Restless Legs Syndrome
Overview
Restless legs syndrome (RLS) is a condition that causes an uncontrollable urge to move your legs, usually because of an uncomfortable sensation. It typically happens in the evening or nighttime hours when you’re sitting or lying down. Moving eases the unpleasant feeling temporarily.
Restless legs syndrome, also known as Willis-Ekbom disease, can begin at any age and generally worsens as you age. It can disrupt sleep, which interferes with daily activities.
Causes
Often, there’s no known cause for RLS. Researchers suspect the condition may be caused by an imbalance of the brain chemical dopamine, which sends messages to control muscle movement.
Heredity
Sometimes RLS runs in families, especially if the condition starts before age 40. Researchers have identified sites on the chromosomes where genes for RLS may be present.
Pregnancy
Pregnancy or hormonal changes may temporarily worsen RLS signs and symptoms. Some women get RLS for the first time during pregnancy, especially during their last trimester. However, symptoms usually disappear after delivery.
Risk factors
RLS can develop at any age, even during childhood. The disorder is more common with increasing age and more common in women than in men.
RLS usually isn’t related to a serious underlying medical problem. However, it sometimes accompanies other conditions, such as:
- Peripheral neuropathy. This damage to the nerves in your hands and feet is sometimes due to chronic diseases such as diabetes and alcoholism.
- Iron deficiency. Even without anemia, iron deficiency can cause or worsen RLS. If you have a history of bleeding from your stomach or bowels, experience heavy menstrual periods, or repeatedly donate blood, you may have iron deficiency.
- Kidney failure. If you have kidney failure, you may also have iron deficiency, often with anemia. When kidneys don’t function properly, iron stores in your blood can decrease. This and other changes in body chemistry may cause or worsen RLS.
- Spinal cord conditions. Lesions on the spinal cord as a result of damage or injury have been linked to RLS. Having had anesthesia to the spinal cord, such as a spinal block, also increases the risk of developing RLS.
Symptoms
The chief symptom is an urge to move the legs. Common accompanying characteristics of RLS include:
- Sensations that begin after rest. The sensation typically begins after you’ve been lying down or sitting for an extended time, such as in a car, airplane or movie theater.
- Relief with movement. The sensation of RLS lessens with movement, such as stretching, jiggling your legs, pacing or walking.
- Worsening of symptoms in the evening. Symptoms occur mainly at night.
- Nighttime leg twitching. RLS may be associated with another, more common condition called periodic limb movement of sleep, which causes your legs to twitch and kick, possibly throughout the night, while you sleep.
Diagnosis & Treatment
Initial Diagnosis
Your doctor will take your medical history and ask for a description of your symptoms. A diagnosis of RLS is based on the following criteria, established by the International Restless Legs Syndrome Study Group:
- You have a strong, often irresistible urge to move your legs, usually accompanied by uncomfortable sensations.
- Your symptoms start or get worse when you’re resting, such as sitting or lying down.
- Your symptoms are partially or temporarily relieved by activity, such as walking or stretching.
- Your symptoms are worse at night.
- Symptoms can’t be explained solely by another medical or behavioral condition.
Advanced Diagnosis
Your doctor may conduct a physical and a neurological exam. Blood tests, particularly for iron deficiency, may be ordered to rule out other possible causes for your symptoms.
In addition, your doctor may refer you to a sleep specialist. This may involve an overnight stay at a sleep clinic, where doctors can study your sleep if another sleep disorder such as sleep apnea is suspected. However, a diagnosis of RLS usually doesn’t require a sleep study.
Initial Treatment
Lifestyle and home remedies
Making simple lifestyle changes can help alleviate symptoms of RLS:
- Try baths and massages. Soaking in a warm bath and massaging your legs can relax your muscles.
- Apply warm or cool packs. Use of heat or cold, or alternating use of the two, may lessen your limb sensations.
- Establish good sleep hygiene. Fatigue tends to worsen symptoms of RLS, so it’s important that you practice good sleep hygiene. Ideally, have a cool, quiet, comfortable sleeping environment; go to bed and rise at the same time daily; and get at least seven hours of sleep nightly.
- Exercise. Getting moderate, regular exercise may relieve symptoms of RLS, but overdoing it or working out too late in the day may intensify symptoms.
- Avoid caffeine. Sometimes cutting back on caffeine may help restless legs. Try to avoid caffeine-containing products, including chocolate, coffee, tea and soft drinks, for a few weeks to see if this helps.
- Consider using a foot wrap. A foot wrap specially designed for people with RLS puts pressure under your foot and may help relieve your symptoms.
Advanced Treatment
Sometimes, treating an underlying condition, such as iron deficiency, greatly relieves symptoms of RLS. Correcting an iron deficiency may involve receiving iron supplementation orally or intravenously. However, take iron supplements only with medical supervision and after your doctor has checked your blood-iron level.
Medications
Several prescription medications, most of which were developed to treat other diseases, are available to reduce the restlessness in your legs. These include:
Medications that increase dopamine in the brain. These medications affect levels of the chemical messenger dopamine in your brain. Ropinirole (Requip), rotigotine (Neupro) and pramipexole (Mirapex) are approved by the Food and Drug Administration for the treatment of moderate to severe RLS.
Short-term side effects of these medications are usually mild and include nausea, lightheadedness and fatigue. However, they can also cause impulse control disorders, such as compulsive gambling, and daytime sleepiness.
- Drugs affecting calcium channels. Certain medications, such as gabapentin (Neurontin, Gralise), gabapentin enacarbil (Horizant) and pregabalin (Lyrica), work for some people with RLS.
- Opioids. Narcotic medications can relieve mild to severe symptoms, but they may be addicting if used in high doses. Some examples include tramadol (Ultram, ConZip), codeine, oxycodone (Oxycontin, Roxicodone, others) and hydrocodone (Hysingla ER, Zohydro ER).
- Muscle relaxants and sleep medications. These drugs help you sleep better at night, but they don’t eliminate the leg sensations, and they may cause daytime drowsiness. These medications are generally only used if no other treatment provides relief.
It may take several trials for you and your doctor to find the right medication or combination of medications that work best for you.
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Primary Source: Mayo Clinic