Restless Legs Syndrome

WHAT IS RESTLESS LEG SYNDROME?

Restless legs syndrome (RLS) is a disorder characterized essentially by an urge to move. The key features of RLS are summarized by the acronym ‘URGE’:

U = Urge to move the legs, usually associated with unpleasant leg sensations

R = Rest induces symptoms

G = Getting active (any movement e.g. walking, stretching) brings relief

E = Evening and night make symptoms worse

About 5-10% of the population suffer from RLS, with 2-3% of the population having moderate to severe RLS.

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What are the causes?

RLS can be divided into primary (idiopathic) and secondary RLS. The cause of primary RLS is not known, and studies suggest there may be a genetic basis to it. Secondary RLS refers to RLS caused by disorders such as iron deficiency, end stage renal disease, diabetes, multiple sclerosis, Parkinson’s disease and pregnancy.

What are the symptoms?

The symptoms are as described in the acronym ‘URGE’ above. The hallmark of RLS is a marked discomfort in the legs that occurs only at rest and is immediately relieved by movement. The discomfort is typically deep seated and localized below the knees. Patients often describe it with words such as crawling, creeping, pulling, aching, itching, drawing or stretching.

How is it diagnosed?

RLS is a clinical diagnosis, based on the above diagnostic criteria. Sometimes a sleep study may be helpful, e.g. to exclude other causes of poor sleep, but is not necessary for diagnosis.

What are the treatment options?

First line treatment for RLS are dopaminergic agents, including dopamine agonists and levodopa. Dopamine agonists such as pramipexole, ropinirole and rotigotine, are generally more effective than levodopa but are associated with more side effects. In patients with iron deficiency, iron supplementation is an important component of treatment. Alternative treatments include opioids and antiepileptic drugs such as gabapentin or pregabalin are also sometimes tried.

What is the prognosis?

RLS is generally a lifelong condition for which there is no cure. Symptoms may gradually worsen with age. Nevertheless, current therapies can control the disorder and minimize symptoms.