Restless leg syndrome

Restless leg syndrome is a sleep disorder characterized by leg discomfort during sleep, which is only relieved by frequent movements of the legs.

Restless leg syndrome (RLS) occurs most often in middle-aged and older adults. It is worsened by stress. The cause is not known. RLS may occur more often in patients with peripheral neuropathy, chronic kidney disease, Parkinson's disease, pregnancy, or iron deficiency.

Restless leg syndrome can result in a decreased quality of sleep (insomnia) with subsequent daytime sleepiness, anxiety or depression, and confusion or slowed thought processes from lack of sleep.

The disorder consists of sensations in the lower legs that make the person uncomfortable unless the legs are moved. The sensations usually occur shortly after going to bed but may also occur during the daytime.

The abnormal sensations occasionally occur in the upper leg, the feet or the arms in addition to the lower leg.

There is an irresistible urge to walk or move the legs to relieve the discomfort, resulting in periodic episodes of leg movements during early sleep stages. Symptoms, which may last for 1 hour or longer, can include:

• Sleeping difficulty
• Persistent leg movements during sleep hours
• Irresistible urge to move the legs
• Abnormal sensation in the legs (occasionally, feet, thighs, arms)
  • Creeping sensations or discomfort (not pain, not cramps) relieved by movement of the legs
  • May occur during the day
  • Worse when lying down

Note: Symptoms may be worse during stress or emotional upset.

There is no specific examination for restless leg syndrome. No structural or other abnormalities are usually discovered unless peripheral nerve disease is also present. Blood tests (CBC and serum ferritin) may be done to rule out iron deficiency anemia, which rarely has been associated with restless leg syndrome.

Examination and testing may be used to rule out other disorders that may cause similar symptoms, especially disorders associated with claudication of the legs.

There is no known cure for restless leg syndrome.

Treatment is aimed at reducing stress and helping the muscles relax. Warm baths, gentle stretching exercises, massage or similar techniques may help.

Low doses of pramipexole or ropinirole (Requip) have been found to be very effective in controlling symptoms in some people. If sleep is severely disrupted, medications such as Sinemet (an anti-Parkinson's medication) or tranquilizers such as clonazepam may be prescribed, but they may cause daytime sleepiness.

Patients with iron deficiency will receive iron supplements.

Low doses of narcotics may sometimes relieve symptoms of restless leg syndrome.

Restless leg syndrome is not dangerous or life-threatening and does not indicate a serious disorder. It can be uncomfortable and can disrupt sleep.

Insomnia may occur.

Call for an appointment with your health care provider if symptoms of restless leg syndrome are present and sleep is disrupted.

Techniques to promote muscle relaxation and stress reduction may reduce the incidence of restless leg syndrome in people prone to the condition.

Goldman L, Ausiello D. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders; 2007.

Kushida CA. Clinical presentation, diagnosis, and quality of life issues in restless legs syndrome. Am J Med. January 2007;120(1 Suppl 1):S4-S12.