Restless legs syndrome (RLS) is a disorder of the part of the nervous system that affects movements of the legs. Because it usually interferes with sleep, it also is considered a sleep disorder.
- People with RLS have strange sensations in their legs (and sometimes arms) and an irresistible urge to move their legs to relieve the sensations.
- The sensations are difficult to describe: they are not painful, but an uncomfortable, "itchy", "pins and needles", or "creepy crawly" feeling deep in the legs.
- The sensations are usually worse at rest, especially when lying in bed.
- The sensations lead to walking discomfort, sleep deprivation, and stress.
RLS affects about 8-10% of the US population. Men and women are affected equally. It may begin at any age, even in infants and young children. Most people who are affected severely are middle-aged or older.
The severity of RLS symptoms ranges from mild to intolerable. Symptoms get gradually worse over time in about two thirds of people with the condition and may be severe enough to be disabling. The symptoms are generally worse in the evening and night and less severe in the morning. While the symptoms are usually quite mild in young adults, by age 50 the symptoms cause severe nightly sleep disruption that leads to decreased alertness in the daytime.
RLS is often unrecognized or misdiagnosed. In many people the condition is not diagnosed until 10-20 years after symptoms begin. Once correctly diagnosed, RLS can often be treated successfully.
The International Restless Legs Syndrome Study Group described the following symptoms of restless legs syndrome (RLS):
- Strange itching, tingling, or "crawling" sensations occurring deep within the legs. These sensations sometimes occur in the arms.
- A compelling urge to move the limbs to relieve these sensations.
- Restlessness - Floor pacing, tossing and turning in bed, rubbing the legs.
- Symptoms may occur only with lying or sitting. Sometimes persistent symptoms occur that are worse with lying or sitting and better with activity. In very severe cases, the symptoms may not improve with activity.
Other symptoms of RLS include the following:
- Sleep disturbances and daytime sleepiness are very common.
- Involuntary, repetitive, periodic, jerking limbmovements occur either in sleep or while awake and at rest. These movements are called periodic leg movements of sleep orperiodic limb movement disorder. About 80% of people with RLS also have this condition.
In some people with RLS, the symptoms do not occur every night but come and go. These people may go weeks or months without symptoms (remission) before the symptoms return again.
The cause of restless legs syndrome (RLS) is not known.
- RLS was once thought to be due to disease in the blood vessels of the legs or in the nerves in the legs that control leg movement and sensation. Both of those suggestions have been rejected.
- RLS may be related to abnormalities inbrain chemicals (neurotransmitters) that help regulate muscle movements, or to abnormalities in the part of the central nervous system that controls automatic movements. Research is still being done in these areas.
RLS can be primary or secondary. Secondary RLS is caused by an underlying medical condition. Primary (idiopathic) RLS has no known underlying cause. Primary RLS is far more common than secondary RLS.
Many different medical conditions can cause secondary RLS.
- The two most common conditions are iron-deficiency anemia and peripheral neuropathy.
- Iron-deficiency anemia ("low blood") means low levels of hemoglobin, thesubstance in the blood that carriesoxygen and makes the blood appear red.
- Peripheral neuropathy is damage to the nerves of the arms and legs. Peripheral neuropathy has many causes. Diabetes is a common cause of peripheral neuropathy. Peripheral neuropathy causes numbness or lack of sensation, tingling, and pain in the affected areas.
- As many as 40% of pregnant women experience RLS symptoms. The symptoms usually fade within a few weeks after delivery.
- Certain medications or substances can cause RLS. Alcohol, caffeine, anticonvulsant drugs (eg, methsuximide, phenytoin), antidepressant drugs (eg, amitriptyline, paroxetine), beta-blockers, H2 blockers, lithium, and neuroleptics (antipsychotics) may cause RLS.
- Withdrawal from vasodilator drugs, sedatives, or imipramine can cause RLS symptoms.
- Cigarette smoking is linked to RLS.
- Other secondary causes include magnesium deficiency, vitamin B-12 deficiency, severe kidney disease (especially if dialysis is required), amyloidosis, Lyme disease, damage to the spinal nerves, rheumatoid arthritis, Sjogren syndrome, and uremia (kidney failure causing build up of toxins within the body).
The causes of primary RLS are unknown, but some of the risk factors are known.
- In 25-75% of cases, primary RLS seems to run in families. Such hereditary cases of RLS tend to start earlier in life and get worse more slowly than other cases.
- Psychiatric factors, stress, and fatigue can worsen the symptoms of RLS.
Other conditions linked to RLS:
- Parkinson disease.
- Stomach surgery.
- Chronic obstructive pulmonary disease (COPD).
- Some tumors.
- Chronic venous insufficiency or varicose veins.
- Myelopathy or myelitis (damage or inflammation of the spinal cord).
- Hypothyroidism or hyperthyroidism.
- Acute intermittent porphyria, a rare metabolic disease leading to accumulation of toxins.
- Peripheral cholesterol microemboli (fragments of cholesterol in the blood vessels).
Treatment of restless leg syndrome is first directed toward any underlying illness, if known.
- Blood testing to reveal underlying iron deficiency anemia may reveal the underlying cause.
- If varicose veins are thought to be the cause, then surgery to repair the circulation may be considered.
- Reduction or elimination of caffeine, nicotine, and alcohol from a person's diet can be very helpful.
- Stopping smoking can significantly diminish or prevent symptoms.
- Getting better sleep and exercise can help some persons affected by restless legs.
- Pregnant women who do not sleep well at night and other people with sleep disorders may develop RLS.
What medications are used to treat restless leg syndrome?
Medications used to treat restless leg syndrome include:
- natural supplements (such as iron),
- carbidopa-levodopa (Sinemet),
- opioids (such as hydrocodone, or tramadol [Ultram] for intermittent symptoms),
- carbamazepine (Tegretol, Tegretol XR, Equetro, Carbatrol),
- clonazepam (Klonopin),
- diazepam (Valium),
- triazolam (Halcion),
- temazepam (Restoril),
- baclofen (Lioresal),
- clonidine (Catapres, Catapres-TTS, Jenloga),
- gabapentin (Neurontin),
- ropinirole (Requip),
- pramipexole (Mirapex).