Restless Leg Syndrome

Learn About Restless Leg Syndrome

Restless legs syndrome (RLS) is a movement disorder characterized by an irresistible urge to move the legs in response to unpleasant sensations in them. Only movement will discharge the sensations; but they soon creep back in, and the urge to move the legs returns. The symptoms occur primarily in the evening or at night, when a person is relaxing or at rest; and further, this very attempt to relax is what provokes the symptoms in the first place. The sensations are technically called paraesthesias (abnormal sensations) or dysaesthesias (unpleasant abnormal sensations); they range in severity from uncomfortable to irritating to painful. RLS occurs in both men and women, although the incidence is about twice as high in women. It may begin at any age. Many individuals who are severely affected are middle-aged or older, and the symptoms typically become more frequent and last longer with age.

People with RLS feel uncomfortable sensations in their legs, especially when sitting or lying down, accompanied by an irresistible urge to move the affected limb. These sensations less commonly affect the arms, trunk, or head. Although the sensations can occur on just one side of the body, they most often affect both sides. Because moving the legs (or other affected parts of the body) relieves the discomfort, people with RLS often keep their legs in motion to minimize or prevent the sensations. They may pace the floor, constantly move their legs while sitting, and toss and turn in bed.

The most distinctive or unusual aspect of the condition is that lying down and trying to relax activates the symptoms. Consequently, people with RLS have difficulty falling asleep and staying asleep. Left untreated, the condition causes exhaustion and daytime fatigue. Many people with RLS report that their job, personal relations, and activities of daily living are strongly affected as a result of their sleep deprivation. They are often unable to concentrate, have impaired memory, or fail to accomplish daily tasks. It also can make traveling difficult and can cause depression.

A classic feature of RLS is that the symptoms are worse at night with a distinct symptom-free period in the early morning, allowing for more refreshing sleep at that time. Other triggering situations are periods of inactivity such as long car trips, sitting in a movie theater, long-distance flights, immobilization in a cast, or relaxation exercises. Many individuals also note a worsening of symptoms if their sleep is further reduced by events or activity.

In most cases, the cause of RLS is unknown. However, considerable evidence suggests that RLS is related to a dysfunction in the brain’s circuits that use the neurotransmitter dopamine. In particular, disturbances of iron metabolism, which is necessary for the synthesis of dopamine, have been strongly implicated. Often restoring the body’s iron economy to normal will diminish or eliminate the signs and symptoms of RLS. Other factors bearing on the functioning of the dopamine circuitry that can trigger RLS include some forms of chronic disease, certain drugs, and pregnancy.

Medications are usually helpful but no single medication effectively manages RLS for all individuals. In addition, medications taken regularly may lose their effect over time, making it necessary to change medications periodically. Common drugs prescribed to treat RLS include Dopaminergic agents (drugs that increase dopamine). However, these agents can cause nausea, dizziness, or other side effects, some of which are bizarre – such as obsessive gambling or shopping, compulsive sexuality, or fascination with disassembling and assembling mechanical items (punding). Further, long-term use can lead to worsening of the symptoms in many individuals. This apparent progressive worsening is referred to as augmentation. Fortunately, this apparent progression is reversible. Benzodiazepines can help individuals who have mild or intermittent symptoms obtain a more restful sleep. However, because these drugs also may induce or aggravate sleep apnea in some cases, they should not be used in people with this condition. Opioids may be prescribed at night to diminish pain and help to relax individuals with more severe symptoms. Side effects include dizziness, nausea, exacerbation of sleep apnea, and the risk of addiction. Finally, anticonvulsants such as gabapentin and pregabalin can decrease the sensory disturbances such as creeping and crawling sensations and nerve pain. Dizziness, fatigue, and sleepiness are among the possible side effects.

RLS is generally a lifelong condition for which there is no cure. Nevertheless, current therapies can control the disorder, minimizing symptoms and increasing periods of restful sleep. Symptoms may gradually worsen with age, although the decline may be somewhat faster for individuals who also suffer from an associated medical condition. In addition, some individuals have remissions—periods in which symptoms decrease or disappear for days, weeks, or months—although symptoms usually eventually reappear. A diagnosis of RLS does not indicate the onset of another neurological disease, such as Parkinson’s disease.

If you believe you may suffer from RLS and would like to learn more, contact us for a no-cost, no-obligation consultation with the physicians of North Star Medical Research, LLC!

Adapted from and elaborated upon:
NIH - Restless Legs Syndrome Fact Sheet
National Sleep Foundation - Restless Legs Syndrome (RLS) and Sleep

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