Restless legs syndrome

Restless legs syndrome (RLS), also known as Willis-Ekbom disease, is a neurological condition that causes an irresistible urge to move the legs, typically accompanied by uncomfortable sensations. The symptoms primarily occur during periods of rest or inactivity, especially in the evening or at night, and are temporarily relieved by movement. 

Symptoms

RLS is characterized by distinct sensations that are often hard to describe, but can include: 

  • Creeping, crawling, or tingling feelings

  • Aching, throbbing, or pulling sensations

  • Burning, gnawing, or itching feelings

  • An overwhelming and irresistible urge to move the legs 

These symptoms disrupt sleep, leading to fatigue, daytime sleepiness, and difficulty concentrating. Most people with RLS also experience periodic limb movement of sleep (PLMS), which causes involuntary leg jerking or twitching during sleep. 

Causes and Risk Factors

The exact cause is often unknown, but it is thought to be linked to an imbalance of the brain chemical dopamine, which helps control muscle movement. 

  • Genetics: RLS often runs in families.

  • Iron Deficiency: Low iron levels in the blood or brain can cause or worsen RLS symptoms.

  • Medical Conditions: Conditions like chronic kidney disease, diabetes, peripheral neuropathy, and Parkinson's disease are associated with RLS. RLS symptoms are also common during pregnancy and usually resolve after delivery.

  • Medications and Substances: Certain antidepressants, anti-nausea drugs, antihistamines, caffeine, alcohol, and nicotine can trigger or worsen symptoms.

Treatments

While there is no cure for RLS, treatments can effectively manage symptoms. 

  • Lifestyle Changes: For mild RLS, simple adjustments can provide relief:

    • Avoiding triggers: Limit or eliminate caffeine, alcohol, and nicotine.

    • Regular, moderate exercise: Avoid vigorous exercise near bedtime.

    • Good sleep hygiene: Maintain a consistent sleep schedule and comfortable sleep environment.

    • Physical relief: Try warm baths, leg massages, or hot/cold packs on the legs.

    • Mental distraction: Engaging in mentally challenging activities like puzzles or reading may reduce symptoms.

  • Medication: For moderate to severe cases, a healthcare provider may prescribe medications:

    • Iron supplements: If iron deficiency is detected via blood tests, supplements may be recommended under medical supervision.

    • Anti-seizure medications: Gabapentin enacarbil (Horizant), gabapentin, and pregabalin are often a first-line choice as they do not cause the augmentation (worsening of symptoms over time) associated with some older dopamine drugs.

    • Dopaminergic agents: Medications like ropinirole (Requip), pramipexole (Mirapex), and the rotigotine patch (Neupro) mimic dopamine effects. They are effective but are now typically used with caution due to the risk of augmentation.

    • Opioids or Benzodiazepines: Low doses may be used in severe, resistant cases that do not respond to other treatments, but carry risks of side effects and dependence.

  • Medical Devices: The FDA has approved devices that use tonic motor activation (TOMAC) or provide compression to the legs to reduce symptoms.