Restless Legs Syndrome

Restless legs syndrome (RLS) or Willis-Ekbom disease is a neurological and sleep-related malady. Individuals with RLS have an overwhelming urge to move their legs due to discomfort and pain relief after moving. The symptoms usually occur when they are at rest or during their sleep. The exact cause of RLS varies from person to person. Disease management often involves lifestyle changes, medications, and addressing underlying medical conditions that may contribute to RLS symptoms.

Types of restless legs syndrome

• Early Onset RLS refers to RLS symptoms that first appear before the age of 45. It is usually caused by genetic disorders or iron deficiency, particularly from heavy menstruation or pregnancy. The symptoms tend to progress gradually.
• Late Onset RLS occurs after age 45. It can progress quickly and can be associated with other medical conditions such as kidney disease, diabetes, or neurological disorders, e.g., Parkinson’s disease.

Symptoms

The discomfort from restless legs syndrome often occurs in your legs, but it can affect other parts of your body. You may have the following sensations:

• Crawling: A sensation as if insects are crawling on your legs.
• Itching: An itchiness or urge to scratch the affected area.
• Aching: A deep, dull ache in the muscles or limbs.
• Burning: A burning or prickling sensation.
• Throbbing: Pulsating or rhythmic sensations in the legs.
• Pulling: A feeling of tension or pulling within the muscles.
• Tugging: An urge to move or adjust the limbs to alleviate the discomfort.

Because of those sensations, you start to develop the symptoms below.

• You feel uncomfortable in your legs and need to move them. 
• The discomfort heightens when you are at rest. 
• Moving your legs provides temporary relief from the discomfort.
• Your legs twitch or jerk when you sleep.

Symptoms of restless legs syndrome disrupt your sleep because you need to wake up to move your legs. It can lead to daytime drowsiness, fatigue, mood swings, difficulty concentrating, anxiety, and even depression.

When to see a doctor

If your condition leads to a lack of quality sleep and daytime sleepiness, visit your doctor for a proper diagnosis.

Causes

• Lack of dopamine. Restless legs syndrome is related to basal ganglia, which uses dopamine neurotransmitters to control your movement. Dopamine deficiency can affect the function of basal ganglia, leading to the condition.
• Hereditary.
• Drugs, such as antihistamines, antidepressants, or anti-emetic medications
• Iron deficiency 
• Medical issues, such as anemia, kidney disease, diabetes, peripheral neuropathy, or pregnancy
• Other possible triggers include alcohol, caffeine, nicotine, stress, or lack of sleep.

Risk factors

• Age: Though restless legs syndrome can develop at all ages, the risk increases as you become older
• Gender: The condition is more common in females and males. 
• Medical conditions: Restless legs syndrome can co-occur with other conditions, including:
  
  • Iron deficiency: Low iron in the blood can exacerbate RLS symptoms.
  • Peripheral neuropathy: This condition is common in patients with diabetes. RLS can be a symptom of peripheral neuropathy.
  • Spinal cord lesions: They can occur due to damage to the spinal cord and the use of local anesthesia to block the spinal cord.
  • Chronic kidney disease: It can cause mineral balance and anemia.
  • Neurological disorders, e.g., Parkinson's disease
  • Pregnancy: This can happen, particularly during the third trimester. The symptoms often improve after childbirth.

Diagnosis

• History taking and physical exam
  Your doctor will inquire about your symptoms, review your personal and family medical history, and assess if you meet the following criteria:  
  
  • You have an irresistible urge to move your legs to relieve the discomfort.
  • The discomfort worsens when you rest, particularly in the evening or at night, and improves when you stretch, walk, or move your legs.
  • Your symptoms are not due to other medical conditions. 
• Blood tests and neurological exam
• Sleep test is advisable if your doctor suspects you are affected by a sleep disorder.

Restless leg syndrome can be challenging to diagnose in children because they may have difficulty expressing their symptoms accurately. The condition can be mistaken for attention-deficit/hyperactivity disorder (ADHD) or the pain of growing up.

Treatment

• Iron supplements, taken with vitamin C.
• Antiseizure medications.
• Dopamine agonists.
• Dopamine precursors.

Medication can help alleviate your symptoms. However, prolonged use of dopamine-augmenting medication can aggravate the condition.

Lifestyle modification and home remedies

• Take a warm bath and massage your legs before bedtime.
• Apply a warm or cold compress to relieve limb sensation.
• Get adequate sleep for at least seven hours every night and stick to your sleep schedule.
• Practice moderate exercise to relieve your symptoms. Avoid high-intensity exercise or working out late in the afternoon.
• Cut back on your caffeine consumption, and avoid tea, soft drinks, or chocolate containing caffeine for a few weeks to see if your symptoms improve. 
• Use a compression foot wrap and a vibrating pad specifically for people with restless legs syndrome.

Prepare Questions before the doctor's appointment

• Note down your symptoms, including their frequency and intensity. Note any preexisting medical conditions you have and the medications you have been taking.
• Bring a friend or family member to help you remember the information discussed during the appointment.
• Write down any questions you want to ask your doctor to ensure you address all your concerns. Sample questions may include:
  • What is the underlying cause of my Restless Legs Syndrome (RLS)?
  • Are there any tests I need to undergo to confirm the diagnosis or assess the severity of RLS?
  • What treatment options do you recommend for managing my RLS?
  • How can I effectively manage my preexisting medical conditions in conjunction with RLS?
  • What lifestyle changes or strategies can I employ to improve my RLS symptoms?

Prepare answers for the questions your doctor may ask

• Do you experience an irresistible urge to move your legs?
• Do your symptoms alleviate after moving your legs or engaging in physical activity?
• At what times of the day do you typically experience RLS symptoms?
• Do your symptoms worsen at night or interfere with your sleep?
• Do you have any sleep issues?
• Are you currently consuming caffeinated beverages regularly?
• Do you engage in late afternoon or evening exercise?
• Have you previously been diagnosed with iron deficiency or received iron supplementation?

A Note from MedPark Hospital

Restless Legs Syndrome (RLS) can significantly disrupt sleep and daily life. However, several lifestyle modifications can alleviate your symptoms and enhance your overall well-being. These include: a medication review for your doctor to assess the need for adjustment of certain medications that may exacerbate RLS symptoms; reducing or eliminating the consumption of caffeinated and alcoholic beverages; engaging in regular, moderate exercise can have a positive impact on RLS.