Restless legs syndrome

Restless leg syndrome (RLS), also known as Willis−Ekbom disease (WED), is a chronic neurological disorder. It is characterized by unpleasant sensations in the legs and an uncontrollable, sometimes overwhelming, urge to move them for relief.

People affected by RLS often describe the sensations as throbbing, tugging or creeping. Symptoms range in severity and may be uncomfortable, irritating or painful, and may severely disrupt sleep and quality of life.

Limb movements during sleep and subsequent disturbances to sleep are common. Some people experience dyskinesias (impaired voluntary movements) during the daytime, especially when at rest.

RLS is generally a life-long condition for which there is no cure

What causes RLS?

The exact cause of RLS is not known. Evidence suggests that RLS occurs when there is a disruption in the brain pathways that use the neurotransmitter dopamine, which is needed to produce smooth muscle activity and movement.

Iron plays an important role in the function of these circuits, and there is evidence to indicate that low levels of iron in the brain also may be responsible for RLS.

There may also be a genetic component, and specific gene variants have been associated with developing RLS.

Who is affected by RLS?

RLS occurs in 7% to 10% of the adult population worldwide; approximately 2-3% have moderate-to-severe RLS and approximately 5% have a milder form.

Although RLS is relatively common in the general population, it often remains undiagnosed. RLS can start at any age, and the incidence is about twice as high in women compared with men.

Signs & symptoms

The primary symptoms of RLS include:

Urges to move, usually due to uncomfortable sensations
Motor restlessness, expressed as activity, that relieves the urge to move
Worsening of symptoms by relaxation
Variability over the course of the day-night cycle, with symptoms worse in the evening and early in the night.

The most distinctive or unusual aspect of the condition is that lying down and trying to relax activates the symptoms, and most people with RLS have difficulty falling asleep and staying asleep.

Left untreated, the chronic lack of sleep can cause exhaustion and fatigue – significantly impacting daytime functioning (including work and personal relations) and quality of life.

People with RLS are often unable to concentrate and have impaired memory. It also can make traveling difficult and can cause depression.

How is RLS diagnosed?

There is no specific test for RLS. Physicians focus largely on the RLS patient’s descriptions of symptoms, their triggers and relieving factors, as well as the presence or absence of symptoms throughout the day.

The International RLS Study Group have set out diagnosis criteria, which are:

Highly unpleasant sensations in the legs and sometimes arms and other parts of the body that are described as creepy, crawly, shock-like, itchy or even painful
Sensations cause an irresistible urge to move
Movement provides temporary relief so long as the movement continues
Symptoms occur in situations of rest and peak during the evening and at night.

What are the treatment options?

There is currently no cure for RLS, but treatment options are available to help manage symptoms.

People with relatively mild RLS can alleviate symptoms with changes in lifestyle, such as regular exercise, and avoiding alcohol and nicotine. For patients with moderate-to-severe symptoms, treatment may be required.

Treatments that can be helpful in providing relief in RLS include:

Dopamine agonists
Hypnotics such as benzodiazepines
Opiods
Anticonvulsants

A doctor may also check to see if there is an underlying iron or vitamin deficiency and then supplement diet accordingly.