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Restless Leg Syndrome: Symptoms, Causes, Diagnosis And Treatment

Experiencing twitchiness and discomfort in the legs, usually after going to bed, could indicate the presence of restless leg syndrome (RLS) [1] . As this condition can lead to insomnia, it is also considered a sleep disorder. This condition is also known as Willis-Ekbom disease [2] . The movements that occur when a person has this condition are called periodic limb movements of sleep (PLMS) [3] . For people with primary restless leg syndrome, there can be no cause in particular. However, for secondary restless leg syndrome, it is typically associated with pregnancy, iron deficiency or chronic kidney failure.

Read on to know more about this condition.

What Is Restless Leg Syndrome?

RLS is a condition where the person experiences an unexpected urge to move his or her legs [1] . This urge is triggered by an uncomfortable sensation (such as crawling, creeping or tingling feelings). Moving is said to ease the unpleasant feeling temporarily.

This condition can begin at any age. It disrupts sleep, which in turn, interferes with daily activities. Doctors attribute the occurrence of this disorder to certain mental or physical problems. In some cases, this condition can also be identified as an adverse effect of some medications [1] . It can be classified as mild or severe, depending on the frequency and severity of the symptoms.

However, it is satisfactory to know that a large number of RLS cases resolve on their own over time.

Symptoms Of Restless Leg Syndrome

The prime symptom is the urge to move the legs. The other accompanying symptoms are as follows [4] :

  • Sensations beginning after rest: This usually begins after you have been lying down or sitting at a stretch for a very long time.
  • Relief with movement: The weird sensations lessen with movement (such as walking or stretching).
  • Worsening of symptoms in the evening: The signs of this condition begin to show mainly at night.
  • Nighttime leg twitching: Your legs might twitch and kick while you sleep. This phenomenon is referred to as periodic limb movement of sleep.

The sensations associated with RLS usually happen on both sides of the body. Very rarely, it affects the arms.

The sensations on the limb can be described as follows [5] :

  • Aching
  • Crawling
  • Creeping
  • Pulling
  • Throbbing
  • Itching
  • Electric

The symptoms can fluctuate in severity.

Causes Of Restless Leg Syndrome

Although there is no known cause for RLS, researchers attribute this condition to an imbalance of the brain chemical dopamine (which sends messages to control muscle movement) [6] .

  • Heredity: Sometimes, this condition runs in families [7] . Genes of RLS have been found on few sites on the chromosomes (usually for people who have this condition before 40 years of age).
  • Pregnancy: Hormonal changes during pregnancy can worsen the signs of RLS. However, there are chances that the symptoms completely disappear after delivery.
  • Medications: The following medications can lead to RLS [8] :
  • Antinausea drugs
  • Antipsychotic drugs
  • Antidepressants
  • Allergy medications containing sedating antihistamines

Risk Factors Associated With Restless Leg Syndrome

This condition can develop at any age, even during childhood. This disorder is more common in women than in men. This disorder can sometimes accompany the following conditions:

  • Peripheral neuropathy: Damage to the nerves of the hands and feet occur due to chronic diseases such as diabetes [9] .
  • Iron deficiency: Even if you do not have anaemia, iron deficiency can cause RLS [10] .
  • Kidney failure: When the kidney function deteriorates, iron stores in the blood can decrease leading to RLS [11] .
  • Spinal cord conditions: Research shows that lesions on the spinal cord can lead to RLS [12] .

Complications Of Restless Leg Syndrome

Although RLS does not lead to serious conditions, symptoms can range from bothersome to incapacitating. Severe symptoms due to this condition can lead to insomnia and depression.

Diagnosis Of Restless Leg Syndrome

There is no medical test to diagnose RLS. However, blood tests and other examinations can be conducted to rule out other conditions. Apart from noting down your symptoms, your doctor would also ask your medical history. The following criteria are taken into consideration for diagnosing RLS [13] :

  • The symptoms worsen at night
  • The symptoms start or get worse when you are resting
  • The symptoms are partially or completely relieved by indulging in some activity, such as walking
  • There exists a strong, irresistible urge to move your legs when the weird sensations occur
  • When the symptoms cannot be explained by another medical condition

Blood tests conducted would particularly be to check for iron deficiency. In some conditions, the doctor might refer the patient to a sleep specialist.

Treatment For Restless Leg Syndrome

In case the symptoms of RLS cannot be managed, the following medications might be prescribed [14] :

  • Iron: Supplements with iron may help people with low levels of iron.
  • Alpha 2 agonists: They are helpful in cases of primary RLS (where the cause is unknown)
  • Anticonvulsants: They treat pain and muscle spasms.
  • Benzodiazepines: These are sedative medicines prescribed for mild to moderate symptoms.
  • Painkillers: These are helpful for mild symptoms
  • Dopaminergic agents: The level of dopamine (a neurotransmitter) is raised using these medications.
  • Dopamine agonists: These are helpful in raising the brain dopamine levels and treating unpleasant leg sensations.
  • Opiates: They can relieve symptoms of RLS. These are usually prescribed when other medications seem to fail.

