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Restless Legs Syndrome by Michelle Badash, MS

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

The sensations are typically worse during periods of inactivity and usually strongest at night. The symptoms are improved with activity. For this reason, people with RLS generally have insomnia , which may be severe.

Causes

The exact cause is unknown. RLS may occur for no identifiable reason. This is called primary RLS. 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 movement

Risk Factors

These factors increase your chance of developing RLS. Tell your doctor if you have any of these risk factors:

Family members with RLS
Pregnant—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 (diabetes)
- Chronic kidney failure
- Chronic venous insufficiency (varicose veins)
- Radiculopathy (nerve problem)
- Anemia
- Diabetes
- Cancer
- Chronic obstructive pulmonary disease
- Rheumatoid arthritis
- Congestive heart failure
Certain medications (eg, tricyclic antidepressants)
Withdrawing from certain drugs (eg, selective serotonin reuptake inhibitors [SSRIs], lithium, caffeine, dopamine antagonists, 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 be this feeling in the arms.
Symptoms typically get worse at night
A strong urge to relieve these uncomfortable feelings 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.

Diagnosis

The doctor will ask about your symptoms and medical history. She will also do a physical and neurologic exam. The diagnosis is based mainly on your symptoms. There is no specific test for RLS. But, tests to check for conditions that may trigger RLS include:

Blood tests to check iron levels and the functioning of the kidneys
Monitoring of leg activity during sleep ("sleep study", polysomnogram [PSG])
Study of leg muscles, such as electromyography (EMG) and nerve conduction studies

Nerves of the Leg

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.
Talk to your doctor about taking supplements that might be helpful, such as:
- Folate
- Iron
- Magnesium
- Vitamins B12 , C , and E
Refrain from 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 even eliminate symptoms:

Treatment for Severe Cases of RLS

Medication

Benzodiazepines
Dopaminergic agents (eg, ropinirole , pramipexole )—considered the most effective
Opioids
Anticonvulsants (eg, gabapentin )
Clonidine

Transcutaneous Electric Nerve Stimulation

During this treatment, electric stimulation is done to the affected area of the leg. This is usually done 15-30 minutes before bedtime to help reduce leg jerking.

Prevention

There are no guidelines for preventing RLS.

RESOURCES:

National Sleep Foundation http://www.sleepfoundation.org/
Restless Legs Syndrome 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. Accupuncture for restless legs syndrome. Cochrane Database of Systematic Reviews . 2008;CD006457.
Current Medical Diagnosis and Treatment . 45th ed. McGraw-Hill; 2006.
National Sleep Foundation website. Available at: http://www.sleepfoundation.org .
Restless legs syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Accessed May 27, 2008.
Restless Legs Syndrome Foundation website. Available at: http://www.rls.org/ .
Salas RE, Gamaldo CE, Allen RP. Update in restless legs syndrome. Curr Opin Neurol . 2010;23(4):401-6.
Shannon, Kathleen. Restless Legs Syndrome In: Gilman S, ed. MedLink Neurology. San Diego, CA: MedLink Corp. MedLink website. Available at: http://www.medlink.com . Accessed May 12, 2008.
Worldwide Education and Awareness for Movement Disorders website. Available at: http://www.wemove.org/ .

Last reviewed March 2011 by Rimas Lukas, MD

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