What Is It?

Restless legs syndrome is a movement disorder that causes uncomfortable sensations in the legs. These sensations typically are worse during periods of rest, especially just before sleeping at night, but they may happen during daytime periods of inactivity, such as watching a movie, attending a long business meeting, or flying in a plane. Whenever the discomfort of restless legs syndrome occurs, it is usually accompanied by an overwhelming urge to move the legs, and this movement may relieve leg discomfort temporarily. At night, people with restless legs syndrome often find that their leg symptoms make it difficult to fall asleep. Because of this, insomnia is common, together with extreme drowsiness and fatigue during the daytime.

The cause of restless legs syndrome remains unknown. However, evidence suggests that there is dysfunction in dopamine pathways in the brain. Since restless legs syndrome tends to occur in several generations of an affected family, scientists suspect that there is some genetic (inherited) risk for the problem. In some people with restless legs syndrome, anemia or vitamin deficiency may be a contributing factor, while in others restless legs syndrome has been linked to pregnancy, diabetes, rheumatoid arthritis, kidney failure, varicose veins or peripheral neuropathy (nerve damage in the hands and feet). High caffeine intake (coffee, tea, cola beverages, chocolate) also may be related to restless legs syndrome. Although restless legs syndrome tends to be more common and more severe in people over age 50, it can occur in men and women of any age group, even in young people who may be misdiagnosed as hyperactive. Currently, tens of thousands of people in the United States have restless legs syndrome that is severe enough to disrupt normal daily life. However, researchers estimate that even more people — possibly up to 3 percent to 8 percent of the U.S. population — may have occasional, milder symptoms of restless legs syndrome.

Restless legs syndrome causes a wide range of uncomfortable leg sensations, which may be described as any of the following: tingling, prickly, wormy, boring, crawling, pulling, drawing and, sometimes, pain. Although the muscles of the lower legs are affected most often, restless legs syndrome occasionally can cause symptoms in the arms as well. The discomfort of restless legs syndrome is almost always accompanied by an irresistible need to move the legs, and leg movement, such as walking, stretching and deep knee bends, seems to bring temporary relief. A leg massage or a warm bath also may help.

In addition to leg discomfort, restless legs syndrome also can cause periodic jerking leg movements during sleep. These involuntary leg movements often disturb both the patient and the patient’s bed partner. Also, because symptoms of restless legs syndrome tend to be worse at bedtime, people with restless legs syndrome may find it hard to fall asleep and to stay asleep. This can cause chronic insomnia and severe daytime drowsiness that may interfere significantly with work, school and social life.

Your doctor will diagnose restless legs syndrome based on your symptoms, medical history, family history, and a physical examination. Your doctor also will perform a neurological examination to rule out nerve damage, and he or she will order routine blood tests to check for anemia, iron or vitamin deficiency, diabetes, and kidney problems. If the body’s stores of iron are low, iron supplements may relieve the restless legs syndrome symptoms. In some cases, an overnight sleep study at a sleep clinic may be necessary.

In women who first develop restless legs syndrome during pregnancy, symptoms often disappear after delivery. In other people with restless legs syndrome, the disorder may be a lifelong problem.

Although there is no way to prevent restless legs syndrome, it may be helpful to avoid caffeine, alcohol and cigarette smoking.

Treatment of restless legs syndrome depends on the severity of your symptoms. If your symptoms are mild, simply exercising, stretching, or massaging your legs, or taking a hot bath may bring relief. Lifestyle changes also may help, especially following a balanced diet and avoiding caffeine, alcohol and cigarette smoking. If your restless legs syndrome is linked to anemia or a low iron level, your doctor may prescribe iron.

When medication is used to treat restless legs syndrome, the following drugs are used individually or in combination:

• Dopaminergic agents — These drugs usually relieve the discomfort of restless legs syndrome symptoms and improve sleep quality. They include carbidopa/levodopa (Sinemet), pergolide (Permax), pramipexole (Mirapex) and ropinirole (Requip).



• Benzodiazepines — These drugs are sedatives that improve sleep quality. They include clonazepam (Klonopin), temazepam (Restoril), triazolam (Halcion) and diazepam (Valium).



• Opioids — These are narcotics, such as codeine (several brand names), propoxyphene (Darvon) or oxycodone (OxyContin), that relieve pain and suppress restless legs syndrome in people with severe, unrelenting symptoms.



• Anticonvulsants — These medicines are especially useful in patients whose symptoms are painful. They include gabapentin (Neurontin), carbamazepine (Tegretol, and others) and valproic acid (Depacon, Depakene, Depakote).



• Others — Clonidine (Catapres), amantadine (Symadine, Symmetrel) and propranolol (Inderal) also may be useful to treat this condition.

Many people with restless legs syndrome also have periodic limb movement disorder (PLMD), a common movement disorder that causes involuntary, periodic, jerking leg movements during sleep. The movements occur one to 10 times per minute. The degree of periodic limb movement and how it affects sleep is best assessed with a sleep study (polysomnogram).

Call your doctor whenever you have long-lasting, unexplained discomfort in any part of your body, especially if this discomfort prevents you from sleeping normally.

Symptoms of restless legs syndrome often become more severe with age, although the disorder tends to come and go. In some cases, avoiding caffeine can dramatically decrease restless legs syndrome symptoms.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.