Restless Leg Syndrome
RLS Fact and Fiction
People with restless legs syndrome have uncomfortable sensations in their legs (and sometimes arms or
other parts of the body) and an irresistible urge to move their legs to relieve the sensations. The sensations are difficult to describe: they are an uncomfortable, "itchy," "pins and needles," or "creepy crawly" feeling in the legs. The sensations are usually worse at rest, especially when lying or sitting. The sensations can lead to sleep deprivation and stress.
The severity of RLS symptoms ranges from mild to intolerable. Symptoms can come and go and severity can also vary. The symptoms are generally worse in the evening and at night and less severe in the morning. For some people, symptoms may cause severe nightly sleep disruption that can significantly impair a person's quality of life.
Who Gets Restless Legs Syndrome?
Restless legs syndrome may affect up to 10% of the U.S. population. It affects both sexes but is more common in women and may begin at any age, even in young children. Most people who are affected severely are middle-aged or older.
RLS is often unrecognized or misdiagnosed. In many people it is not diagnosed until 10 to 20 years after symptoms begin. Once correctly diagnosed, RLS can often be treated successfully.
Causes of Restless Legs Syndrome
In most cases, doctors do not know the cause of restless leg syndrome; however, they suspect that genes play a role. About half of people with RLS also have a family member with the condition.
Other factors associated with the development or worsening of restless legs syndrome include:
Chronic diseases. Certain chronic diseases and medical conditions, including iron deficiency, Parkinson’s disease, kidney failure, diabetes, and peripheral neuropathy often include symptoms of RLS. Treating these conditions often gives some relief from restless legs symptoms.
Medications. Some types of medications, including antinausea drugs, antipsychotic drugs, some antidepressants, and cold and allergy medications containing antihistamines may worsen symptoms.
Pregnancy. Some women experience RLS during pregnancy, especially in the last trimester. Symptoms usually go away within a month after delivery.
Other factors, including alcohol use and sleep deprivation, may trigger symptoms or make them worse. Improving sleep or eliminating alcohol use in these cases may relieve symptoms.
Diagnosis of Restless Legs Syndrome
There is no medical test to diagnose restless legs syndrome; however, doctors may use blood tests and other exams to rule out other conditions. The diagnosis of restless legs syndrome is based on a patient’s symptoms and answers to questions concerning family history of similar symptoms, medication use, the presence of other symptoms or medical conditions, or problems with daytime sleepiness.
Treatment for RLS is targeted at easing symptoms. In people with mild to moderate restless legs syndrome, lifestyle changes, such as beginning a regular exercise program, establishing regular sleep patterns, and eliminating or decreasing the use of caffeine, alcohol, and tobacco, may be helpful. Treatment of an RLS-associated condition also provides relief of symptoms.
Other non-drug restless legs treatments may include:
Hot baths or heating pads or ice packs applied to the legs
Good sleep habits
Medications may be helpful as RLS treatments, but the same drugs are not helpful for everyone. In fact, a drug that relieves symptoms in one person may worsen them in another. In other cases, a drug that works for a while may lose its effectiveness over time.
Drugs used to treat RLS include:
Dopaminergic drugs, which act on the neurotransmitter dopamine in the brain. Pramipexole (Mirapex), rotigotine (Neupro), and ropinirole (Requip) are FDA approved for treatment of moderate to severe RLS. Others, such as levodopa (Larodopa, Dopar) and pergolide (Permax) may also be prescribed.
Benzodiazepines, a class of sedative medications, may be used to help with sleep, but they can cause daytime drowsiness.
Narcotic pain relievers may be used for severe pain.
Anticonvulsants, or antiseizure drugs, such as carbamazepine (Tegretol) and gabapentin (Neurontin, Horizant).
Although there is no cure for restless legs syndrome, current treatments can help control the condition, decrease symptoms, and improve sleep.