Restless legs syndrome

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD medical weight loss NYC and sleep center NYC

Restless legs syndrome
Synonyms	Willis-Ekbom disease
Pronounce	N/A
Specialty	N/A
Symptoms	Uncomfortable sensation in legs, urge to move legs
Complications	N/A
Onset	Any age, but more common in middle-aged and older adults
Duration	Long-term
Types	N/A
Causes	Often unknown, sometimes iron deficiency, kidney failure, pregnancy, Parkinson's disease
Risks	Family history, pregnancy, iron deficiency
Diagnosis	Based on symptoms, polysomnography
Differential diagnosis	Peripheral neuropathy, arthritis, leg cramps
Prevention	N/A
Treatment	Lifestyle changes, medications such as dopamine agonists, gabapentin
Medication	Dopamine agonists, gabapentin, opioids
Prognosis	N/A
Frequency	5-10% of adults
Deaths	Not directly fatal

Restless Legs Syndrome (RLS) is a long-term disorder characterized by a strong urge to move one's legs, often accompanied by unpleasant sensations such as aching, tingling, or crawling. Occasionally, arms may also be affected. These sensations typically occur when at rest and can make it difficult to sleep. As a result, people with RLS may experience daytime sleepiness, low energy, irritability, and a depressed mood. Limb twitching during sleep is also common in individuals with RLS.

Signs and Symptoms

Primary and Secondary

• Strong urge to move legs, usually accompanied by uncomfortable sensations
• Symptoms worsen during periods of rest or inactivity
• Relief from symptoms with movement
• Symptoms are more severe in the evening or at night
• Involuntary limb twitching during sleep

Causes

The exact cause of RLS is still not well understood, but it is believed to involve a combination of genetic, environmental, and lifestyle factors.

ADHD

There is evidence suggesting a link between RLS and Attention Deficit Hyperactivity Disorder (ADHD), with both conditions sharing common neurological pathways and dopamine imbalances.

Medications

Certain medications, such as antidepressants, antipsychotics, and some antihistamines, can exacerbate or trigger RLS symptoms.

Genetics

Genetic factors play a role in RLS, with multiple genes associated with an increased risk of developing the disorder.

Mechanism

Although the exact mechanism of RLS is not fully understood, it is believed to involve an imbalance of dopamine, a neurotransmitter that plays a crucial role in regulating movement and mood.

Diagnosis

Differential Diagnosis

The diagnosis of RLS is primarily based on a detailed clinical evaluation, including a thorough medical history and physical examination. The following diagnostic criteria are typically used to diagnose RLS:

• A strong urge to move the legs, usually accompanied by uncomfortable sensations
• Symptoms worsen during periods of rest or inactivity
• Relief from symptoms with movement
• Symptoms are more severe in the evening or at night
• Additional tests, such as blood tests or sleep studies, may be ordered to rule out other conditions or identify underlying causes.

Treatment

Treatment for RLS aims to alleviate symptoms, improve sleep quality, and address any underlying causes.

Physical Measures

• Regular exercise
• Stretching and massage
• Hot or cold packs
• Good sleep hygiene

Iron

If iron deficiency is identified as an underlying cause, supplementation or dietary changes may be recommended to increase iron levels.

Medications

• Dopaminergic agents (e.g., pramipexole, ropinirole, rotigotine)
• Benzodiazepines (e.g., clonazepam)
• Opioids (e.g., tramadol, oxycodone)
• Anticonvulsants (e.g., gabapentin, pregabalin)

Prognosis

The prognosis for RLS varies from person to person, with some individuals experiencing mild symptoms that can be easily managed, while others may have more severe symptoms that significantly impact their quality of life. However, with appropriate treatment, many people with RLS can achieve symptom relief and improved sleep quality.

Epidemiology

RLS affects approximately 5-15% of the general population, with a higher prevalence in women and individuals of middle age or older. The condition can begin at any age but is more common in adults.

History

Nomenclature

RLS was first described by Sir Thomas Willis in 1672, but the term "restless legs syndrome" was not coined until 1945 by Swedish neurologist Karl-Axel Ekbom. Since then, the understanding of RLS has evolved significantly, with ongoing research into its causes, mechanisms, and treatment options.

Controversy

There has been some controversy surrounding the classification and diagnosis of RLS. Some critics argue that the condition is overdiagnosed or that the diagnostic criteria are too broad, leading to the potential for misdiagnosis or unnecessary treatment.

Research

Current research on RLS is focused on improving the understanding of its underlying causes, identifying more effective treatment options, and exploring potential preventive measures. Studies have investigated the role of iron and dopamine in the development of RLS, as well as the relationship between RLS and other conditions such as ADHD, sleep apnea, and cardiovascular disease.

External links

• Restless Legs Syndrome Foundation
• National Institute of Neurological Disorders and Stroke: Restless Legs Syndrome Fact Sheet
• National Sleep Foundation: Restless Legs Syndrome

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