Restless legs syndrome (RLS, and also sometimes called Willis-Ekbom disease) is a condition that causes unusual sensations in the legs combined with an urge to move the legs at night, which can make it difficult to fall asleep.
In some cases, low levels of iron in the blood (iron deficiency anemia) can cause restless legs.
However, in most cases, restless legs syndrome has no known cause (primary RLS). In addition to iron deficiency anemia, other causes of restless legs syndrome may include:
- Genetics (runs in families)
- Dysfunction in the basal ganglia in the brain
Risk factors for developing restless legs syndrome include:
- Sleep deprivation and other sleep conditions such as sleep apnea
- Use of alcohol, caffeine, and nicotine
- Parkinson’s disease
- Multiple sclerosis
- Nerve damage (neuropathy)
- Kidney disease, including end stage renal disease (ESRD)
- Pregnancy, especially in the last trimester (symptoms usually go away within a month after delivery)
Some medications can also worsen RLS symptoms, such as:
- Some cold and allergy medications that contain older antihistamines (e.g., diphenhydramine)
- Antidepressants that increase serotonin (e.g., fluoxetine or sertraline)
- Antinausea drugs (e.g., prochlorperazine or metoclopramide)
- Antipsychotic drugs (e.g., haloperidol or phenothiazine derivatives)
What Are Symptoms of Restless Leg Syndrome?
Symptoms of restless legs syndrome (RLS) include:
- An uncomfortable urge to move the legs when at rest
- The feeling is often described as crawling, creeping, pulling, or itching
- Feeling is deep in the legs, usually below the knees
- Legs may move on their own while the person is asleep
- Symptoms usually worsen as the day progresses, and are worst at night
- Symptoms may be particularly bad when trying to stay still
- Symptoms may go away when a person moves their legs
Restless legs syndrome can make it difficult to get a restful night's sleep, so people who have RLS may feel tired during the day.
How Is Restless Leg Syndrome Diagnosed?
Restless legs syndrome (RLS) is usually diagnosed based on a patient’s symptoms, along with a physical and neurological exam.
Laboratory tests may be used to help rule out other conditions such as kidney failure, iron deficiency anemia, or pregnancy that can cause RLS symptoms.
- Blood tests can identify iron deficiencies and other medical disorders
- A sleep study, where patients spend the night in a lab hooked up to different machines that monitor movements, heart rate, breathing, and other body functions may be used to help diagnose sleep apnea or other sleep disorders
What Is the Treatment for Restless Leg Syndrome?
Treatment for restless leg syndrome (RLS) is aimed at relief of symptoms.
Lifestyle modifications and treatments that may relieve RLS symptoms include:
- Moving the legs
- Leg massage
- Heating pads applied to the legs or a warm bath
- Regular exercise
- Keeping alert during the day with activities that stimulate the brain
- Avoiding medications that can worsen RLS symptoms
- Limiting caffeine and alcohol intake
- Avoiding tobacco use
- Treating sleep apnea
Medications used to treat restless leg syndrome include:
- Iron supplements
- Pramipexole (Mirapex)
- Ropinirole (Requip)
- Rotigotine (Neupro)
- Carbidopa-levodopa (Sinemet)
- Gabapentin enacarbil (Horizant)
- Gabapentin (Neurontin)
- Pregabalin (Lyrica)
- Opioids may be prescribed to treat patients with severe symptoms of RLS who do not respond well to other medications
A device called Relaxis is an FDA-approved pad to treat RLS.
- The patient lies in bed on the pad, and the pad delivers vibrations that gradually ramp down and shut off
- It is an alternative for patients who do not want to interrupt their sleep by getting up to move their legs, or who do not want to use medications
Hemodialysis treatment may improve symptoms of RLS in patients who also have kidney failure.
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