Restless legs syndrome: what patients need to know

What is restless legs syndrome?

Restless legs syndrome, also named Willis-Ekbom disease, is a condition characterized by an uncomfortable/unpleasant sensation, usually accompanied by an urge to move the legs. This primarily happens during periods of inactivity, such as when lying in bed, and is especially pronounced during evening or at bedtime.

What are the symptoms?

Words such as “crawling,” “cramping,” “creeping,” “pulling” and “discomfort” are commonly used to describe the sensation of restless legs syndrome (RLS); however, many patients cannot find any appropriate way to characterize the feeling. These symptoms are usually alleviated by moving the legs or maneuvers such as stretching, pressure application and rubbing. Immersing the legs in cold or hot water is also reportedly helpful.

Although it is called restless legs syndrome, patients who have had the lower extremity syndrome for many years may start to experience symptoms in the upper extremities. In addition, although the symptoms typically emerge or are most pronounced at bedtime, they could occur at other times of day.

RLS is frequently accompanied with another sleep disorder called period limb movement of sleep (PLMS), characterized by periodic episodes of repetitive, stereotyped leg movement during sleep. According to the studies, around 80% of people with RLS have PLMS.

In 2014, the International Restless Legs Syndrome Study Group announced the criteria for neurologists to officially diagnose the condition. Likewise, there is also criteria for PLMS diagnosis.

What causes RLS?

The current cause remains to be investigated but there are multiple abnormalities in the central and peripheral nervous systems identified as potential causes. The leading consistent finding is reduced iron storage in the central nervous system. Other findings include alteration of the dopaminergic system, change of the brain network in the brainstem, abnormal small blood vessel system leading to poor circulation in the legs and sensory threshold change to cause hypersensitivity to sensory stimuli.

Who is most likely to get RLS?

There have been multiple risk factors identified in RLS. People who have a family history of it tend to be at higher risk. Despite some preliminary findings, no specific gene has been identified as highly linked to the condition. People with low iron in the body, such as iron deficiency anemia, tend to develop RLS. Other medical and neurological conditions, including Parkinson’s disease, multiple sclerosis, uremia/ poor kidney function and pregnancy, particularly in the third trimester, are all known to be related to the RLS.

Are there any home remedies (ex: exercise or diet)?

Exercise may be effective for people with RLS. A randomized controlled trial administered a three-day-a-week exercise program with aerobic and lower-body resistance training that effectively alleviated symptoms after 12 weeks. Other measures, such as cognitive stimulating games (e.g., crossword puzzles), avoiding alcohol or coffee and leg massage or soaking were known to be helpful.

Are there any preventative measures someone can take?

Some medications are known to precipitate RLS or aggravate existing symptoms. These include antihistamines such as diphenhydramine, which is commonly used as an over-the-counter sleep aid. Another common one is anti-nausea/vomiting medication, such as metoclopramide, chlorpromazine and prochlorperazine. While RLS is considered a neurological condition, some neurological medication, including antidepressants or antipsychotics, can also exacerbate the symptoms.

When should you see a doctor for RLS?

From a quality-of-life standpoint, if you can live with the RLS symptoms or live with it by home remedies and other non-medication measures, you do not need to see a doctor. However, from a medical perspective, medical evaluation can be quite useful for early detection of an underlying medical condition, such as iron deficiency anemia.

Learn more about our neurology services at Baylor Medicine.

By Dr. Chi-Ying (Roy) Lin, assistant professor of neurology at Baylor College of Medicine

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