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What Is Restless Leg Syndrome? FAQ About the Condition

Read Flo’s blog post to get the facts about restless leg syndrome: its symptoms, causes, and treatment options.

Restless leg syndrome (RLS), which may also be referred to as restless legs syndrome/Willis-Ekbom disease (RLS/WED), is a condition that creates an uncontrollable urge to move one's leg(s). The urge is usually uncomfortable. Affecting approximately 2.5% of adults in the United States, it has a higher prevalence in women and is more common with increasing age.

Restless leg syndrome most commonly occurs in the evening or sleeping hours, when one is sitting or lying down. Movement can temporarily ease the unpleasant feeling(s).

There are usually some classic features that can be identified in people with RLS.

  • Urge to move: People who have RLS often have an irresistible need to move. This urge is often accompanied by uncomfortable sensations in the lower limbs. There is not a clear way that people with RLS define those sensations. Common descriptions include throbbing, crawling, creeping, aching, itching, and pulling. The sensations typically occur on both sides of the body and can range in severity.
  • Nighttime exacerbations: Known as a “classic” RLS qualification, people with RLS usually complain of symptoms that are worse at night. They also usually report symptom-free periods when they wake up. It’s not uncommon for people with RLS to have difficulty falling or staying asleep.
  • Frequent movement: People with RLS usually move frequently. You may notice them tapping their legs or feet (or another affected area), as this often relieves the discomfort and sensations they are feeling.
  • Remission periods: It is not uncommon for people with RLS to go weeks or months without symptoms before they come back. These periods of remission are more common during the earlier years of the disorder; overall, symptoms generally get worse over time.

Primary RLS, in which the cause is unknown, is the most common form of the condition. However, there are some factors that are believed to contribute or be related to the development of RLS.

  1. Genetics: RLS does have a genetic component. This can be found in families where the onset of symptoms begins before the age of 40.
  2. Iron levels: Some research indicates that low levels of iron in the brain may play a role in the development of RLS. Low levels of iron often coincide with kidney failure and anemia.
  3. Basal ganglia dysfunction: There is evidence that suggests that RLS may be caused by dysfunction in the basal ganglia of the brain, which controls movement.
  4. Medications: Some medications, including anti-nausea drugs, antipsychotic drugs, SSRIs, and medications that contain older antihistamines may contribute to the development of RLS.
  5. Pregnancy: Pregnancy does not cause RLS, but the hormonal changes of pregnancy often aggravate it. It is usually worse in the third trimester and alleviates within four weeks after pregnancy.
  6. Neuropathy: Nerve damage can contribute to the development of RLS.
  7. Spinal cord conditions: Some spinal cord lesions have been linked to RLS. Persons who have had anesthesia directly in their spinal cord also have increased risk for RLS development.

Currently, there is no specific diagnostic test for RLS. However, after a physical evaluation and assessment, a provider generally uses five criteria to diagnose the condition.

  • Overwhelming urge to move legs, usually associated with unpleasant sensations
  • Sensations and urge for movement are worse during inactivity
  • RLS symptoms are worse in the evening or during the night
  • Movement (even if temporarily) relieves the discomfort
  • None of the prior four symptoms can be attributed to any other condition

Restless legs syndrome treatment is meant to relieve symptoms. While movement of the affected limbs often helps temporarily, it is not a long-term solution. After diagnosis, your care provider will be able to work with you to find a treatment plan that should be more effective. It is possible that your treatment plan may need to be modified a couple of times until you find the right combination of medications and lifestyle modifications.

  • Control any coexisting conditions: If your RLS is related to an existing condition, medications will likely be prescribed to control that condition.
  • Restless leg medications: Iron, opioids, anti-seizure drugs, benzodiazepines, and dopaminergic drugs all may be used to treat RLS. Anti-seizure drugs are typically the first-line prescription for RLS. Dopaminergic drugs have been shown to be effective if taken in the evening. Because of their side effects, opioids and benzodiazepines are the last choices if no other treatment has proven effective.
  • Lifestyle choices: Most providers will recommend decreasing or eliminating the use of alcohol and tobacco, regulating sleep patterns, exercising, utilizing heat, and massage. Stretching exercises may also provide some relief.

It is important to note that many of the drugs used to treat RLS can have significant side effects. There is also the potential for a drug to become ineffective, in which case your provider will have to prescribe something new. Your care provider should be able to make the appropriate recommendations related to your current symptoms and any drug side effects that begin to cause issues.

Restless leg syndrome is a lifelong condition with no cure. Though symptoms typically worsen with age, RLS has not been shown to cause any additional physical or neurological complications.

Many people experience periods of remission that last for days up to years, though RLS always returns. And for some, the symptoms of RLS remain mild and do not require treatment.

Restless legs syndrome can show up in any life at any point. While it can’t be prevented, healthy lifestyle modifications, particularly for those with mild RLS, may prove a strong defense. Preventive steps include:

Fortunately, RLS is not a life-threatening condition. However, for those with moderate to severe RLS, the symptoms can be debilitating. If you believe you may have RLS or your current symptoms are significantly affecting your life, reach out to your care provider to ensure you’re getting appropriate treatment. It may take a couple of tries, but there is probably a treatment or combination of therapies that can bring you relief.

https://www.mayoclinic.org/diseases-conditions/restless-legs-syndrome/symptoms-causes/syc-20377168

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5206998/pdf/NEUROLOGY2016734087.pdf

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Restless-Legs-Syndrome-Fact-Sheet

https://www.nhs.uk/conditions/restless-legs-syndrome/

https://www.nhs.uk/conditions/restless-legs-syndrome/symptoms/

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Restless-Legs-Syndrome-Fact-Sheet

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