Restless legs syndrome

Understanding Restless Legs Syndrome (RLS)

Restless Legs Syndrome (RLS), also referred to as Willis-Ekbom Disease, is a common neurological condition characterized by an overwhelming and uncontrollable urge to move the legs. The condition often leads to a variety of uncomfortable sensations and can significantly disrupt sleep, leading to daytime fatigue and impacting quality of life. RLS affects both men and women, though it is more common among women and typically develops in middle age.

What Are the Symptoms of Restless Legs Syndrome?

The primary symptom of Restless Legs Syndrome is an intense, irresistible urge to move the legs. This sensation is often described as an uncomfortable, creeping, or crawling feeling that is difficult to ignore. The sensations may also extend to other parts of the body, including the arms, chest, or even the face. These sensations can vary widely in intensity, ranging from mild discomfort to painful and unbearable experiences.

Common descriptions of RLS sensations include:

• A tingling or burning sensation
• Itchy or throbbing feelings
• A "creepy-crawly" sensation
• A fizzy or bubbly feeling inside the blood vessels in the legs
• Painful cramps, especially in the calves

For most individuals, the symptoms tend to worsen during the evening or night. The discomfort is typically relieved by movement—such as walking, rubbing the legs, or stretching—but often returns once the person resumes resting. Some people experience these sensations sporadically, while others may deal with them on a daily basis. Prolonged periods of sitting or resting, such as during long car or train rides, can exacerbate symptoms.

The Link Between Periodic Limb Movements and Restless Legs Syndrome

More than 80% of people with Restless Legs Syndrome (RLS) also experience Periodic Limb Movements (PLM). PLMs are involuntary jerks or twitches of the legs, most often occurring during sleep. These movements typically happen every 20-40 seconds and can disrupt both the person experiencing them and their sleep partner. In some cases, these movements may also occur when the person is awake and resting.

What Causes Restless Legs Syndrome?

In many instances, the exact cause of Restless Legs Syndrome remains unknown. This is referred to as primary or idiopathic RLS. However, research has identified several potential causes and risk factors that may contribute to its development.

Dopamine Deficiency and Brain Function

A growing body of evidence suggests that RLS is linked to a dysfunction in a part of the brain known as the basal ganglia, which is responsible for controlling muscle movement. The basal ganglia relies on a neurotransmitter called dopamine to regulate muscle activity. When dopamine levels are low or when dopamine receptors are impaired, muscle spasms and involuntary movements (such as those seen in RLS) can occur. Dopamine levels naturally decline at night, which may explain why RLS symptoms are often worse in the evening and during sleep.

Genetic Factors and Hereditary RLS

Research indicates that RLS can run in families, suggesting a genetic component. Some individuals with a family history of RLS experience symptoms earlier in life, often before the age of 40. Specific genes have been linked to the development of RLS, providing further evidence of a hereditary factor.

Secondary Restless Legs Syndrome

In some cases, RLS is caused by an underlying health condition, a situation referred to as secondary RLS. Various conditions can trigger or exacerbate RLS symptoms, including:

• Iron Deficiency Anemia: Low iron levels can lead to decreased dopamine production, worsening RLS symptoms.
• Chronic Health Conditions: Conditions such as kidney disease, diabetes, Parkinson’s disease, and rheumatoid arthritis can increase the likelihood of developing RLS.
• Pregnancy: Around 20% of pregnant women experience RLS symptoms, particularly during the third trimester. Fortunately, symptoms usually resolve within a few weeks after childbirth.

External Triggers

Certain lifestyle factors and medications can worsen RLS symptoms, though they do not directly cause the condition. Common triggers include:

• Caffeine and Alcohol: Excessive consumption can intensify symptoms.
• Medications: Some drugs, such as antidepressants, antipsychotics, lithium, and antihistamines, can trigger or aggravate RLS.
• Smoking and Obesity: Both can contribute to the worsening of RLS symptoms.
• Stress and Anxiety: Emotional stress can also trigger flare-ups of RLS.

Diagnosing Restless Legs Syndrome

There is no single test that can diagnose Restless Legs Syndrome. Instead, the diagnosis is typically made through a combination of medical history, symptom patterns, and physical examinations. Your doctor may refer you to a neurologist for further evaluation if the diagnosis is unclear.

Four main criteria are used to diagnose RLS:

1. Uncontrollable urge to move the legs, usually accompanied by uncomfortable sensations such as tingling or itching.
2. Symptoms worsen during periods of inactivity (especially in the evening or night).
3. Symptoms are relieved by movement (such as walking or stretching).
4. The discomfort is worse at night or during sleep.

Your healthcare provider may also recommend blood tests to rule out underlying causes such as iron deficiency, anemia, or kidney dysfunction. Sleep studies (polysomnography) may be conducted if your symptoms significantly disrupt sleep and to assess periodic limb movements.

Treatment Options for Restless Legs Syndrome

Treatment for RLS can vary depending on the severity of symptoms and whether an underlying condition is contributing to the disorder.

Lifestyle Changes

For mild cases, simple lifestyle changes can help alleviate symptoms:

• Sleep hygiene: Maintain a regular sleep schedule, avoid caffeine or alcohol late in the day, and establish a relaxing bedtime routine.
• Exercise regularly: Aim for physical activity during the day, but avoid vigorous exercise close to bedtime.
• Quit smoking: Smoking exacerbates symptoms, so cessation may improve RLS.

During episodes of RLS, individuals may benefit from activities such as:

• Leg massages or hot baths
• Hot or cold compresses
• Stretching or walking
• Relaxation techniques, such as yoga or meditation

Medications

For more severe cases of RLS, medications may be necessary to control symptoms:

• Dopamine Agonists: Medications like ropinirole, pramipexole, and the rotigotine skin patch help increase dopamine levels and reduce symptoms.
• Iron Supplements: For RLS related to iron deficiency, supplements can help restore normal dopamine function.
• Pain Relievers: Mild opiate-based painkillers, such as codeine, or gabapentin and pregabalin, may be prescribed for pain relief.
• Sleep Aids: In cases where sleep is severely disrupted, short-term use of hypnotic medications such as zopiclone or zolpidem can aid sleep, but these are generally used for no longer than a week.

Who Is Most Likely to Develop Restless Legs Syndrome?

Restless Legs Syndrome can affect anyone, but certain groups are more likely to develop the condition:

• Women: RLS is twice as common in women as in men.
• Age: RLS becomes more common with age, particularly in middle-aged adults, though it can also develop in children.
• Family History: RLS tends to run in families, so if a close relative has the condition, you are more likely to develop it.

Long-Term Outlook and Management

The outlook for RLS varies. If it is caused by an underlying condition, such as iron deficiency anemia, treating that condition may relieve symptoms. However, for idiopathic RLS, symptoms may worsen over time if left untreated. While RLS is not life-threatening, its impact on sleep and daily activities can be significant, often leading to anxiety, depression, and chronic fatigue.

With proper treatment, many individuals can effectively manage their symptoms and lead a fulfilling life.

For more support, resources like Restless Leg Syndrome UK (RLS-UK) provide useful information and community support for individuals dealing with RLS.