Restless Legs Syndrome (RLS): Symptoms, Causes, & Treatment

Sitting in the same place for a long time can cause us to get fidgety.

After some time, you might feel the urge to move your legs. 

However, this urge to move your limbs is more than that for some. It can become a bit of a nuisance and even lead to more severe complications down the road. 

In that case, they may suffer from Restless Legs Syndrome.

Restless Legs Syndrome (RLS), sometimes called the Willis-Ekbom disease, is a chronic multifactorial disease of the limbs, in which patients have the irresistible urge to move their legs.

RLS sufferers can even experience sleep disturbances, as patients with this condition often experience worsening symptoms at night.

This disease is often underdiagnosed, leading to a delay in treatment. (1)

But it doesn’t have to be that way.

We hope that after reading this article, you are more aware of RLS and its causes, the diagnosis of RLS, and the many different treatment options available to patients.

What is Restless Legs Syndrome (RLS)?

While it is possible that you might not know much about Restless Legs Syndrome, it is a widespread condition.

Did you know that an estimated 7-10% of the population suffers from RLS?

Women are also more likely to suffer from RLS than men. (2)

The disorder starts during early childhood, but a patient does not usually receive a diagnosis until they are in their 30s*. 

This condition can be debilitating, but fortunately, it is now treatable thanks to advancements in medicine. We will discuss some of these treatment options and medications later in this article.

There are two types of Restless Legs Syndrome(3):

1. Primary Restless Legs Syndrome
2. Secondary Restless Legs Syndrome

A patient is diagnosed with primary Restless Legs Syndrome when no leading cause can be found.

Secondary Restless Legs Syndrome, conversely, can stem from various causes. You can learn more about these different causes in the next section.

What Causes Restless Legs Syndrome?

Idiopathic Restless Legs Syndrome usually stems from a problem in the dopaminergic systems – systems involving dopamine, a “happiness hormone” –  and iron stores in the brain. RLS can develop where there is a decrease in these areas.

Studies have suggested that RLS may be inherited from our parents and that specific genes may carry the cause of RLS.

However, there are many potential causes for secondary Restless Legs Syndrome. These etiologies include:

1. Varicose veins 
2. End-stage renal disease (ESRD)
3. Celiac disease
4. Fibromyalgia
5. Amyloidosis
6. Folate or magnesium deficiency
7. Diabetes mellitus (either Type 1 or Type 2)
8. Iron deficiency
9. Lumbosacral radiculopathy
10. Rheumatic disease
11. Certain depression medications, such as tricyclic antidepressants (TCA), selective serotonin reuptake inhibitors (SSRI), and other medications like diphenhydramine

RLS can stem from certain vitamin or mineral imbalances, such as a lack of calcium, phosphate, vitamin D, and iron. 

Patients who have anemia, nerve problems, low ferritin, or high estrogen levels can develop Restless Legs Syndrome.

RLS is common in pregnant patients as well, especially in the 3rd trimester. (4)

As you can see, there are a lot of different experiences and ailments that can lead to RLS! 

Now that we’ve established the many causes let’s talk about some of the signs and symptoms of RLS.

What are the Signs and Symptoms of Restless Legs Syndrome?

When patients suffer from Restless Legs Syndrome, they may describe a feeling of crawling, itching, or stretching – one that feels like it comes from their muscles or bones rather than on the skin.

They might complain of paresthesia, or a tickling or prickling sensation, even when nothing is in contact with the skin.

Leg movements are usually involuntary and forceful dorsiflexion (backward bending) of the foot that lasts between 0.5 and 5 seconds. These can occur every 20 to 40 seconds during sleep. This is noted in 80% of patients with RLS.(1) 

Symptoms can vary from mild annoyance to significant impairment – sometimes to the point where it disrupts their day-to-day life.

As we mentioned earlier in this article, symptoms are often worse at the end of the day and increase at night, making it difficult for patients to sleep. Symptoms often come about 15 to 30 minutes before sleeping.

