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Restless leg syndrome

Nocturnal myoclonus; RLS; Akathisia

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Biller J, Love BB, Schneck MJ. Sleep and its disorders. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Bradley: Neurology in Clinical Practice. 5th ed. Philadelphia, Pa: Butterworth-Heinemann Elsevier; 2008:chap 72.

Lang AE. Other movement disorders. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 417.

Definition

Restless leg syndrome is a disorder in which there is an urge or need to move the legs to stop unpleasant sensations.

Complications

Insomnia may occur.

Prevention

Techniques to promote muscle relaxation and stress reduction may reduce the incidence of restless leg syndrome in people prone to the condition.

Causes, incidence, and risk factors

Restless leg syndrome (RLS) occurs most often in middle-aged and older adults. Stress makes it worse. The cause is not known in most patients.

RLS may occur more often in patients with:

  • Chronic kidney disease
  • Diabetes
  • Iron deficiency
  • Parkinson's disease
  • Peripheral neuropathy
  • Pregnancy
  • Use of certain medications such as caffeine, calcium channel blockers, lithium, or neuroleptics
  • Withdrawal from sedatives

RLS is commonly passed down in families. This may be a factor when symptoms start at a younger age. The abnormal gene has not yet been identified.

Restless leg syndrome can result in a decreased quality of sleep (insomnia). This lack of sleep can lead to daytime sleepiness, anxiety or depression, and confusion or slowed thought processes.

Symptoms

RLS leads to sensations in the lower legs between the knee and ankle. The feeling makes you uncomfortable unless you move your legs. These sensations:

  • Usually occur at night when you lie down, or sometimes during the day when you sit for long periods of time
  • May be described as creeping, crawling, aching, pulling, searing, tingling, bubbling, or crawling
  • May last for 1 hour or longer
  • Sometimes also occur in the upper leg, feet, or arms

You will feel an irresistible urge to walk or move your legs, which almost always relieves the discomfort.

Most patients have rhythmic leg movements during sleep hours, called periodic limb movement disorder (PLMD).

All of these symptoms often disturb sleep. Symptoms can make it difficult to sit during air or car travel, or through classes or meetings.

Symptoms may be worse during stress or emotional upset.

Signs and tests

There is no specific test for restless leg syndrome.

The health care provider will not usually find any problems, unless you also have peripheral nerve disease.

Tests will be done to rule out disorders with similar symptoms, including iron deficiency anemia.

Treatment

There is no known cure for restless leg syndrome.

Treatment is aimed at reducing stress and helping the muscles relax. The following techniques may help:

  • Gentle stretching exercises
  • Massage
  • Warm baths

Low doses of pramipexole (Mirapex) or ropinirole (Requip) can be very effective at controlling symptoms in some people.

If your sleep is severely disrupted, your health care provider may prescribe medications such as Sinemet (an anti-Parkinson's medication), gabapentin and pregabalin, or tranquilizers such as clonazepam. However, these medications may cause daytime sleepiness.

Patients with iron deficiency should receive iron supplements.

Low doses of narcotics may sometimes relieve symptoms of restless leg syndrome.

Expectations (prognosis)

Restless leg syndrome is not dangerous or life-threatening, and it is not a sign of a serious disorder. However, it can be uncomfortable and disrupt your sleep, which can affect your quality of life.

Calling your health care provider

Call for an appointment with your health care provider if:

  • You have symptoms of restless leg syndrome
  • Your sleep is disrupted