Restless Leg Syndrome (RLS)
Restless Legs Syndrome Overview
Restless Legs Syndrome (RLS) is a neurological sleep and movement disorder characterized by unpleasant sensations in the legs and an uncontrollable, sometimes overwhelming urge to move the legs for relief. Patients describe the sensations as throbbing, pulling or creeping—they range from uncomfortable to irritating to painful.
RLS is a serious condition that cannot be cured, but it can be successfully treated in many patients. A diagnosis of Restless Legs Syndrome does not indicate the onset of another neurological disease such as Parkinson’s Disease.
The condition affects children as well as adults and symptoms may worsen with age. Some people will experience an interruption in symptoms (remission) before symptoms reappear, usually during early stages. About twice as many women as men are affected.
An unusual aspect of RLS is that lying down and trying to relax activates the symptoms. As a result, people with RLS have trouble falling and staying asleep, which leads to fatigue/sleep deprivation. The lack of sleep makes it hard to concentrate, and can lead to memory problems, depression or failure to accomplish tasks.
Some patients do not seek medical help because they believe the condition is not serious enough, or they doubt that anything can help. Wellstar neurologists urge individuals with these symptoms to make an appointment in order to confirm that the symptoms are not related to an underlying condition and to explore ways to feel better.
Symptoms
Patients with RLS describe the symptoms in diverse, personal terms. According to the National Sleep Foundation, some describe the feeling as, “like ants crawling through my legs” or “like soda running through my veins.”
If you answer yes to several of the following questions you may have RLS and should visit your doctor:
- When you sit or lie down do you have a strong desire to move your legs?
- Does the desire to move your legs feel impossible to resist?
- Have you ever used words like “creepy crawly,” “creeping,” “itching,” “pulling” or “tugging” to describe how your legs feel?
- Does the urge to move often occur when you are resting or sitting still?
- Does moving your legs make you feel better?
- Do you have more of these symptoms at night?
- Have you kept your bed partner awake with jerking movements in the legs?
- Do you ever have involuntary leg movements while you are awake?
- Are you tired or find it difficult to concentrate during the day?
- Do any other family members report similar symptoms?
- Have you identified any medical cause for these symptoms?
Risk Factors
More than half of people with Restless Legs Syndrome have a family history of the condition. RLS is also more common in people from northern and western Europe, which may support the idea of a genetic basis. A 2011 study found that people with Parkinson’s disease may be more likely to have a disorder called leg motor restlessness, but not RLS, as previous studies suggested.
The condition has been associated with other factors including:
- Pregnancy, especially during the last trimester. Symptoms usually disappear within four weeks post-delivery
- Osteoarthritis (degenerative joint disease) and rheumatoid arthritis
- Varicose veins
- Chronic diseases like kidney failure, diabetes and peripheral neuropathy
- Hypertension
- Hypothyroidism
- Fibromyalgia
- Emphysema
- Being on dialysis
- Sleep apnea
- Chronic alcoholism
- Chronic headache
- Brain or spinal injuries
- Some medications taken for other purposes may worsen symptoms of RLS. Examples are anti-nausea drugs, antipsychotic medications and some cold and allergy medicines containing sedating antihistamines
Restless Legs Syndrome Prevention
The best way to prevent RLS is to make lifestyle changes and avoid the triggers that bring on symptoms or make them worse. Some people find that keeping their legs in motion (rather than at rest) helps. Others find alcohol and tobacco to be triggers, as well as some over-the-counter medications. Make sure to tell your physician about all the medicines you take. Other preventive measures:
- Adopt good habits to help you fall asleep and stay asleep. These include sleeping in a cool, quiet, dark room and removing distractions like TV, computer and phone. If possible, go to bed and wake up at the same time each day.
- Get regular, moderate physical activity.
Some activities that seem to relieve symptoms:
- Walking or stretching
- Taking a hot or cold bath
- Massaging the affected limb or limbs
- Using heat or ice packs
- Doing mentally challenging tasks
Restless Legs Syndrome Diagnosis
If you believe you may have Restless Legs Syndrome make an appointment to see your Wellstar neurologist. The doctor will take a medical history and will ask questions about your family history, symptoms and habits including sleep and daytime alertness.
Tools and Tests
There is no specific test for RLS. Your neurologist will look for four basic criteria that are used to diagnose the disorder.
- A strong urge to move your legs, often accompanied by unpleasant feelings in the legs. In severe cases there may also be a desire to move the arms.
- Symptoms that start or worsen when you are inactive. The urge to move increases when you are sitting still or lying down and resting.
- Relief from movement, especially by walking.
- Symptoms that start or get worse in the evening or at night.
- You must have all four to be diagnosed with RLS.
Restless Legs Syndrome Treatment
The doctor will want to check for any underlying causes such as an iron or vitamin deficiency, medications and supplements as well as choices (alcohol, caffeine, diet) that could be worsening your symptoms. The doctor will discuss lifestyle changes that you can make to may eliminate or lessen symptoms. etc.
Medications
There is no single medication that relieves symptoms in all patients, but a number of drugs have been approved to treat Restless Legs Syndrome. Trials of various medications may be necessary or periodically changing the combination of medicines for maximum benefit. Approved drugs include:
- Horizant®
- Mirapex®
- Requip®, a drug commonly used to treat Parkinson’s disease
You will want to discuss these and other options with your neurologist. All three can have side effects like sedation, nausea and dizziness. Some may worsen symptoms or problems with excessive gambling, shopping or sexual activity.
Other medications that may help:
- Opiods (narcotic medications) have been proven to relieve mild to severe symptoms of RLS, but they can be highly addictive. Examples are codeine, oxycodone, Percocet® and Vicodin®
- Muscle relaxants and sleep medications (benzodiazepines) improve sleep but do not necessarily eliminate leg movement
- Gabapentin (Neurontin®), is a drug used in some patients with RLS who have severe renal or diabetic neuropathy
Ongoing Care for Restless Legs Syndrome
There is no cure for Restless Legs Syndrome, but patients can take a number of steps to help manage and improve their condition. For example:
- Walking
- Massaging the legs
- Stretching
- Applying heat or cold packs
- Vibration
- Relaxation techniques like meditation or yoga
Other self-management techniques:
- Choosing an aisle seat on airplanes or at movies so you can get up and move about as needed
- Plan travel when symptoms are least severe and allow times for movement breaks
- Get sleep when you can, for example in the early morning if that is what works
- Get regular, moderate physical activity