restless legs syndrome

What is restless legs syndrome?

restless leg syndrome
Restless legs syndrome (RLS) is a neurological sensory motor disorder. It’s characterised by extremely uncomfortable, unpleasant and sometimes painful sensations in your legs (often described as crawling, creeping, pulling, throbbing, itching, tugging, gnawing or burning) that make you feel like getting up and moving around. When you do start moving, the abnormal feelings in your legs temporarily go away. 1, 2

There are two types of RLS. Primary (or “idiopathic”) RLS, whose cause is largely unknown, may be triggered by a problem with chemicals in the brain and could be a matter of genes. Secondary RLS tends to occur later in life and is often associated with another disorder and may be confused with other neurological conditions. Both primary and secondary RLS require a full clinical history and a detailed physical and neurological examination to verify the diagnosis. 2,4

How is RLS diagnosed?

Anywhere between 5-15 in every 100 people will suffer from RLS, which means the condition is fairly common. 2 Women are twice as likely to have it than men. 2, 3 It can begin at any age and generally worsens, as you get older. 2 While there are no standard laboratory diagnostic tests, your doctor may order some blood tests to check your levels of iron, vitamin B12 and glucose, and to check for various underlying medical conditions which are associated with RLS. 2 You may also be asked to have a ‘polysomnography’ sleep test to make sure you don’t have another kind of sleep disorder. 2, 4

What are the symptoms?

Diagnosis is primarily based on your symptoms so you need to freely communicate with your doctor. 2,3

A diagnosis is generally made up of four symptomatic criteria: 2,3,4,5

1

In order to accurately diagnose primary RLS, secondary RLS, which can be due to conditions such as renal failure, pregnancy and iron deficiency should be ruled out 2,3,4,5

Some people who have severe RLS also suffer from a condition called periodic limb movement disorder (PLMD) or night time leg twitching (involuntary leg flexes and extensions while sleeping). Four out of five people with RLS also experience PLMD. If you have severe RLS, these kicking movements may also occur while you’re awake.1
If you have a first degree relative who suffers from RLS you are three to five times more likely to get it.4
The risk of getting RLS is also two to three times higher if you are pregnant, particularly if you are iron deficient.2
Children can also get RLS.3

The impact of restless leg syndrome

One in every four people with RLS has been diagnosed.6 Whereas the overall sensory symptoms of RLS bother about 88 % of sufferers, nearly 60 % of sufferers experience painful symptoms.5 Undiagnosed or untreated, it can have a serious impact on a person’s ability to function from day to day.2

  • More than 75 % of RLS sufferers experience at least one sleep-related problem such as disrupted sleep, inability to fall asleep, and/or insufficient sleep hours5
  • It is estimated that people suffering with RLS sleep an average of five hours a night2
  • 55 % of sufferers report disturbance of daytime functioning and are more likely to suffer disruption during work and reduced social life 4,5
  • Some experience short term memory problems4
  • More than half the children with RLS experience mood and behavioural problems3
  • Sufferers can feel depressed4, 5
  • 40 % of adolescents with RLS are unable to concentrate on their schoolwork3
  • People with RLS are more prone to developing headaches secondary to sleep-loss.4

Living with restless legs syndrome means developing coping strategies that work for you. There are many things you can do to help yourself and also various medications you can discuss with your doctor to establish what’s best for you. 1, 4

Treatment Optoions

Treatment aims to: 2
• Reduce the symptoms and associated sleep disturbances
• Reduce daytime fatigue or sleepiness
• Improve quality of life

Modifying your lifestyle may help.

  • Avoid alcohol and smoking1, 2
  • Cut back on caffeine and caffeine containing products1
  • Exercise1, 2
  • Apply a heat pad to your legs2
  • Massage your legs while having a warm bath1, 2
  • Create a cool, quiet, comfortable sleep environment1
  • Go to bed at the same time every night and rise at the same time in the morning1
  • Try to relax before going to bed – stress can aggravate RLS1
  • Don’t hide your condition and talk to others about RLS1
  • Don’t resist the urge to move and try to find an activity that distracts you1
  • Keep a sleep diary to show your doctor so he/she can understand how you experience sleep problems7
  • Begin and end each day with stretching7
  • Consider joining a support group7
  • When travelling, take morning flights and try to get up and walk around.7

See the Willis-Ekbom Disease Foundation (formerly the RLS foundation – www.rls.org) for more information on coping with RLS.

1. Mayo Clinic staff. Restless legs syndrome. Available at: http://www.mayoclinic.com/health/restless-legs-syndrome/DS00191 Accessed on: 13/12/13

2. Nagandla K, De S. Restless legs syndrome: pathophysiology and modern management. Postgrad Med J 2013;89:402-410.

3.Yeh P, Walters AS, Tsuang JW. Restless legs syndrome: a comprehensive overview on its epidemiology, risk factors, and treatment. Sleep Breath. 2012;16:987-1007.

4. Zhang W, Wang Y, Cong SY, et al. Efficacy and tolerability of pramipexole for the treatment of primary restless leg syndrome: a meta-analysis of randomized placebo-controlled trials. Neuropsychiatr Dis Treat 2013;9:1035-1043

5. Ekbom K, Ulfberg J. Restless legs syndrome. J Intern Med 2009;266:419-431.

6. Allen RP, Walters AS, Montplaisir J, et al. Restless legs syndrome prevalence and impact. REST General Population Study. Arch Intern Med  2005;165:1286-1292.

7. Happe S, Vennemann M, Evers S, et al. Treatment wish of individuals with known and unknown restless legs syndrome in the community. J Neurol 2008;255:1365-1371.

8. Zanni GR. Restless legs syndrome: Learning to live with it. Available at: http://rlstreatmentzone.com/restless-leg-syndrome-treatment/ Accessed on 14/01/14

9. Garcia-Borreguero D, Ferini-Strambi L, Kohnen R, et al. European guidelines on management of restless legs syndrome: report of a joint task force by the European Federation of Neurological Societies, the European Neurological Society and the European Sleep Research Society. Eur J Neurol 2012;19(11):1385-1396.

10. Scholz H, Trenkwalder C, Kohnen R, et al. Dopamine antagonists in the treatment of restless legs syndrome (review). Cochrane Database System Rev 2011 (3).

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