Restless Legs Syndrome (RLS):

Signs and symptoms of Restless Legs Syndrome (RLS)

RLS affects about 10% of adults in North America and Europe, and incidence increases with age. Women have a higher incidence of RLS than men, especially during the last months of pregnancy. The syndrome also appears to run in families.

Although the symptoms are distinctive, many people dismiss the feelings as muscle aches or restlessness, and do not suspect that they have RLS. Thus, RLS is frequently misdiagnosed and often left untreated, resulting in restlessness, insomnia, and daytime sleepiness.

Common Symptoms of RLS
An irritating sensation in legs	Sensations can be painful or just uncomfortable. Feelings are described as creeping, crawling, tingling, pulling. While people usually feel the sensations in the calf area, some feel them in the upper leg, the feet, the arms, or the hands.
An overwhelming urge to move	Getting up and moving around can relieve the discomfort.
Sensations that vary depending on position and time of day	Discomfort tends to increase when sitting or lying down and during the evening or night. These sensations can vary in intensity; some describe the sensations as merely bothersome or annoying, while others describe them as quite painful and feel them deep in the leg.
Visible movements in toes or feet	Others may notice your feet or toes moving slightly or jerking when you are sitting still or resting.

Children and RLS

Many people diagnosed as adults with Restless Legs Syndrome look back upon childhood hyperactivity or “growing pains” and realize that these were actually symptoms of RLS. Sometimes a child is misdiagnosed with Attention Deficit Hyperactivity Disorder, when the true diagnosis is Restless Legs Syndrome.

Causes of Restless Legs Syndrome (RLS)

Restless Legs Syndrome is a central nervous system disorder (a disorder based in the brain or spinal column). It may have a genetic basis (meaning it sometimes runs in families), or be related to brain chemistry. Psychiatric conditions or stress may exacerbate RLS, but they do not cause RLS.

Restless Legs Syndrome can also be a secondary condition, brought on by another condition, such as:

• An underlying medical problem, such as diabetes mellitus, kidney disease, Parkinson’s Disease, or rheumatoid arthritis
• Pregnancy - Many women experience Restless Legs Syndrome in the last months of pregnancy. This may be related to an iron deficiency. Left untreated, the symptoms often go away after delivery.
• Iron deficiency anemia
  Neurologic lesions - People with spinal cord tumors, peripheral nerve lesions, or spinal cord injury often report symptoms of RLS.
• Particular medications - Medications including tricyclic antidepressants, anti-nausea and anti-seizure drugs, selective serotonin reuptake inhibitors (SSRIs), lithium, and some cold and allergy drugs may increase or trigger RLS symptoms. In addition, withdrawal from sedatives may trigger RLS.
• Sleep apnea or narcolepsy
• Varicose veins
• Thyroid problems
• Trouble with the nerves in the hands or feet

Treating Restless Legs Syndrome (RLS)

Although no cure exists for Restless Legs Syndrome, different types of treatment can be used to manage the condition and relieve discomfort. If your symptoms are mild, self-help may be sufficient treatment. For those with severe RLS, where the disorder disrupts sleep or daily activities, medications may be the proper treatment approach. Lastly, if your Restless Legs Syndrome is caused by an underlying condition, your doctor can treat that condition. Treatment of the underlying condition often cures the RLS.

Self-care for RLS

Your RLS symptoms may respond to changes in your daily behaviors and habits. Exercise, new sleeping positions, or hot/cold compresses may alleviate your symptoms and help you to get the rest you need.

Self-help tips for RLS
During the day	At bedtime
Develop an exercise program that relieves the RLS symptoms. Wrap your legs in ace bandages, or wear compression stockings or tight pantyhose. Take iron supplements for low iron levels. Be sure to get tested first; too much iron in your system can be dangerous. Reduce caffeine, alcohol, and tobacco use, particularly in the evenings. These substances often increase symptoms. Keep a regular sleep schedule.	Pace, walk, or jog for a few minutes to relieve discomfort. Stretch your legs, do knee bends, or rotate your ankles. Massage your legs. Relax with meditation, yoga, or deep breathing. Apply heat or cold. Take a bath or soak your feet in hot water, briefly use a heating pad or cold compresses, or apply a hot water bottle. Lie on your side with a pillow between your knees to initiate sleep.

Transcutaneous Electric Nerve Stimulation (TENS)

Applying electrical stimulation to feet and legs helps to reduce nighttime leg jerking in some patients experiencing severe RLS. Using a portable, bedside TENS unit, you apply electrical stimulation for 15 to 30 minutes to your legs.

