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Restless Legs Syndrome

• Definition of Restless Legs Syndrome
• Description of Restless Legs Syndrome
• Causes and Risk Factors of Restless Legs Syndrome
• Symptoms of Restless Legs Syndrome
• Diagnosis of Restless Legs Syndrome
• Treatment of Restless Legs Syndrome
• What Questions To Ask Your Doctor About Restless Legs Syndrome

Definition of Restless Legs Syndrome

Restless legs syndrome (RLS), also known as Ekbom’s syndrome, refers to an unpleasant feeling in the legs that typically occurs in the evening, primarily when an individual is at rest. These sensations compel the person to move their legs to get relief, only to have the symptoms recur. These difficult to describe sensations in the legs are experienced as “tingling”, “itching”, “creeping crawling”, and are occasionally painful. Infrequently, RLS symptoms occur in the face and arms.

Description of Restless Legs Syndrome

About 10 percent of people between the ages of 30 and 79 have restless leg syndrome (RLS) at least five times per month. RLS affects individuals of all ages, with a more common occurrence in women. Its prevalence tends to increase with age and it appears to be occur more commonly in people of European and North American background.

People with RLS have difficulty falling and staying asleep and suffer from chronic sleep deprivation, which can lead to fatigue, depression, and an increased risk of accidents due to slowed reflexes.

About 80% of people with RLS are also affected by a similar condition that occurs during sleep, known as periodic limb movement disorder. This disorder is characterized by repetitive limb twitching during sleep (as opposed to RLS which occurs when awake), which can also disrupt sleep.

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Causes and Risk Factors of Restless Legs Syndrome

In many cases, RLS is a primary disorder, meaning that it is unrelated to other medical conditions, but it also can be associated with a variety of underlying medical disorders. The exact cause of RLS is unknown. In previous years, research has centered on the dopamine supply in the brain, but newer research suggests that it may actually have more to do with the iron levels in the brain. Interestingly, dopamine is involved in the processing of the brain’s iron stores and therefore may have an affect on RLS. In fact, the treatment of RLS revolves around dopamine-related drugs.

Primary RLS seems to have a genetic basis. Secondary RLS occurs in conditions such as pregnancy, iron deficiency, diabetes mellitus, kidney disease, neuropathy, spinal disease, and Parkinson’s disease. Strikingly, many of these conditions are characterized by inability to effectively use iron in the body.

Symptoms of Restless Legs Syndrome

Symptoms can occur during the day or night when sufferers are trying to sleep (nighttime symptoms are referred to as periodic leg movements in sleep). All patients who have day-time episodes also have nighttime discomfort, but the reverse is not true.

Episodes can last from a few minutes to several hours, and typically occur many times during the day or night, especially when sufferers relax or are trying to fall asleep (although they are not the same as "night starts," the sudden, jerky movements that sometimes occur when falling asleep). Symptoms are worse at the end of the day when the patient is either seated or in bed.

Regardless of when an episode strikes or how often it lasts, the only way to obtain relief is to get up and walk around - although symptoms usually resume once patients sit or lie down again. In addition to walking, those with RLS can make certain that adjustments to keep their daily routines as normal as possible.

Diagnosis of Restless Legs Syndrome

The diagnosis is made based on the medical history including symptoms and the physical examination. A sleep study is not necessary to diagnose restless legs syndrome, but periodic limb movement disorder can only be assessed with an overnight sleep study. Also, if symptoms of RLS are present, iron deficiency needs to be ruled out with blood tests.

Treatment of Restless Legs Syndrome

Treatment for RLS includes pharmacologic and non-pharmacologic methods. Often symptoms respond to warm baths, hot packs, stretching exercises, walking, or massaging the legs. As noted earlier, iron deficiency has been associated with RLS, so iron pills will often be prescribed. In addition, many medications can lead to some improvement in the symptoms of RLS and the exact type of medication is usually dictated by the frequency of the symptoms. The symptom occurrence can be divided into intermittent, daily, and refractory. For intermittent symptoms, a medication that contains dopamine (levodpa/carbidopa--typically a treatment for Parkinson’s disease) is usually used on an as needed basis. For daily symptoms, two medications, pramipexole (Mirapex) and ropinirole (Requip) that increase the amount of dopamine in the brain are used on a daily basis. Other medications such as benzodiazepines and opiates help induce sleep and often improve the uncomfortable sensations of RLS. When symptoms persist some anti-seizure medications, such as gabapentin (Neurontin), can be added.

An interesting phenomenon, called augmentation, can occur in those taking dopamine-related medications. Augmentation is when RLS symptoms start earlier in the day, symptom intensity increases, or spread to the arms. This is often managed with medication additions and adjustments.

What Questions To Ask Your Doctor About Restless Legs Syndrome

What are the causes of restless legs syndrome?

Is there evidence of low dopamine levels?

Would anti-parkinsonian drugs help?

Is the use of pain medications indicated?

What are the side effects of these drugs?