For patients with severe RLS, these movements and feelings occur whenever the patient is seated.

Despite this condition’s name, patients may sometimes experience these movements in upper extremities like their arms or hands!

If this sounds like something you or a loved one is experiencing, you may be dealing with RLS.

Read on to learn more about RLS diagnosis.

How is Restless Legs Syndrome Diagnosed?

If someone is experiencing the above symptoms, they may be dealing with Restless Legs Syndrome.

But it could also be several other ailments. So, how do you know if it’s RLS?

To be diagnosed, you must meet the criteria below(5).

1. You feel an uncontrollable urge to move the lower extremities, which may be accompanied by uncomfortable sensations like paresthesia (that “crawling” or itching sensation).
2. The urge to move these extremities is less so during the daytime but progressively worsens in the evening, especially when asleep. The symptoms also appear during rest or periods of inactivity.
3. The urge to move the lower extremities may be wholly or partially relieved by the movement of the legs. While there is continued activity, the symptoms are often absent or mild.
4. The urge to move the lower extremities often worsens during nighttime and makes sleep impossible. Patients then feel fatigued during the day because of the lack of sleep.
5. Finally, the symptoms listed above do not result from other behavioral conditions, such as leg cramps, muscle cramps, discomfort from certain positions, or tardive dyskinesia. 

While there is no specific test to diagnose Restless Legs Syndrome, medical professionals can perform many different tests to rule out other causes of these symptoms. 

An EMG, or electromyography, may also be requested by your doctor to rule out neuropathies or muscle disorders. 

Once all other causes have been ruled out and a patient receives their diagnosis, it’s time to move on to treatment options. And there are several – let’s learn more. 

What are the Treatments for Restless Legs Syndrome?

Here is a list of things a patient can do to alleviate the symptoms of Restless Legs Syndrome:

• Avoid caffeine, decrease your intake of caffeinated beverages, such as coffee or energy drinks, and avoid or reduce the use of caffeine-containing medication.
• Avoid certain medications, such as antidepressants, antipsychotics, antiemetics, and centrally-acting antihistamines. 
• Exercise daily; however, this may not be recommended for patients with symptoms occurring in the middle of the night.
• Massage and heat or warm compress may provide some relief.
• Medications such as pramipexole, ropinirole, rotigotine, and cabergoline may help decrease a patient’s symptoms and improve sleep and quality of life.
• Rotigotine transdermal patches can also be effective and are often well tolerated.
• Using gabapentin or pregabalin can be used for the initial treatment of patients with severe sleep disturbance and insomnia. It is also used for patients with pain, anxiety, and impulse control disorder. 
• If a patient’s RLS is connected to varicose veins, radiofrequency ablation is a minimally invasive procedure of removing varicose veins, which can, in turn, reduce RLS symptoms.
• If patients also suffer from renal failure, short daily dialysis is recommended. 

While the medications listed above are effective for 1-5 years of symptoms, they may have adverse effects or be contraindicated in certain patients. It is essential to consult with a physician before starting any medications.

For patients with RLS who also suffer from specific vitamin or mineral deficiencies, adding supplements or making dietary changes to account for said deficiencies can alleviate RLS symptoms.

And in the case of pregnant women suffering from RLS, symptoms often improve after delivery.

As you can see, there are a number of medications included on this list that can help alleviate the symptoms of RLS. We will dive a bit more into some of these in the next section:

Medication for Restless Legs Syndrome

There are many different medications out there that can help patients suffering from Restless Legs Syndrome, each working in different ways. Medical professionals can provide recommendations based on a patient’s individual RLS experience.

One example is anti-seizure drugs: the FDA has approved gabapentin enacarbil for treating moderate to severe RLS. The drug has similar effects as dopaminergic treatment, another potentially helpful drug (more on this below).

Recent studies have shown pregabalin, another anti-seizure drug, is as effective for RLS treatments as the dopaminergic drug pramipexole.

