Restless leg syndrome (RLS), also known as Willis-Ekbom disease, is a common condition of the nervous system that causes an overwhelming, irresistible urge to move the legs. The urge to move is usually due to unpleasant sensations in the legs that occur when at rest. People with RLS use words such as creeping, crawling, tingling, or burning to describe these feelings.
Moving the legs eases the unpleasant feelings temporarily. Symptoms tend to be worse in the evening and night. RLS can make it hard to fall asleep and stay asleep.
While there is no cure for RLS, treatment is aimed at easing symptoms. Treatment options include lifestyle changes, medication, and other therapies. Finding the right treatment plan may take some time.
What causes restless leg syndrome?
The exact cause of RLS is unknown. However, it appears to involve a malfunction of the basal ganglia and related dopamine pathways in the brain. The basal ganglia help control movement and relay messages between the brain and muscles. When these pathways are impaired or dopamine levels are low, symptoms of RLS can occur.
RLS has also been associated with the following risk factors:
- Family history. RLS tends to run in families. Having a close relative with RLS increases your risk.
- Chronic diseases. RLS is associated with kidney failure, peripheral neuropathy, Parkinson’s disease, diabetes, thyroid problems, anemia, and rheumatoid arthritis.
- Pregnancy. Some women experience RLS during pregnancy, especially in the last trimester.
- Medications. Certain prescription and over-the-counter medicines can worsen symptoms.
- Alcohol, nicotine, and caffeine. These substances can make symptoms worse for some people.
- Sleep deprivation. Fatigue can aggravate RLS symptoms.
- Iron deficiency. People with low iron levels may be more prone to RLS.
What are the symptoms of restless leg syndrome?
The primary symptom of RLS is an overwhelming urge to move the legs when they are at rest. Symptoms typically occur in the late afternoon or evening hours and are less common in the morning.
The urge to move is usually accompanied by uncomfortable sensations in the legs such as:
- Crawling, creeping, pulling, or tingling under the skin
- Aching in the legs or arms
- Itching of the legs or arms
- Restlessness or inability to sit still
- Urge to move or involuntary jerking of legs or arms
Symptoms can affect the arms but are more commonly felt in the legs or feet. Moving and stretching can provide temporary relief. Walking, stretching, massaging the legs, or taking a hot or cold bath can help lessen sensations.
In more severe cases, RLS symptoms can also include:
- Involuntary jerking of the legs or arms when resting or sleeping
- Daytime sleepiness and fatigue from lack of quality sleep
- Difficulty concentrating and decreased mood or motivation
Symptoms tend to be worse in the evening and at night when a person is resting or sitting for long periods. They improve temporarily with movement. RLS can make it very difficult to fall asleep and stay asleep.
How is restless leg syndrome diagnosed?
There is no specific test for RLS. A doctor will diagnose RLS based on a patient’s symptoms, medical history, physical exam, and tests to rule out other conditions. Diagnosis requires all of the following:
- An urge to move the legs, usually due to uncomfortable sensations
- Symptoms that begin or worsen during rest
- Temporary relief from movement
- Worsening of symptoms in the evening or at night
The doctor will also check for underlying conditions associated with RLS, such as peripheral neuropathy, arthritis, diabetes, and iron deficiency. Blood tests can check for iron levels and other vitamin and mineral deficiencies.
Other conditions can cause similar symptoms as RLS, so the doctor may order tests to rule these out. These may include:
- Nerve conduction study
- Electromyography
- Nocturnal polysomnography
- MRI scan of the brain and spine
Keeping a sleep diary for 1-2 weeks before seeing the doctor can help identify symptoms and any sleep disturbances.
What is the treatment for restless leg syndrome?
Treatment for RLS focuses on relieving symptoms. Finding the right treatment plan may take some trial and error. Options include:
Lifestyle changes and home remedies
- Take warm baths, use heating pads or ice packs, massage legs, and perform gentle stretches
- Establish regular sleep hours and good sleep practices
- Reduce caffeine, alcohol, and tobacco
- Get moderate daily exercise but avoid exhausting activities close to bedtime
- Keep rooms cool while sleeping
Medications
If symptoms persist, medications may be prescribed, including:
- Dopaminergic drugs such as pramipexole or ropinirole
- Benzodiazepines such as clonazepam
- Opioids such as oxycodone or tramadol
- Anticonvulsants such as gabapentin
Medical procedures
If symptoms are severe and do not improve with other treatments, procedures may include:
- Pneumatic compression devices that apply pressure to the legs
- Repetitive transcranial magnetic stimulation (rTMS)
- Implantable nerve stimulators
What is the first line treatment for restless leg syndrome?
The first line treatment for restless leg syndrome depends on the severity of symptoms:
Mild RLS
For mild cases, the first line treatment involves lifestyle changes and home remedies:
- Take warm baths, massage, and stretch legs
- Use heating pads or ice packs
- Follow good sleep habits like avoiding caffeine in the evenings
- Reduce alcohol and tobacco use
- Get moderate daily exercise but not too close to bedtime
Making dietary changes may also help. Some people find relief by increasing iron and vitamin intake through diet or supplements. Folate supplements may help those with low levels.
Moderate to severe RLS
For moderate to severe restless leg syndrome, medications are usually the first line treatment:
- Dopamine agonists such as pramipexole (Mirapex) or ropinirole (Requip) are commonly prescribed as a first choice. They help reduce symptoms by mimicking dopamine effects in the brain.
- Alpha-2-delta ligands such as gabapentin (Neurontin) or pregabalin (Lyrica) may be tried. They regulate calcium channels in the nerves.
- Benzodiazepines like clonazepam (Klonopin) may be used short-term to help with sleep and anxiety.
- Opioids such as oxycodone may be considered for severe pain or discomfort. Tramadol and codeine may also be tried.
Oral iron supplements are also recommended for those with low iron levels. Vitamin B12, magnesium, and folate supplements may be beneficial for some people.
What are the side effects of RLS medications?
All medications can potentially cause side effects. Common side effects of drugs used for RLS include:
Dopamine agonists
- Nausea, dizziness, drowsiness
- Sudden onset of sleep
- Impulse control disorders like compulsive gambling, shopping, or eating
- Augmentation – worsening symptoms that occur earlier in the day
Alpha-2-delta ligands
- Dizziness, fatigue, blurred vision
- Weight gain, swelling in hands and feet
- Difficulty concentrating
Benzodiazepines
- Drowsiness, fatigue, lethargy
- Impaired coordination and balance
- Memory problems
- Dependency with long-term use
Opioids
- Nausea, constipation, drowsiness
- Itching, sweating
- Confusion
- Dependence, tolerance, and addiction
Side effects can often be managed by adjusting dosage or choosing alternative medications. Patients should discuss benefits and risks with their doctor when starting new medications.
Conclusion
In mild cases of restless leg syndrome, lifestyle remedies and home treatments are recommended as first line therapy. For moderate to severe RLS, medications like dopamine agonists, alpha-2-delta ligands, benzodiazepines, or opioids are usually prescribed first. Finding the right medication or combination of treatments for RLS symptoms may take some trial and error. Patients should work closely with their doctor to find the most effective treatment plan.