Restless Legs Syndrome

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

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

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
• 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.

• 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 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.

Prevention

There are no guidelines for preventing RLS.