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Restless legs syndrome

Restless legs syndrome – Definition

Restless legs syndrome (RLS) is a neurologic disorder. It is characterized by:

  • Unpleasant sensations in the legs
  • An irresistible urge to move your legs

The sensations are typically worse during periods of inactivity and usually strongest at night. The symptoms are improved with activity. For this reason, people with RLS generally have insomnia, which may be severe.

Restless legs syndrome – Causes

The exact cause is unknown. RLS may occur for no identifiable reason. This is called primary RLS. Or, it may be caused by other conditions or certain drugs. This is called secondary RLS.

Many people with RLS also have periodic limb movement disorder (PLMD). This is a related motor disorder characterized by:

  • Involuntary, repetitive, jerking movements
  • Interrupted sleep because of periodic leg movements

Restless legs syndrome – Risk Factors

These factors increase your chance of developing RLS. Tell your doctor if you have any of these risk factors:

  • Family members with RLS
  • Pregnant — Some women have RLS during pregnancy. The symptoms usually go away after giving birth.
  • Low iron levels (with or without anemia) — may happen if you give blood a lot.
  • Northern European descent
  • Chronic disease (which can lead to secondary RLS):
    • Peripheral neuropathy
    • Chronic kidney failure
    • Chronic venous insufficiency (varicose veins)
    • Radiculopathy (nerve problem)
    • Anemia
    • Diabetes
    • Cancer
    • Chronic obstructive pulmonary disease
    • Rheumatoid arthritis
    • Congestive heart failure
  • Certain medicines (eg, tricyclic antidepressants, selective serotonin reuptake inhibitors [SSRIs], lithium, caffeine, dopamine antagonists, sedating antihistamines)

Restless legs syndrome – Symptoms

Symptoms may include:

  • Feelings of tingling, creeping, pulling, prickling, “pins and needles,” or pain in the legs during periods of rest or inactivity—may also be this feeling in the arms.
  • Symptoms typically get worse at night
  • A strong urge to relieve these uncomfortable feelings with movement
  • Restlessness, including floor pacing, tossing and turning in bed, and rubbing the legs
  • Difficulty falling asleep and staying asleep
  • Hypersomnia — recurrent episodes of excessive daytime sleepiness or prolonged nighttime sleep

Symptoms may begin at any age. But, they are most common in people older than 60 years old. Symptoms usually increase in the evening and during times of rest, relaxation, or inactivity.

Restless legs syndrome – Diagnosis

The doctor will ask about your symptoms and medical history. She will also do a physical and neurologic exam. The diagnosis is based mainly on your symptoms. There is no specific test for RLS. But, tests to check for conditions that may trigger RLS include:

  • Blood tests to check iron levels and the functioning of the kidneys
  • Monitoring of leg activity during sleep
  • Study of leg muscles, such as electromyography (EMG) and nerve conduction studies

Restless legs syndrome – Treatment

There is no cure for RLS. Treatments are aimed at relieving or reducing symptoms.

Treatment for Mild Cases of RLS


  • Massage your legs.
  • Use a heating pad or ice pack.
  • Take a hot bath.
  • Talk to your doctor about taking supplements that might be helpful, such as:
    • Folate
    • Iron
    • Magnesium
    • Vitamins B12, C, and E
  • Refrain from using tobacco, alcohol, or caffeine.
  • Follow a sleep routine.
  • Begin a safe exercise program with the advice of your doctor.
  • Avoid the use of medicines that may worsen RLS.

Treatment for Conditions That May Trigger RLS

Effective treatment of conditions that may trigger RLS can ease or even eliminate symptoms:

  • Anemia
  • Diabetes
  • Neuropathy
  • Kidney failure
  • Hypothyroidism

Treatment for Severe Cases of RLS


  • Benzodiazepines
  • Dopaminergic agents (eg, ropinirole, pramipexole)—considered the most effective
  • Opioids
  • Anticonvulsants (eg, gabapentin)
  • Clonidine

Transcutaneous Electric Nerve Stimulation

During this treatment, electric stimulation is done to the affected area of the leg. This is usually done 15-30 minutes before bedtime to help reduce leg jerking.

Restless legs syndrome – Prevention

There are no guidelines for preventing RLS.

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