Seeking medical treatment for RLS

If self-help doesn’t relieve your RLS symptoms, a doctor or sleep specialist might be helpful in exploring alternative treatments. No laboratory test can confirm a diagnosis of RLS, so the condition is often overlooked. To diagnose RLS, your doctor will request:

• A medical history
• A familial survey to see if anyone else in your family has similar symptoms
  Interview about other medical conditions you have
• A blood test for low iron levels

Keeping a sleep diary is helpful if you suspect you have RLS. Recording changes in your diet, lifestyle, sleep habits and routine might help you and your doctor make helpful changes.

Medications for Restless Legs Syndrome (RLS)

Medications are a common treatment for RLS. However, no single drug works for everyone with the condition. The medications prescribed for Restless Legs Syndrome are frequently “off-label” uses of the drugs, meaning they are not specifically intended for RLS, but have been found to help with symptoms. The dosage given for RLS is usually much less than the dosage for the intended condition.

Common medications prescribed for RLS include:

• Dopaminergic agents (Examples: Ropinirole, Pramipexole) - Often, this is the first line of treatment for RLS. Normally used to treat Parkinson’s Disease. These increase the brain chemical dopamine, a neurotransmitter that regulates muscle movements.
• Benzodiazepines - These are sleep medications, or central nervous system depressants, which also suppress muscle contractions.
• Non-benzodiazepine sedatives - Short-acting hypnotic agents, or sleeping pills. These may be helpful for mild RLS that occurs primarily at bedtime.
• Opiates / narcotics (Examples: low-potency Darvon, high-potency Percodan) - Pain-killing and relaxing drugs that can suppress RLS in some people. Addictive and should be used only in low dosages.
• Anticonvulsants (Examples: Gabapentin, Neurontin) - normally used to prevent seizures, and reduce muscle contractions for some people.
• Hypertensive medications - Generally prescribed for high blood pressure.

Be cautious with your use of drugs. Drug ads may make sleep medications seem effective and safe, when in reality they often work only slightly better than a placebo, and cause more side-effects. Many drugs are approved based on very short-term studies, even though the medication may be prescribed for the long term. Additionally, some medications may actually increase RLS symptoms in certain cases, a condition called "augmentation."

Periodic Limb Movement Disorder (PLMD)

Periodic Limb Movement Disorder (PLMD) is very similar to RLS. While RLS is a sensation in the legs and subsequent voluntary movement to avert the sensation, PLMD is involuntary, rhythmic limb movements, either while asleep or when awake. RLS disrupts sleep by delaying sleep; PLMD can disrupt sleep because of the constant limb movements. Many people with PLMD are not even aware of their symptoms until a bed partner brings it to their attention.

PLMD can be primary (with no known cause) or secondary (caused by an underlying medical condition). Primary PLMD has thought to be affected by an abnormal regulation of nerves traveling from the brain to the limbs. Secondary PLMD is associated with many of the same conditions as RLS, including spinal cord injuries, sleep apnea, diabetes, and iron deficiencies.

Most people who have Restless Legs Syndrome also have PLMD. However, the reverse is not true -  only some people with PLMD also have RLS. See the resources below for more information about PLMD.

Related links for Restless Legs Syndrome (RLS)

General information on Restless Legs Syndrome

Restless legs syndrome – An overview of RLS, plus signs and symptoms, causes, screening and diagnosis, treatment, self-care, and coping skills. (Mayo Clinic)

Treatment for Restless Legs Syndrome

RLS/PLMD Treatment Page: Comprehensive Review of Medications used in Treating RLS and PLMD – Comprehensive listing of treatments for Restless Legs Syndrome, including alternative treatments. (Southern California RLS Support Group)

Support for sufferers of RLS and PLMD

Support Groups: Find a group – Locate a support group for RLS in the United States or Internationally. (RLS.org)

International Guide to Movement Disorder Patient Advocacy Groups and Foundations – Links to support and advocacy organizations around the world for Restless Legs Syndrome. (WeMove.org)

Periodic Limb Movement Disorder

Periodic Limb Movements – Describes the symptoms of Periodic Limb Movement Disorder and provides guidelines for when to seek help. (SleepEducation.com, American Academy of Sleep Medicine)

Guide to Periodic Limb Movement Disorder – A comprehensive guide to PLMD. (eMedicineHealth)

Tina de Benedictis, Ph.D., Gina Kemp, M.A., Heather Larson, and Suzanne Barston contributed to this article. Last modified on: 10/16/07.