Restless leg syndrome

Definition

Restless leg syndrome is a disorder in which there is an urge or need to move the legs to stop unpleasant sensations.

Alternative Names

Nocturnal myoclonus; RLS; Akathisia

Causes, incidence, and risk factors

Restless leg syndrome (RLS) occurs most often in middle-aged and older adults. Stress makes it worse. The cause is not known in most patients.

RLS may occur more often in patients with:

• Peripheral neuropathy
• Chronic kidney disease
• Parkinson's disease
• Pregnancy
• Iron deficiency
• Use of certain medications

A form of RLS may be passed down in families. This may be a factor when symptoms start at a younger age. The abnormal gene has not yet been identified.

Restless leg syndrome can result in a decreased quality of sleep (insomnia). This lack of sleep can lead to daytime sleepiness, anxiety or depression, and confusion or slowed thought processes.

Symptoms

RLS leads to sensations in the lower legs that make you uncomfortable unless you move your legs. These sensations:

• Usually occur at night when you lie down, or sometimes during the day when you sit for long periods of time
• May be described as creeping, crawling, aching, pulling, searing, tingling, bubbling, or crawling
• May last for 1 hour or longer
• Sometimes also occur in the upper leg, feet, or arms

You will feel an irresistible urge to walk or move your legs, which almost always relieves the discomfort.

Most patients have rhythmic leg movements during sleep hours, called periodic limb movement disorder (PLMD).

All of these symptoms often disturb sleep. Symptoms can make it difficult to sit during air or car travel, or through classes or meetings.

Note: Symptoms may be worse during stress or emotional upset.

Signs and tests

There is no specific examination for restless leg syndrome. The health care provider will not usually find any abnormalities, unless you also have peripheral nerve disease. Blood tests (CBC and serum ferritin) may be done to rule out iron deficiency anemia, which in rare cases can occur with restless leg syndrome.

Examination and testing may be used to rule out other disorders with similar symptoms.

Treatment

There is no known cure for restless leg syndrome.

Treatment is aimed at reducing stress and helping the muscles relax. The following techniques may help:

• Warm baths
• Gentle stretching exercises
• Massage

Low doses of pramipexole or ropinirole (Requip) can be very effective at controlling symptoms in some people.

If your sleep is severely disrupted, your health care provider may prescribe medications such as Sinemet (an anti-Parkinson's medication), gabapentin and pregabalin, or tranquilizers such as clonazepam. However, these medications may cause daytime sleepiness.

Patients with iron deficiency will receive iron supplements.

Low doses of narcotics may sometimes relieve symptoms of restless leg syndrome.

Expectations (prognosis)

Restless leg syndrome is not dangerous or life-threatening, and it is not a sign of a serious disorder. However, it can be uncomfortable and disrupt your sleep.

Complications

Insomnia may occur.

Calling your health care provider

Call for an appointment with your health care provider if:

• You have symptoms of restless leg syndrome
• Your sleep is disrupted

Prevention

Techniques to promote muscle relaxation and stress reduction may reduce the incidence of restless leg syndrome in people prone to the condition.

References

Bayard M, Avonda T, Wadzinski J., Am Fam Physician. 2008 Jul 15;78(2):243

Goldman L, Ausiello D, eds. Cecil Textbook of Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007

Kushida CA. Clinical presentation, diagnosis, and quality of life issues in restless legs syndrome. Am J Med. January 2007;120(1 Suppl 1):S4-S12.