Definition and Overview

Also known as Willis-Ekbom Disease or Wittmaack-Ekbom Syndrome, restless legs syndrome (RLS) is a relatively common condition that affects the nervous system. This neurological disorder is characterized by an irresistible, often overwhelming urge to move the legs, as the name implies. However, in some cases, the urge is not limited to the legs, but also the arms, head, and torso. In rare cases, patients experience symptoms in phantom limbs.

Individuals experiencing the symptoms find that moving the legs (or other affected body parts) temporarily relieves or tempers the urge. The sensations associated with the condition vary from an ache or an itch to tickling feelings or like something is crawling inside the body. Patients report that the sensation and urges will commence or grow more powerful when they are trying to sleep or while they are relaxing, studying, reading, or any time they are awake and trying to do something else quietly.

Studies show that patients with the condition also suffer from limbs moving or jerking while they are deep in slumber (also known as periodic limb movement disorder). The presence of this disorder can confirm restless legs syndrome.

RLS is considered a spectrum disease, with some patients experience limited to minor annoyance while others suffer from a sleep disruption disorder (which can seriously affect the lives of patients).

Cause of Condition

Many medical researchers and experts believe that restless leg syndrome is caused by iron deficiency. 20% of patients with this condition have below 50 micrograms per litre of iron but over 70% may have increased iron in their blood. RLS is commonly associated with other conditions, issues, and illnesses as well, such as magnesium or folate deficiency, sleep apnoea, diabetes, Parkinson’s disease, celiac disease, varicose vein, fibromyalgia, uremia, and rheumatoid arthritis. Research shows that pregnant women are also prone to developing the condition.

Some common causes of restless legs syndrome include:

  • ADHD. Research shows that there is a close link between attention deficit hyperactivity disorder and restless leg syndrome because of the dysfunctions in the individual’s production of dopamine, a neurotransmitter that serves as a precursor of other biochemicals such as epinephrine. Researchers have discovered that over 40% of ADHD patients have co-existing restless leg syndrome, and more than 20% of RLS patients have ADHD (or symptoms of the disorder).

  • Certain medication. Research also shows that medication such as antihistamines, antiemetics, sedative-hypnotic drugs, antidepressants, anticonvulsants, and antipsychotics drugs can cause restless leg syndrome. In patients already suffering from RLS, the intake of these drugs can worsen the symptoms.

  • Genetic factors. Many RLS patients have family members suffering from the same condition, and research shows that restless legs syndrome can indeed be inherited.

Key Symptoms

Restless legs syndrome can start early in life—even during childhood—with the symptoms progressing or remaining the same over time. In a survey conducted by the Restless Legs Syndrome Foundation among its members, over 40% of the respondents reported that their symptoms manifested before they reached the age of twenty.

One of the most common symptoms is uncomfortable sensation in the legs, which might also be present in other parts of the body such as the torso and the arms. The discomfort is always accompanied by an overwhelming and irresistible urge to move the legs or other parts of the body, seemingly stemming from the need for relief of those sensations. Some patients describe the sensations as an ache, an itch, a crawling sensation, or like being pricked by multiple pins and needles. In some cases, the sensations can also come in the form of numbness in the legs or arms. Most of the time, patients experience these sensations during moments of quiet wakefulness, when they are simply resting, sitting, or lying down.

The symptoms can range from very mild to intolerable, and can be isolated in one part of the body. Some patients also report that they do not experience sensations of any kinds in their extremities or torso, but have an uncomfortable and strong urge to move the affected body part.

Moving the affected part brings instant relief, even if it is just partial or temporary. Some patients try to “walk off” the sensations, but others prefer to engage in other physical activities, such as biking, yoga, and stretching. Many patients find that stomping the legs quickly or moving the legs away from one another can take the place of walking off the symptoms. Medical experts report that the activity that results from the urge to move can vary from one person to the other.

Restless legs syndrome can also affect a patient’s sleep, especially if it occurs during the night. Many patients report that their symptoms are generally worse during nighttime, or even when they are preparing to sleep. However, RLS can also occur in the morning. The general consensus is that most patients experience the symptoms whenever they are staying still or engaging in a relaxing activity.

The United States National Institute of Health declared four criteria to diagnose RLS. First, the patient must have an urge to move the limbs (even without the often reported sensations in the legs or arms). Second, the sensations can be improved or eliminated by engaging in an activity. Third, the sensations worsen during periods of rest. Finally, the symptoms worsen in the evening.

Who to See and Types of Treatment Available

Most of the treatment options for RLS are designed to simply reduce the symptoms and prevent the condition from interfering with the patient’s daytime and nighttime activities. A general practitioner or your family doctor can prescribe medication such as gabapentin enacarbil or dopamine agonists, or in rare and extreme cases, opioids to relieve the symptoms. It is important to note that taking medication for RLS does not completely cure the disorder but merely provides temporary relief.

References:

  • Aurora RN, Kristo DA, Bista SR, et al. The treatment of restless legs syndrome and periodic limb movement disorder in adults-an update for 2012: practice parameters with an evidence-based systematic review and meta-analyses: an American Academy of Sleep Medicine Clinical Practice Guideline. Sleep. 2012;35:1039-1062.

  • Borkan JM. Restless Legs Syndrome. In: Ferri: Ferri's Clinical Advisor. 1st ed. Philadephia, Pa: Mosby Elsevier; 2014:section 1.

  • Chokroverty S, Avidan AY. Sleep and its disorders. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. In: Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 68.

  • Mahowald MW. Disorders of sleep. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 412.

  • Schurks M, Bussfeld P. Multiple sclerosis and restless legs syndrome: a systematic review and meta-analysis. Eur J Neurol. 2013;20:605-615.

  • Wilt TJ, MacDonald R, Ouellette J, et al. Pharmacologic therapy for primary restless legs syndrome: a systematic review and meta-analysis. JAMA Internal Med. 2013;173:496-505.

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