Restless leg syndrome

• Alternative Names

  Nocturnal myoclonus; RLS; Akathisia

• 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:

  • Peripheral neuropathy
  • Chronic kidney disease
  • Parkinson's disease
  • Pregnancy
  • Iron deficiency
  • Use of certain medications

  A form of RLS may be 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 that make 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.

  Note: Symptoms may be worse during stress or emotional upset.

• Signs and tests

  There is no specific examination for restless leg syndrome. The health care provider will not usually find any abnormalities, unless you also have peripheral nerve disease. Blood tests (CBC and serum ferritin) may be done to rule out iron deficiency anemia, which in rare cases can occur with restless leg syndrome.

  Examination and testing may be used to rule out other disorders with similar symptoms.

• 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:

  • Warm baths
  • Gentle stretching exercises
  • Massage

  Low doses of pramipexole 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 will 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.

• Complications

  Insomnia may occur.

• 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
• Prevention

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

• References

  Bayard M, Avonda T, Wadzinski J., Am Fam Physician. 2008 Jul 15;78(2):243

  Goldman L, Ausiello D, eds. Cecil Textbook of Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007

  Kushida CA. Clinical presentation, diagnosis, and quality of life issues in restless legs syndrome. Am J Med. January 2007;120(1 Suppl 1):S4-S12.

Review Date: 8/28/2009

Reviewed By: Luc Jasmin, MD, PhD, Departments of Anatomy Neurological Surgery, University of California, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.