RESTLESS LEG SYNDROME

Symptoms

The chief symptom is an urge to move the legs. Common accompanying characteristics of RLS include:

• Sensations that begin while resting. 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 the 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 the legs to twitch and kick, possibly throughout the night, while you sleep.

People typically describe RLS symptoms as compelling, unpleasant sensations in the legs or feet. They usually happen on both sides of the body. Less commonly, the sensations affect the arms.

The sensations, which generally occur within the limb (legs, sometimes arms) rather than on the skin, are described as:

• Crawling

• Creeping

• Pulling

• Throbbing

• Aching

• Itching

• Electric

Sometimes the sensations are difficult to explain. It's common for symptoms to fluctuate in severity. Sometimes, symptoms disappear for periods of time, then come back.

 

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.

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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.

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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.

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Risk factors

RLS can develop at any age, even during childhood. The condition 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 the 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 the 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 the 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.

• Parkinson's disease. People who have Parkinson's disease and take certain medications called dopaminergic agonists have an increased risk of developing RLS.

 

Complications

Although RLS doesn't lead to other serious conditions, symptoms can range from barely bothersome to incapacitating. Many people with RLS find it difficult to fall or stay asleep.

Severe RLS can cause marked impairment in life quality and can result in depression. Insomnia may lead to excessive daytime drowsiness, but RLS may interfere with napping.

 

Diagnosis

Your provider 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 the 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.

Your provider 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. A sleep study might also be needed in some cases especially to exclude other sleep disorders that might be contributing to your symptoms.

 

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 provider has checked your blood-iron level.

If you have RLS without an associated condition, treatment focuses on lifestyle changes. If those aren't effective, your provider might prescribe medications.

 

Medications

Several prescription medications, most of which were developed to treat other diseases, are available to reduce the restlessness in the legs. These include:

• Medications that increase dopamine in the brain. These medications affect levels of the chemical messenger dopamine in the brain. 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.

• 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.

• Opioids. Narcotic medications are used mainly to relieve 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).

 

It may take several trials for you and your provider to find the right medication or combination of medications that work best for you.

 

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 the legs can relax the muscles.

• Apply warm or cool packs. Use of heat or cold, or alternating use of the two, may lessen the 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, alcohol and tobacco. 

• Consider using a foot wrap or a vibrating pad. A foot wrap specially designed for people with RLS puts pressure under the foot and may help relieve your symptoms. You may also find relief using a pad that vibrates on the back of the legs.