It affects both men and women, but is slightly more common in women. The condition can begin at any age, including in childhood, but the risk increases with age. RLS may occur on its own (primary RLS) or as a result of an underlying health condition (secondary RLS).

Causes

The exact cause of primary Restless Legs Syndrome is not fully understood, but research suggests a strong genetic component, especially in individuals who develop symptoms before the age of 40. Dysfunction in the dopaminergic pathways of the brain — which help regulate movement — is also thought to play a role.

Primary (Idiopathic) RLS:

• No identifiable underlying medical condition

Secondary RLS:

Secondary RLS is associated with other health conditions or factors, such as:

• Iron deficiency: Low iron levels can disrupt dopamine function

• Pregnancy: Especially in the third trimester; symptoms often resolve after delivery

• Chronic kidney disease: Often linked to severe RLS symptoms

• Peripheral neuropathy: Caused by diabetes, alcohol abuse, or other nerve-damaging conditions

• Parkinson’s disease: May coexist with or exacerbate RLS

• Medications: Certain antihistamines, antipsychotics, antidepressants, and anti-nausea drugs may trigger or worsen RLS

Symptoms

The hallmark symptom of RLS is an overwhelming urge to move the legs, usually accompanied by uncomfortable sensations. Symptoms typically worsen at rest and improve with movement. They are most intense during the evening and night, which can significantly affect sleep quality.

Common Symptoms:

• Unpleasant sensations described as creeping, crawling, tingling, burning, itching, or aching

• Symptoms triggered or worsened by long periods of inactivity (e.g., sitting, lying down)

• Temporary relief with movement (walking, stretching, massaging)

• Symptoms that are worse in the evening or at night

• Difficulty falling or staying asleep due to leg discomfort

• Daytime fatigue or sleepiness due to disrupted sleep

Periodic Limb Movements (PLMS):

Many people with RLS also experience periodic limb movements during sleep — involuntary, repetitive jerking of the legs or arms, which can further disturb sleep.

Diagnosis

There is no specific test for RLS; diagnosis is based primarily on clinical criteria and patient history. A thorough medical evaluation is essential to distinguish RLS from other conditions with similar symptoms, such as neuropathy, arthritis, or nocturnal leg cramps.

Diagnostic Criteria (According to the International Restless Legs Syndrome Study Group):

• An uncontrollable urge to move the legs, often accompanied by unpleasant sensations

• Symptoms begin or worsen during rest or inactivity

• Symptoms are relieved by movement

• Symptoms are worse in the evening or night

• Symptoms are not solely explained by another condition

Additional Diagnostic Tools:

• Blood tests: To check for iron deficiency, kidney function, or vitamin deficiencies

• Polysomnography (sleep study): May be recommended if periodic limb movements during sleep are suspected

• Neurological evaluation: To rule out other disorders

Treatment

Treatment for RLS aims to relieve symptoms, improve sleep, and address any underlying causes. The approach may involve lifestyle modifications, correcting nutritional deficiencies, and medication.

1. Lifestyle and Home Remedies:

• Establish a regular sleep schedule

• Avoid caffeine, nicotine, and alcohol, especially in the evening

• Engage in moderate regular exercise (but not too close to bedtime)

• Leg massage, warm baths, or heating/cooling pads for symptomatic relief

• Reduce screen time before sleep

2. Nutritional Support:

• Iron supplementation: If ferritin levels are low (typically below 50 ng/mL)

• Supplementation with magnesium, folate, or vitamin B12 if deficient

3. Medications:

When lifestyle changes are insufficient, medications may be prescribed. Options include:

• Dopamine agonists: Such as pramipexole, ropinirole, or rotigotine patch

• Gabapentin or pregabalin: Useful for painful symptoms or if associated with neuropathy

• Benzodiazepines: Such as clonazepam for sleep improvement (use with caution due to dependency risk)

• Opioids: In severe, treatment-resistant cases (lowest effective dose only)

4. Treating Secondary RLS:

If RLS is caused by an underlying condition (e.g., iron deficiency, kidney disease), treating the root cause often alleviates symptoms.

Prognosis

Restless Legs Syndrome is a chronic condition that can significantly impact quality of life due to sleep disruption and fatigue. While it is not life-threatening, it can interfere with work, relationships, and mental health if left untreated.

For many individuals, symptoms can be effectively managed with a combination of lifestyle changes and medication. Early recognition and appropriate treatment improve long-term outcomes. In secondary RLS, symptoms often improve or resolve when the underlying cause is addressed.

Ongoing research continues to explore the genetic and neurological basis of RLS, which may lead to more targeted therapies in the future.