Restless Legs Syndrome

Definition

Restless legs syndrome (RLS), also called Willis-Ekbom Disease, is a neurological sleep disorder in which a person experiences an urge to move their legs or arms, and this urge is accompanied by or in response to uncomfortable sensations in the limbs. These uncomfortable sensations are often described as creeping, crawling, tingling, burning, or itching. Restless leg syndrome can affect just one side of the body, but it most often occurs in both sides at once; sometimes the pain can even migrate around.

The prevalence statistics of restless legs syndrome vary widely but range from 2 to 7.2 percent of the general population. The prevalence of restless legs syndrome increases with age, and women are more likely than males to have this condition. Restless legs syndrome is generally diagnosed after symptoms have persisted for at least three months.

Symptoms

People with restless legs syndrome experience uncomfortable feelings in their legs and have a strong desire to move their legs. This urge to move the legs is worse when the person is resting or inactive, and frequent movement of the legs occurs to relieve the urge. Symptoms are worse in the evening or at night, with some people only experiencing the symptoms at night. The symptoms of restless legs syndrome can make falling asleep difficult and may awaken a person from their sleep. As a result, restless legs syndrome is associated with daytime sleepiness, significant distress, and impairment in daily functioning. 

The symptoms of restless leg syndrome are unpredictable and tend to vary in severity and frequency, depending on the individual patient. They grow worse as the disorder progresses. Restless leg syndrome can also contribute to anxiety, depression, difficulty concentrating, and poor performance at work or school. It can affect someone’s personal relationships and can make traveling extremely challenging.

Causes

The cause of restless legs syndrome is not clear, but there are several factors that can influence the development of the condition. Risk factors include female gender, increasing age, genetic variants, and a family history of restless legs syndrome. Low levels of iron and abnormal regulation of dopamine may also play a role. Pregnant women are at greater risk for restless leg syndrome, particularly in the last trimester, but RLS symptoms generally clear up within 4 weeks of giving birth. Sleep deprivation and other sleep-related conditions, like sleep apnea, have been known to trigger episodes of restless legs syndrome. Additionally, symptoms can worsen if a person takes certain medications, such as anti-depressants and medications that block dopamine in the brain. 

Treatments

Treatment for restless legs syndrome depends on the severity of the condition. If symptoms are mild and do not cause a great deal of distress, behavioral changes such as increasing exercise, massaging the legs, or soaking the legs in water may be beneficial. Medication may be a necessary form of treatment if symptoms are more severe.  Medications approved by the U.S. Food and Drug Administration for restless legs syndrome include pramipexole, ropinirole, rotigotine patch, and gabapentin enacarbil. The symptoms of restless legs syndrome may also be associated with another medical condition (iron deficiency), in which case symptoms may improve once the underlying condition has been treated. 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Muth, C. C. (2017). Restless Legs Syndrome. Jama, 317(7), 780-780.

Last reviewed 02/28/2018