Restless Leg Syndrome

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Restless Legs Syndrome (RLS) is a sensory disorder causing an almost irresistible urge to move the legs. Restless legs syndrome may affect as many as 12 million people in the United States, or roughly 10-15% of white adults.[1]

The urge to move is usually due to unpleasant feelings in the legs that occur when at rest. People with RLS use words such as creeping, crawling, tingling, or burning to describe these feelings. Moving the legs eases the feelings, but only for a while. The unpleasant feelings may also occur in the arms. Often RLS is accompanied by poor sleep and jerking movements of the legs while asleep.


Contents

Types of RLS

Restless leg syndrome has two forms: primary and secondary RLS.

Primary RLS

This is the most common type of RLS. It is also called idiopathic RLS, which means that the cause is not known. A good deal of research has studied this condition recently, and preliminary studies suggest that it can be a genetic disorder of altered brain chemistry. Primary RLS, once it starts, usually becomes a lifelong condition. Over time, symptoms tend to get worse and occur more often, especially if they began in childhood or early in adult life. In milder cases, there may be long periods of time with no symptoms, or symptoms may last only for a limited time.[2]

Secondary RLS

This type of RLS is caused by another disease or condition or, sometimes, from taking certain medicines. Symptoms usually go away when the disease or condition improves, or if the medicine is stopped. Conditions associated with RLS include the following:[2]

Periodic limb movement disorder

Most people with RLS also have a condition called Periodic Limb Movement Disorder (PLMD). PLMD is a condition in which a person’s legs twitch or jerk uncontrollably about every 10 to 60 seconds. This usually happens during sleep. These movements cause repeated awakenings that disturb or reduce sleep. PLMD usually affects the legs but can also affect the arms.

Signs and Symptoms

As stated above, RLS is typified by the irresistible urge to move the legs and a feeling of intense discomfort when the legs are held still. RLS can make it hard to fall asleep and stay asleep. People with RLS often don’t get enough sleep and may feel tired and sleepy during the day. This fatigue impairs several functions of daily living:


Sleep pattern of a Restless Legs Syndrome patient (red) vs. a healthy sleep pattern (blue). Source: Wikimedia Commons.
  • Concentrate, making it harder to learn and remember things
  • Work
  • Take part in family and social activities
  • Many other daily activities

Not getting enough sleep can also cause depression and mood swings.

Below are the symptoms of RLS:

Urge to move

RLS gets its name from the urge to move the legs when sitting or lying down. This urge is due to unpleasant feelings in the legs that are relieved by movement. Typical movements that help alleviate RLS include the following:

  • Pacing and walking
  • Jiggling the legs
  • Stretching and flexing
  • Tossing and turning
  • Rubbing the legs

Unpleasant feelings

The urge to move the legs usually is due to unpleasant feelings in the legs. These unpleasant feelings are often described as the following:

  • Creeping
  • Crawling
  • Pulling
  • Itching
  • Tingling
  • Burning
  • Aching
  • Painful
  • Hard to describe

Children may describe RLS symptoms differently than adults.

The unpleasant feelings in RLS usually occur in the lower leg (calf). But the feelings can occur at any place between the thigh and the ankle and also in the arm. The feelings are worse when lying down, sitting for a long period of time, or during the evening or night. The unpleasant feelings also make falling asleep or maintaining sleep difficult, and typically are alleviated or lessened by movement.

Classifying RLS as mild, moderate, or severe is dependent on several factors:

  • The degree of discomfort in the legs and arms
  • The degree of relief obtained by moving around
  • The degree of sleep disturbance and resulting daytime sleepiness
  • The frequency of symptoms
  • The degree to which the disorder affects a patient’s day to day life

Duration and Severity

RLS symptoms tend to get worse over time. They may begin in childhood and develop slowly over several years. People with early symptoms are more likely to have other family members with RLS than people who develop RLS later in life.

Symptoms tend to worsen faster when RLS occurs later in life. RLS that occurs later in life is also more likely to result from an underlying condition or illness than RLS that occurs early in life.

People with mild symptoms may only notice them when they are still or awake for a long time, such as on a long airplane trip.

Diagnosis

Primary RLS is a clinical diagnosis, which means it is diagnosed in patients who present with a story suggestive of RLS and do not have an alternative condition which can explain their symptoms. Primary RLS has a completely normal physical exam.

Secondary RLS requires the diagnosis of one or more condition that predispose RLS, and examination findings which support the alternative diagnoses.

Four symptoms indicate primary or secondary RLS:

  • The urge to move the legs is present and associated with an unpleasant sensation
  • The urge to move the legs worsens with inactivity
  • The unpleasant sensation in the legs is relieved partially or completely by movement
  • The urge to move the legs must be worse at night than during the day, at least at the start of the disease

Chances of Developing Restless Legs Syndrome

RLS is an exceedingly common disorder, affecting as many as 12 million people in the USA to a greater or lesser extent. Certain types of people are at higher risk than others:

Gender

RLS affects both men and women. The disorder occurs more often in women than in men.

Age

The number of cases of RLS increases with age. Many people with RLS are diagnosed in middle age. But in up to two out of every five cases, the symptoms of RLS begin before the age of 20. People who develop RLS early in life usually have a family history of the disorder.

Race/ethnic group

RLS can affect people of any race or ethnic group. The disorder is more common in persons of northern European descent.

Pregnancy

RLS is common in pregnant women. It usually occurs during the last three months of pregnancy and usually improves or disappears within a few weeks after delivery. However, some women may continue to have symptoms after giving birth or may develop RLS again later in life.

