Restless Leg Syndrome

Condition

Definitions

Restless legs syndrome (RLS) is a condition in which you have an uncontrollable urge to move your legs, usually due to leg discomfort. It typically happens in the evenings or nights while you’re sitting or lying down. Moving eases the unpleasant feeling temporarily.

Restless legs syndrome, now known as restless legs syndrome/Willis-Ekbom disease (RLS/WED), can begin at any age and generally worsens as you age. It can disrupt sleep — leading to daytime drowsiness — and make traveling difficult.

Simple self-care steps and lifestyle changes may help you. Medications also help many people with restless legs syndrome.

Symptoms

The compelling desire to move is what gives restless legs syndrome its name. Common characteristics of RLS signs and symptoms include:

  • Sensation starts after being at rest. The sensation typically begins after you’ve been lying down or sitting for an extended time, such as in a car, airplane or movie theater.
  • Relief by movement. The sensation of RLS/WED lessens with movement, such as stretching, jiggling your legs, pacing or walking.
  • Worsening of symptoms in the evening. Symptoms occur mainly at night.
  • Nighttime leg twitching. RLS/WED may be associated with another, more common condition called periodic limb movement of sleep, which causes your legs to twitch and kick, possibly throughout the night, while you sleep.

People typically describe restless legs syndrome symptoms as abnormal, unpleasant sensations in their legs or feet, usually on both sides of the body. Less commonly, the sensations affect the arms.

The sensations, which generally occur within the limb rather than on the skin, are described as:

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

Sometimes the sensations seem to defy description. Affected people usually don’t describe the condition as a muscle cramp or numbness. They do, however, consistently describe the desire to move their legs.

It’s common for symptoms to fluctuate in severity. In some cases, symptoms disappear for periods of time, then recur.

When to See a Doctor

Some people with restless legs syndrome never seek medical attention because they worry they won’t be taken seriously. Some doctors wrongly attribute symptoms to nervousness, stress, insomnia or muscle cramps.

But RLS/WED has received attention and focus from the media and medical community in recent years, making more people aware of the condition.

If you think you may have RLS/WED, call your doctor.

Causes

Often, there’s no known cause for restless legs syndrome. Researchers suspect the condition may be due to an imbalance of the brain chemical dopamine, which sends messages to control muscle movement.

Heredity
Sometimes RLS/WED runs in families, especially if the condition starts before age 50. Researchers have identified sites on the chromosomes where genes for RLS/WED may be present.

Pregnancy
Pregnancy or hormonal changes may temporarily worsen RLS/WED signs and symptoms. Some women get RLS/WED for the first time during pregnancy, especially during their last trimester. However, signs and symptoms usually disappear after delivery.

Treatments

Sometimes, treating an underlying condition, such as iron deficiency, greatly relieves symptoms of restless legs syndrome. Correcting an iron deficiency may involve taking iron supplements. However, take iron supplements only with medical supervision and after your doctor has checked your blood-iron level.

If you have RLS/WED without an associated condition, treatment focuses on lifestyle changes, and if those aren’t effective, medications.

Medication therapy

Several prescription medications, most of which were developed to treat other diseases, are available to reduce the restlessness in your legs. These include:

  • Medications that increase dopamine in the brain. These medications reduce motion in your legs by affecting the level of the chemical messenger dopamine in your brain. Ropinirole (Requip), rotigotine (Neupro) and pramipexole (Mirapex) are approved by the Food and Drug Administration for the treatment of moderate to severe RLS/WED.Short-term side effects of these medications are usually mild and include nausea, lightheadedness and fatigue. However, they can also cause impulse control disorders, such as compulsive gambling, and daytime sleepiness.
  • Drugs affecting calcium channels. Certain medications, such as gabapentin (Neurontin) and pregabalin (Lyrica), work for some people with RLS/WED.
  • Opioids. Narcotic medications can relieve mild to severe symptoms, but they may be addicting if used in high doses. Some examples of these medications include codeine, oxycodone (Oxycontin, Roxicodone), combined oxycodone and acetaminophen (Percocet, Roxicet), and combined hydrocodone and acetaminophen (Norco).
  • Muscle relaxants and sleep medications. This class of medications, known as benzodiazepines, helps you sleep better at night, but they don’t eliminate the leg sensations, and they may cause daytime drowsiness. Commonly used sedatives for RLS/WED include clonazepam (Klonopin), eszopiclone (Lunesta), temazepam (Restoril), zaleplon (Sonata) and zolpidem (Ambien).

It may take several trials for you and your doctor to find the right medication or combination of medications that work best for you.

Source: Mayo Clinic

Staff

Risa Ravitz, MD
Neurology / Pain Medicine

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