Dopaminergic agents, as mentioned earlier, are drugs that increase dopamine effects. They are typically used to treat Parkinson’s disease; however, they have been shown to reduce the symptoms of RLS when taken at night. 

The FDA has also approved ropinirole, pramipexole, and rotigotine to treat moderate to severe RLS. Side effects may include nausea, dizziness, and other short-term effects. 

Long-term use of dopaminergic agents is not recommended as they can worsen symptoms. Stopping the medication can reverse the progression. 

For those suffering from more severe symptoms of RLS, opioids such as methadone, codeine, hydrocodone, and oxycodone may be prescribed in low doses to individuals. Side effects can include constipation, dizziness, nausea, exacerbation of sleep apnea, and risk of addiction. 

Benzodiazepines such as clonazepam and lorazepam are drugs that are generally prescribed to treat anxiety, muscle spasms, and insomnia. They can help obtain more restful sleep. Side effects may include daytime sleepiness, reduced energy, and reduced concentration. They should not be prescribed to individuals with sleep apnea. 

Remember: when it comes to medications, you must talk to your doctor to determine the best treatment option based on your symptoms.

Complications of Restless Legs Syndrome

As mentioned earlier, 7-10% of people are estimated to suffer from Restless Legs Syndrome. This condition is a common one!

70% of patients with RLS may have moderate to severe symptoms.

And, as previously stated, some of these patients may even experience these symptoms in their legs and upper extremities, such as their arms or hands.

For sufferers, symptoms are typically less severe in the morning, especially when living an active life, but they often worsen during nighttime.

When RLS impacts a patient’s sleep, they then suffer from fatigue during the day, and constant fatigue can lead to more severe complications, such as depression.

Conclusion

In this article, we have discussed the following: 

• What is Restless Legs Syndrome (RLS)? 
• What Causes Restless Legs Syndrome?
• How is Restless Legs Syndrome Diagnosed?
• What are the Treatments for Restless Legs Syndrome?
• Medication for Restless Legs Syndrome
• Complications of Restless Legs Syndrome

Restless Legs Syndrome is a complicated and devastating illness, and it can significantly impact the quality of life of those who suffer from it. 

It is crucial that when managing these patients, their disease is explained to them, and supportive care is given. 

RLS can be debilitating and can significantly affect the quality of life of patients.

Fortunately, there are many treatments out there to help alleviate symptoms.

Understanding the symptoms and causes of RLS is the first step toward getting treatment. 

In the case of those suffering from secondary Restless Legs Syndrome, the underlying cause of RLS should also be treated in addition to symptom relief.

The team of experts at Elite Vein Clinic can help. 

If you think you or a loved one has Restless Legs Syndrome and may need further treatment, click here to book a free consultation with Elite Vein Clinic.

Reach out to our clinic today!

References

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1. Mansur A, Castillo PR, Rocha Cabrero F, et al. Restless Leg Syndrome. [Updated 2020 Apr 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430878/
2. Restless Legs Syndrome Fact Sheet. (n.d.). Retrieved from https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/restless-legs-syndrome-fact-sheet
3. Pratt D. P. (2016). Restless Legs Syndrome/Willis-Ekbom Disease and Periodic Limb Movements: A Comprehensive Review of Epidemiology, Pathophysiology, Diagnosis and Treatment Considerations. Current rheumatology reviews, 12(2), 91–112. https://doi.org/10.2174/1573403×12666160223120340
4. Prosperetti, C., & Manconi, M. (2015). Restless Legs Syndrome/Willis-Ekbom Disease and Pregnancy. Sleep medicine clinics, 10(3), 323–xiv. https://doi.org/10.1016/j.jsmc.2015.05.016
5. Guo, S., Huang, J., Jiang, H., Han, C., Li, J., Xu, X., Zhang, G., Lin, Z., Xiong, N., & Wang, T. (2017). Restless Legs Syndrome: From Pathophysiology to Clinical Diagnosis and Management. Frontiers in aging neuroscience, 9, 171. https://doi.org/10.3389/fnagi.2017.00171