Restless legs syndrome (RLS) is a neurological disorder characterized by unpleasant sensations in the legs and an almost uncontrollable urge to move when at rest in an effort to relieve these feelings.
Some researchers estimate that RLS affects as many as 12 million Americans. However, other researchers believe that the number of people affected by RLS is much greater because RLS can be easily confused with other conditions. Therefore, RLS is under-diagnosed and, in some cases, misdiagnosed. Some people with RLS do not seek medical attention because they believe that they will not be taken seriously, that their symptoms are too mild, or that their condition is not treatable. And, in some cases, doctors wrongly attribute the symptoms of RLS to nervousness,
insomnia, stress,
arthritis, muscle cramps, or aging.
RLS occurs in both genders, although the incidence may be slightly higher in women. Although the syndrome may begin at any age, even as early as infancy, most patients who are severely affected are middle-aged or older.
Common RLS symptoms include:
- Unpleasant or uncomfortable feelings or sensations in the legs often described as creeping, crawling, tingling, pulling, or painful, and often producing an irresistible urge to move the legs. These feelings usually occur deep inside the leg, between the knee and ankle. In rare cases, they can also occur in the feet, thighs, arms, and hands. Most of these feelings involve both sides of the body, although they can occur on just one side of the body. These symptoms usually occur later in the day, the evening, and during the night.
- Leg discomfort that occurs and gets worse when lying down or sitting for long periods of time. Long car trips, sitting in the movies, long-distance flights, and having a cast on can trigger RLS.
- The need for constant movement of the legs (or other affected body parts) to lessen discomfort. People may pace the floor, move their legs when sitting, and toss and turn in bed.
- Having uncontrollable leg and sometimes arm movements when sleeping.
- Trouble falling asleep or staying asleep.
- Sleepiness or tiredness during the day.
People who have both RLS and an associated condition (such as
diabetes, neuropathy, or
Parkinson's disease) tend to develop more severe symptoms rapidly.
(Click RLS Symptoms for more information.)
In most cases, the cause of RLS is unknown (referred to as idiopathic). A family history of the condition is seen in approximately 50 percent of idiopathic cases, which suggests a genetic form of the disorder. People with familial RLS tend to be younger when symptoms begin and they tend to have a slower progression of the condition.
In other cases, RLS appears to be related to the following factors or conditions:
- People with low iron levels or anemia may be prone to developing RLS. After correcting iron levels or anemia, patients may see a reduction in symptoms.
- Chronic diseases such as kidney failure, diabetes, Parkinson's disease, and peripheral neuropathy are associated with RLS. Treating the underlying condition often provides relief from RLS symptoms.
- Some pregnant women experience RLS, especially in their last trimester. However, symptoms usually disappear within four weeks after delivery.
- Certain medications such as antinausea drugs (prochlorperazine or metoclopramide), antiseizure drugs (phenytoin or droperidol), antipsychotic drugs (haloperidol or phenothiazine derivatives), and some cold and allergy medications may aggravate symptoms. Patients should talk with their physician about the possibility of changing medications.
- Research scientists also have found that caffeine, alcohol, and tobacco may aggravate or trigger symptoms in patients who are predisposed to developing RLS. Some studies have shown that a reduction or complete elimination of such substances may relieve symptoms, although it remains unclear whether elimination of such substances can prevent RLS symptoms from occurring.
There are no tests available to detect RLS. Therefore, RLS can be hard to diagnose because it is easily confused with other conditions. In order to make an RLS diagnosis, your doctor will:
- Take a complete medical history
- Do a complete physical examination
- Order other tests.
The diagnosis of RLS usually requires the following four conditions to be present:
- An urge to move the legs due to an unpleasant feeling in the legs
- Leg pain that begins or worsens when you are at rest or not moving around frequently
- Leg pain that is partly or completely relieved by continuous movement (such as walking or stretching)
- Leg pain that is worse in the evening and at night, or only occurs in the evening or at night.
Despite these efforts to establish standard criteria, the clinical diagnosis of RLS is difficult to make because doctors have to rely on a patient's:
- Description of symptoms
- Information from their medical history, including past medical problems
- Family history
- Current medications.
The diagnosis of RLS is especially difficult with children because doctors rely heavily on the child's explanations of symptoms, which can be difficult for a child to describe. Children with RLS are sometimes misdiagnosed with growing pains or attention deficit disorder.
(Click RLS Detection for more information about diagnosing RLS.)
There is no cure for RLS. However, there may be an underlying disease or condition, such as peripheral neuropathy or
diabetes, causing RLS. Treating the underlying disease can relieve many of the
symptoms of restless legs syndrome.
For people who have
restless legs syndrome and do not have an underlying disease or condition, treatment will focus on symptom relief. For those with mild to moderate symptoms, lifestyle changes are often suggested, including:
- Reducing or stopping the use of caffeine, alcohol, and tobacco products
- Taking supplements to increase iron, folate, and magnesium in the body
- Developing and keeping a regular sleep schedule
- Getting moderate exercise
- Taking hot or cold baths, rubbing or massaging the legs or other affected body parts, or using a heating pad or ice pack.
Healthcare providers may prescribe medication for RLS symptom relief, which can include:
- Benzodiazepines
- Dopaminergic agents
- Opioids
- Antiseizure medication.
Left untreated, RLS can cause exhaustion and daytime fatigue. Many people with RLS report that their job, personal relations, and activities of daily living are strongly affected as a result of their exhaustion.
RLS is generally a lifelong condition for which there is no cure. Current RLS treatments can decrease symptoms and increase periods of restful sleep. In addition, some patients with RLS have remissions, which are periods in which their symptoms decrease or disappear for days, weeks, or months, although symptoms usually reappear. A diagnosis of RLS does not indicate the beginning of any other neurological disease.
RLS and Periodic Limb Movement Disorder
More than 80 percent of people with RLS also experience a more common condition known as periodic limb movement disorder (PLMD). PLMD is also called periodic limb movement in sleep (PLMS).
Periodic limb movement disorder is characterized by involuntary leg twitching or jerking movements during sleep that typically occur every 10 to 60 seconds, sometimes throughout the night. The symptoms cause repeated awakening and severely disrupted sleep. Unlike RLS, the movements caused by PLMD are involuntary and people have no control over them. Although many patients with RLS also develop PLMD, most people with PLMD do not experience RLS. The cause of PLMD is unknown.
(Click Periodic Limb Movement Disorder for more information.)
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