The Facts

Restless Legs Syndrome (RLS), also known as Willis-Ekbom disease, is a neurological (nervous system) disorder. It is characterized by an urge to move the legs in order to relieve abnormal sensations such as pain, creeping, or burning. In fact, some people say it feels like insects are crawling around inside their legs.

The urge to move the legs occurs during periods of rest, such as before falling asleep, and generally tends to be worse in the evenings and at night. Although movement relieves the symptoms, the sensations often return. Although this condition is known as Restless Legs Syndrome, the abnormal sensations can occur in the arms as well.

According to the age of onset, RLS is categorized as early-onset or late-onset. RLS occurs in both men and women, although the incidence is slightly higher in women. This condition also becomes more frequent and severe with age.

In around 80% of cases, people with RLS also experience sudden jerking of the arms and legs known as periodic limb movements. People don't have control over this movement, which generally occurs every 20 to 60 seconds and may continue throughout the night.

Between 2% to 15% of people around the world may have RLS.

Causes

The cause of RLS is not clear. Scientists have observed that approximately half of the people who have RLS also have a family member with the condition.

RLS is thought to be caused by one the following underlying conditions:

• low levels of iron or certain vitamins
• kidney failure
• diabetes
• Parkinson's disease
• other diseases of the nervous system
• arthritis
• pregnancy
• medications used to treat nausea, allergies, seizures, depression, or psychosis

People with these conditions sometimes experience relief from RLS symptoms once the underlying condition is treated or when the suspected drug is discontinued.

Drinking coffee or alcohol and smoking may aggravate or trigger symptoms in people with RLS or those who are likely to develop it. Decreasing your intake of these substances, or stopping them altogether, may relieve or reduce symptoms of RLS. Not getting enough sleep also seems to aggravate the disorder.

Symptoms and Complications

The following are characteristic symptoms of RLS:

• During periods of rest, abnormal sensations occur in the legs or arms including crawling, creeping, tingling, burning, and pain. These abnormal sensations can range from mild to intolerable.
• Movement temporarily helps relieve abnormal sensations, although they often return after the movement is stopped.
• Symptoms are generally worse in the evenings or at night.
• Symptoms are not always constant and may disappear and return for no apparent reason.
• The symptoms tend to get more frequent and severe with age.

Over 80% of people with RLS also experience uncontrollable movements of the arms or legs during sleep, a phenomenon known as periodic limb movements in sleep (PLMS).

Since the symptoms are worse at night, people with RLS may have problems falling asleep or may wake up several times during the sleep. Some may find it difficult to function normally at school or work or to carry out their normal activities due to tiredness.

Making the Diagnosis

There are no lab tests to diagnose RLS. However, your doctor may order a series of tests to identify if you have any other disorders that may be causing your symptoms, such as a vitamin deficiency.

The diagnosis of RLS requires an assessment of your medical history and description of symptoms. The doctor will rule out other possibilities and focus on the presence of four factors in order to diagnose your condition:

• an overwhelming need to move the arms or legs in order to relieve abnormal sensations such as crawling, tingling, burning or pain.
• symptoms that are temporarily relieved by movement.
• symptoms that are worse or only present during periods of rest such as at rest or while sitting.
• symptoms that get worse at night.

Occasionally, the doctor may ask you to undergo an overnight sleep test in a sleep clinic to determine the cause of sleep disturbance more conclusively.

In addition to a thorough questionnaire, your physician will do a complete physical exam, a complete blood count, iron levels and ferritin levels. If low levels of iron are found, your physician will investigate if there is a possible reason for this by ordering a colonoscopy or other tests.

Treatment and Prevention

Treatment for RLS focuses on controlling any underlying health condition that may be causing RLS (e.g., correcting a lack of iron). The doctor will first suggest non-medication measures to manage mild symptoms. For example, some people find that light exercise such as walking or stretching, taking a bath, massaging the leg, applying hot or cold packs, and practicing relaxation techniques such as meditation or yoga reduces the symptoms. Changing your sleep schedule to allow more time for sleeping in may also help. The doctor may suggest you keep your mind active (e.g., by reading) during periods of prolonged inactivity, such as travelling, in order to take your mind off RLS symptoms.

However, if your symptoms are frequent and severe or if you are having difficulty falling or staying asleep, the doctor may prescribe medications for you. To control daily symptoms, medications that are used for Parkinson's disease such as ropinirole, rotigotine and pramipexole are frequently prescribed. Levodopa/carbidopa is effective for intermittent symptoms and as prevention just before a long car ride or travelling on a plane. The medications have side effects and sometimes need to be weaned off for a period before being started again.

Antiseizure medications (such as gabapentin and pregabalin), benzodiazepines (such as clonazepam and zolpidem), or opioids (such as codeine) can give some relief.

Since the cause of RLS is not well understood, there are no known ways to prevent it. However, people who have RLS may be able to decrease episodes by making simple lifestyle changes including eliminating caffeine and alcohol and by treating any underlying conditions.