Restless Legs Syndrome: Symptoms, Causes, and Treatment

• Restless legs syndrome is a condition that causes uncomfortable, unpleasant, or even painful sensations in the legs that are only alleviated by movement.
• There isn't a single known cause of restless legs syndrome, though fluctuating dopamine levels, low iron, genetic factors, and underlying medical conditions may all play a role.
• There isn't a cure for restless legs syndrome, so treatment focuses on symptom relief primarily through lifestyle changes and medication.

Restless legs syndrome, also called Willis-Ekbom disease, is a neurological condition that causes uncomfortable sensations, leading to a powerful, irresistible urge to move the legs. These feelings can occur in the late afternoon or evening hours and may worsen at night, making it harder to fall asleep and/​or stay asleep.

There are two types of RLS: early-onset and late-onset.

• Early-onset, typically starting at a younger age, is often linked to RLS being a genetic condition.
• Late-onset is often diagnosed after 45 and usually occurs alongside another medical condition.

Periodic Limb Movement Disorder vs. Restless Legs Syndrome

In some cases, RLS can be mistaken for another condition called Periodic Limb Movement Disorder (PLMD). Both involve involuntary repetitive leg movements, mainly during sleep, and share similar symptoms, such as frequent nighttime awakenings and insomnia. Additionally, RLS can cause PLMD, so the conditions can occur simultaneously. Approximately 80% of people with RLS also experience periodic limb movements during sleep.

The main difference between the two conditions is that RLS sensations are often uncomfortable or painful, while many with PLMD may not even be aware of their movements during sleep.

The main symptom of restless legs syndrome is an uncomfortable feeling in the legs while resting, which results in a very strong urge to move them.

Some people describe these feelings as:

• Tingling
• Aching
• Throbbing
• Itching
• Crawling
• Twitching

Other RLS symptoms include:

• Relief of sensations with leg movement
• Worsening of sensations at night/​during sleep, with a symptom-free period in the mornings

These unpleasant sensations commonly affect both sides of the body, but may also occur on only one side. Rarely, these symptoms affect the arms. Symptoms for RLS vary from person to person and from day to day.

Because RLS causes sleep disruption, it can result in other symptoms that may occur alongside the sensations, including:

Anxiety and depression

The specific cause of RLS remains a mystery, but research shows that an imbalance of the brain chemical dopamine, which sends messages that affect muscle movement, may be a key player. Other factors that increase your risk of RLS include:

• Family history of RLS
• Iron deficiency
• Certain medications, like antihistamines, anti-nausea drugs, and antidepressants
• Underlying medical conditions, such as Parkinson's disease, pregnancy, or nerve damage
• Damage or dysfunction in the basal ganglia, the part of the brain that controls movement

While RLS can occur at any time and affect anyone, a few factors increase the likelihood of experiencing it. RLS is more likely to occur in

• Older adults
• Women (in general)
• Pregnant women (especially during the third trimester)
• Those with a family history of RLS

Additionally, RLS often co-occurs or is linked to other medical conditions, such as:

To diagnose RLS, a healthcare provider can review symptoms, medical history, medications, and family history. There isn't a specific test for diagnosing RLS, so the provider will evaluate your symptoms based on the following criteria:

• You have a strong, often irresistible urge to move your legs due to unpleasant or uncomfortable sensations.
• Your symptoms start or worsen when you're resting, such as when sitting or lying down.
• Your symptoms are partially or temporarily alleviated by activity, such as walking or stretching.
• Your symptoms worsen at night.
• Your symptoms can't be explained solely by a different medical or behavioral condition.

After this, a blood sample may be obtained to determine if there are underlying causes, such as low iron levels, pregnancy, or kidney failure at play.

In some cases, you may be referred to a sleep specialist to undergo a sleep study, which may be necessary to determine how much periodic leg movement is occurring and how it impacts your sleep. This is typically recommended if a sleep condition, such as sleep apnea, is suspected.

There currently isn't a cure or a known way to prevent restless legs syndrome, so the treatment focus is on symptom relief. The most common methods include treating an underlying condition, lifestyle changes, and medications.

Treating Underlying Conditions

If RLS is caused by another medical condition, treatment will focus on that condition. For example, if iron deficiency is the cause of your RLS symptoms, a provider will likely recommend iron supplements to raise iron levels, which will ideally also relieve symptoms of RLS.

Lifestyle Changes

The most common form of treatment involves making lifestyle changes to relieve or reduce symptoms. Some of these changes include:

• Forming good sleep habits : Maintaining a regular sleep schedule, avoiding screens before bed, and getting approximately 7-9 hours of sleep a night can provide some relief.
• Relaxation techniques: Stress can be a trigger for RLS symptoms, so finding ways to relax can help avoid making symptoms worse. Examples include meditation, yoga, or seeking out a mental health professional to help lessen your overall stress.
• Avoiding caffeine, nicotine, and alcohol: Caffeine, nicotine, and alcohol, especially when consumed close to bedtime, can disrupt sleep, which can worsen RLS symptoms.
• Staying physically active : Getting regular, moderate exercise can be beneficial, including aerobics, walking, and cycling. However, avoid intense physical activity before bedtime to avoid difficulty falling asleep.
• Using heat for symptom relief: Using heat can provide temporary relief for RLS symptoms. Options include soaking in a warm bath or applying a heating pad to the legs.
• Trying a leg massage: Leg massages may provide temporary relief for RLS symptoms.

Medications

For those with severe symptoms of RLS, lifestyle changes may not be enough. There are several drugs that can be prescribed to help with symptoms, including:

• Anti-seizure medications: These medications, such as Gabapentin enacarbil or pregabalin, can target brain receptors that produce neurotransmitters (brain chemicals) like dopamine, which can help with symptoms.
• Opioids: In severe cases that don't respond to other treatments, opioids may be administered
• Benzodiazepines: These are used to treat symptoms of RLS such as anxiety, muscle spasms, or insomnia
• Dopaminergic agents: If low dopamine is a trigger of your RLS this class of medication can increase dopamine levels, temporarily alleviating symptoms. However, these medications aren't used as often due to the possibility of ​"augmentation," or the possibility of symptoms worsening over time or appearing earlier in the day due to long-term use.
• Tonic Motor Activation (TOMAC): This is a nerve stimulation device worn on the lower legs to activate leg muscles, mimicking the feeling of movement and potentially helping with symptoms. While not a medication, this technology must be prescribed by a provider.

You should see a doctor if you experience the following:

• Your symptoms get worse, even after medication or other forms of treatment
• Your symptoms become more frequent or start occurring during the day
• Your symptoms impact your ability to sleep

What is the main cause of restless legs syndrome?

A common cause of restless legs syndrome is thought to be an imbalance of dopamine in the brain, resulting in involuntary movements.

What age group is most affected by Restless legs syndrome?

While restless legs syndrome can happen at any time, it primarily affects people who are middle-aged or older.

What is mistaken for restless legs syndrome?

Many conditions can be mistaken for restless legs syndrome. Some of the most common include periodic limb movement disorder, leg cramps, "growing pains" (most commonly in children), and other neurological disorders like peripheral neuropathy.