Restless Leg Syndrome

Also called Willis-Ekbom disease, RLS is classified as a sleep disorder since the symptoms usually occur in the late afternoon or evening hours and are triggered by resting and attempting to sleep. It is also classified as a movement disorder since people are forced to move their legs in order to relieve symptoms. However, it is best characterized as a neurological sensory disorder because the symptoms are produced from within the brain.

It is estimated that up to seven to ten percent of the U.S. population may have RLS. It can begin at any age and occurs in both men and women, although women are more likely to have it than men. Many individuals who are severely affected are middle-aged or older, and the symptoms typically become more frequent and last longer with age.

RLS is generally a lifelong condition for which there is no cure. Fortunately, there are therapies—which include lifestyle and medications—that can help control the disorder, minimize symptoms, and increase periods of restful sleep.

The most common symptom reported by people with RLS is the irresistible urge to move, which is often accompanied by uncomfortable sensations in their lower limbs that are unlike normal sensations experienced by people without the disorder.

These sensations are often described as an aching, throbbing, pulling, itching, crawling, or creeping feeling in the legs.

Symptoms can vary from person to person in severity and frequency:

• In moderate cases, symptoms occur only once or twice a week but often result in a significant delay of sleep onset, with some disruption of daytime function.
• In severe cases, symptoms occur more than twice a week and result in troublesome interruption of sleep which can impair daytime function.

These sensations most often alternate between both sides of the body, but sometimes only one side is affected. They less commonly affect the arms, and rarely the chest or head.

A classic feature of RLS is that the symptoms occur in the late afternoon or evening hours and are often most severe at night when a person is resting, such as sitting or lying in bed. There is often a distinct symptom-free period in the early morning, allowing for more refreshing sleep at that time. They also may occur when someone is inactive and sitting for extended periods (for example, when taking a trip by plane or watching a movie).

Some people with RLS have difficulty falling asleep and staying asleep since symptoms can increase in severity during the night. Moving the legs or walking typically relieves the discomfort but the sensations often recur once the movement stops.

In many cases, people with RLS report exhaustion and daytime sleepiness, which negatively affects their mood, concentration, job, and school performance, and personal relationships. RLS can also make traveling difficult.

Since there is no specific test for RLS, the condition is diagnosed by a doctor’s evaluation. At Semmes Murphey Clinic, physician experts in RLS, as well as sleep disorders, diagnose patients by focusing on the individual’s descriptions of symptoms, their frequency and severity, their triggers and relieving factors, as well as the presence or absence of symptoms throughout the day.

Individuals may be asked how much time it takes to fall asleep; any pain related to symptoms; and any tendency toward daytime sleep patterns and sleepiness, disturbance of sleep, or daytime function.

Laboratory tests may rule out other conditions that may be causing the RLS symptoms. But the five basic criteria for clinically diagnosing the disorder are:

• The strong and uncontrollable need or urge to move the legs that is often accompanied by abnormal, unpleasant, or uncomfortable sensations.
• The urge to move the legs starts or get worse during rest or inactivity.
• The urge to move the legs is at least temporarily and partially or totally relieved by movements.
• The urge to move the legs starts or is aggravated in the evening or night.
• The above four features are not due to any other medical or behavioral condition.

Diagnosing pediatric RLS may be difficult because it may be hard for children to describe what they are experiencing, when and how often the symptoms occur, and how long symptoms last. It can sometimes be misdiagnosed as "growing pains" or attention deficit disorder.

For those with mild to moderate symptoms, many physicians suggest certain lifestyle changes and activities to reduce or eliminate symptoms:

• Decreased use of caffeine, alcohol, and tobacco
• Over-the-counter or prescribed supplements to correct deficiencies in iron, folate, and magnesium.
• Taking a hot bath, massaging the legs, or using a heating pad or ice pack
• Aerobic and leg-stretching exercises of moderate-intensity

Physicians also may suggest a variety of prescription medications to treat more severe RLS.

Symptoms may gradually worsen with age, and it may occur somewhat faster for individuals who also suffer from an associated medical condition. It is important to note that a diagnosis of RLS does not indicate the onset of another neurological disease, such as Parkinson’s disease.

Some individuals have been known to enjoy remission periods in which symptoms decrease or disappear for days, weeks, months, or years, although symptoms often eventually reappear.

This information was provided by the specialists at Semmes Murphey Clinic and the National Institute of Neurological Disorders and Stroke. Readers are encouraged to research trustworthy organizations for information. Please talk with your physician for websites and sources that will enhance your knowledge and understanding of this issue and its treatments.