Medication-induced RLS

Below is a list of some of the types of medicines that can cause RLS:

RLS symptoms usually go away when the medicine is stopped.

Lifestyle choices

Certain lifestyle choices can trigger RLS symptoms or make them worse. This includes ingestion of caffeine and alcohol, or smoking tobacco.

Prevention

Primary RLS is often hereditary and remains incompletely understood, hence there are no known ways to prevent it. Secondary RLS can be prevented by avoiding those conditions which predispose to it, which includes treating iron deficiency anemia (and correcting its cause), preventing diabetes with diet and exercise, and possibly by avoiding excessive caffeine intake.

Treatment

RLS can be unpleasant and uncomfortable. However, there are some simple self-care approaches and lifestyle changes that can help in mild cases. RLS symptoms often improve with medical treatment. Research is ongoing to better understand the causes of RLS and to develop better treatments.

The treatment of RLS has several goals:

  • Relieve symptoms
  • Increase the amount and quality of sleep
  • Treat or correct any underlying condition that may cause RLS

Types of treatment of RLS include lifestyle changes and other nondrug treatments, as well as medicines.

Lifestyle changes

Lifestyle changes can improve and relieve symptoms of RLS. Lifestyle changes may be the only treatment needed for mild RLS. Some lifestyle changes that may help improve RLS include the following:

  • Avoidance of things that can make symptoms of RLS worse:
    • Tobacco
    • Alcohol
    • Caffeine—Chocolate, coffee, tea, and some soft drinks contain caffeine. Although it may seem to help overcome daytime sleepiness, caffeine usually only delays or masks RLS symptoms, and often makes them worse.
    • Some medicines—Some types of over-the-counter and prescription medicines can also make RLS symptoms worse. These include the majority of antidepressants, antinausea medicines, antipsychotics, and antihistamines.
  • Adoption of good sleep habits:
    • Maintenance of a cool, quiet, and comfortable sleeping area.
    • Using the bedroom for sleeping, not for watching TV or using computers or cell phones.
    • Going to bed every night at the same time and waking up at the same time every morning. Some people with RLS find it helpful to go to bed later in the evening and get up later in the morning.
  • Follow a program of moderate exercise.

Other activities that also may help relieve symptoms include the following:

  • Walking or stretching
  • Taking a hot or cold bath
  • Massaging the leg or arm
  • Using heat or ice packs

Medicines

Medicines can help relieve some symptoms of RLS. Doctors prescribe medicines to treat RLS in people with clearly defined symptoms, and whose symptoms cannot be controlled by lifestyle and nondrug treatments.

No single medicine is helpful in all persons with RLS. It may take several changes in medicines and dosages to find the best approach. Sometimes, a medicine will work for a while and then stop working.

Some medicines may not be safe for pregnant women.

Specific medicines

Medicines used to treat Parkinson’s disease also are used to treat RLS. Even though these medicines help reduce RLS symptoms, and secondary RLS may be associated with Parkinson’s disease, RLS is not a form of Parkinson’s disease. The medicines help reduce the amount of motion in the legs. Several of these drugs are listed below:[3]

  • Levodopa
    • Is best used to treat mild cases of RLS
    • Is short-acting
    • Works for a while but does not work long term in most people
  • Dopamine agonists (pergolide, pramipexole, and ropinirole)
    • Are used to treat moderate and severe cases of RLS
    • Are used to treat mild cases of RLS if levodopa stops working
    • Are long-acting

The U.S. Food and Drug Administration recently approved ropinirole to treat moderate to severe RLS.

Other medicines may be used to treat RLS, including the following:

  • Narcotics (strong pain-relieving medicines):
    • Used most often when symptoms are severe
    • May be used in people who don’t respond to dopamine agonists
  • Benzodiazepines (sedatives):
    • Help with falling asleep
    • May cause daytime sleepiness
    • Are not recommended for people with sleep apnea and for older persons
  • Anticonvulsants (medicines used to treat epilepsy: gabapentin, carbamazepine, and valproate). These types of medicines are considered when dopamine agonists fail. They are most effective in persons with daytime and evening symptoms, as well as sleep-onset symptoms, and in those who describe the unpleasant feelings in the legs as painful.
  • Iron supplements, if iron deficiency appears to be contributing to RLS. Iron supplements should only be used if recommended by a doctor.

Living With Restless Legs Syndrome

Restless legs syndrome (RLS) is often a lifelong condition. The symptoms may come and go frequently or disappear completely for long periods of time. They may get worse over time. Lifestyle changes and medicines can help control and relieve the symptoms of RLS. For severe symptoms, ongoing medicines may be needed.

RLS that occurs during pregnancy usually improves or disappears within a few weeks after delivery.

Clinical Trials

For a list of American government-sponsored clinical trials researching Restless Legs Syndrome, click here.

References

  1. Phillips B, Young T, Finn L, Asher K, Hening WA, Purvis C. Epidemiology of restless legs symptoms in adults. Arch Intern Med 2000;160: 2137-41. Full Text
  2. 2.0 2.1 Trenkwalder C, Seidel VC, Gasser T, et al. Clinical symptoms and possible anticipation in a large kindred of familial restless legs syndrome. Mov Disord. 1996;4:389–94. Full Text
  3. Cotter PE and O'Keeffe ST. Restless leg syndrome: is it a real problem? Ther Clin Risk Manag. 2006 December; 2(4): 465–475. Full Text

External Links

National Heart Lung and Blood Institute:

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