If certain underlying conditions are the cause behind RLS, then this condition might go away when the underlying cause is treated.

Lifestyle And Home Remedies For Restless Leg Syndrome

The following simple lifestyle changes can help you alleviate symptoms of RLS:

  • Apply warm or cool packs: Using hot or cold packs can lessen the limb sensations [15] .
  • Try baths and massages: Soaking in a warm bath along with a mild leg massage can relax the muscles.
  • Establish good sleep hygiene: Ensure that you sleep in a cool and comforting sleeping environment. Go to bed and wake up at the same time daily. Also, ensure that you get adequate sleep.
  • Exercise regularly: Moderate amount of exercises daily can lessen the symptoms of RLS. However, ensure that you do not overdo it.
  • Avoid caffeine: Cutting back on caffeine can help with restless legs [16] .
View Article References
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  2. [2] Ulfberg, J., Stehlik, R., & Mitchell, U. (2016). Treatment of restless legs syndrome/Willis-Ekbom disease with selenium.Iranian journal of neurology,15(4), 235–236.
  3. [3] Choi, J. W., Song, J. S., Lee, Y. J., & Jeong, D. U. (2017). Periodic Limb Movements in Sleep is Associated with Increased Mortality.Psychiatry investigation,14(5), 669–673.
  4. [4] Cotter, P. E., & O'Keeffe, S. T. (2006). Restless leg syndrome: is it a real problem?.Therapeutics and clinical risk management,2(4), 465–475.
  5. [5] Salas, R. E., Gamaldo, C. E., & Allen, R. P. (2010). Update in restless legs syndrome.Current opinion in neurology,23(4), 401–406.
  6. [6] Mitchell, U. H., Obray, J. D., Hunsaker, E., Garcia, B. T., Clarke, T. J., Hope, S., & Steffensen, S. C. (2018). Peripheral Dopamine in Restless Legs Syndrome.Frontiers in neurology,9, 155.
  7. [7] Dhawan, V., Ali, M., & Chaudhuri, K. R. (2006). Genetic aspects of restless legs syndrome.Postgraduate medical journal,82(972), 626–629.
  8. [8] Bliwise, D. L., Zhang, R. H., & Kutner, N. G. (2014). Medications associated with restless legs syndrome: a case-control study in the US Renal Data System (USRDS).Sleep medicine,15(10), 1241–1245.
  9. [9] Anderson, J. C., Fritz, M. L., Benson, J. M., & Tracy, B. L. (2017). Nerve Decompression and Restless Legs Syndrome: A Retrospective Analysis.Frontiers in neurology,8, 287.
  10. [10] Connor, J. R., Patton, S. M., Oexle, K., & Allen, R. P. (2017). Iron and restless legs syndrome: treatment, genetics and pathophysiology.Sleep medicine,31, 61–70.
  11. [11] Novak, M., Winkelman, J. W., & Unruh, M. (2015, July). Restless legs syndrome in patients with chronic kidney disease. InSeminars in nephrology(Vol. 35, No. 4, pp. 347-358). WB Saunders.
  12. [12] Kumru, H., Vidal, J., Benito, J., Barrio, M., Portell, E., Valles, M., ... & Santamaria, J. (2015). Restless leg syndrome in patients with spinal cord injury.Parkinsonism & related disorders,21(12), 1461-1464.
  13. [13] Guo, S., Huang, J., Jiang, H., Han, C., Li, J., Xu, X., … Wang, T. (2017). Restless Legs Syndrome: From Pathophysiology to Clinical Diagnosis and Management.Frontiers in aging neuroscience,9, 171.
  14. [14] Comella C. L. (2014). Treatment of restless legs syndrome.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics,11(1), 177–187.
  15. [15] Carlyle, M., Ouellette, J., Khawaja, I., & Wilt, T. J. (2013). Treatment for Restless Legs Syndrome: Future Research Needs: Identification of Future Research Needs From Comparative Effectiveness Review No. 86.
  16. [16] Allen, R. P., Picchietti, D., Hening, W. A., Trenkwalder, C., Walters, A. S., & Montplaisi, J. (2003). Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology: a report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health.Sleep medicine,4(2), 101-119.
Story first published: Wednesday, June 12, 2019, 10:31 [IST]
Read more about: leg syndrome sleep disorder limb movement