Restless leg syndrome (RLS) may affect as much as 10% of the U.S. population, affecting more people than type 2 diabetes. While a cure for RLS has not yet been discovered, many treatments, coping strategies, and support resources are available to help individuals and families living with the disease. Fortunately, the vein clinic at Novus Spine & Pain Center in Lakeland, Florida offers cutting edge therapies to help relieve the pain and suffering from restless leg syndrome.
The term “restless legs syndrome” was first used by Sir Thomas Willis, an English doctor, in 1672 to describe limb movements that disrupted sleep. It was not until almost three centuries later, in 1945, that Karl-Axel Ekbom, a Swedish neurologist, provided a detailed and comprehensive report of the condition. In his doctoral thesis, Ekbom coined the term “restless legs.”
Today, restless leg syndrome (RLS) is also called Willis-Ekbom disease (WED). RLS is a common and treatable neurological disorder that can affect anyone, regardless of age. RLS results in an irresistible urge to move the legs or other parts of the body, often accompanied by unusual or unpleasant sensations. Because symptoms most often occur in the evening, they can severely disrupt sleep and reduce the quality of life. Because RLS usually interferes with sleep, it also is considered a sleep disorder.
Estimates vary, but RLS may affect up to 10% of the U.S. population. It is found in both sexes, but is more common in women. RLS can begin at any age, even young children. RLS is often unrecognized or misdiagnosed, especially if the symptoms are intermittent or mild.
In This Article:
- What Is Restless Leg Syndrome?
- What Causes Restless Leg Syndrome?
- What are the Symptoms of Restless Leg Syndrome?
- How is Restless Leg Syndrome Diagnosed?
- How is Restless Leg Syndrome Treated?
- What is the Prognosis for Patients with Restless Leg Syndrome?
- Novus Spine & Pain Center
- Restless Leg Syndrome Tests and Clinical Trials
- Restless Leg Syndrome Resources
What Is Restless Leg Syndrome?
Restless legs syndrome (RLS), is a neurological condition associated with abnormal sensations in the legs.
There are four primary features of RLS:
- An uncomfortable sensation in the legs with a clear need or urge to move the legs. The sensation may be described in many ways, from aching and pulling, to creepy-crawling feelings. The sensations can also be painful, not just uncomfortable.
- The symptoms are worse at night. Symptoms may be present only at bedtime, or begin in the evening when trying to sit for any period of time. Sleep problems are common with RLS, because of the difficulty it causes in getting to sleep. Some individuals may have symptoms throughout the day, but the symptoms will always be worse at night and better in the morning.
- The symptoms come on with rest. Whether trying to lie quietly at bedtime or an extended period of sitting, the sensations are likely to strike.
- The symptoms are relieved with movement. All sufferers quickly learn that getting up and walking will immediately relieve the symptoms. However, as soon as the individual settles back into a restful state, the symptoms usually return. Any movement of the legs usually brings about some immediate, although temporary, relief. If the legs are not moved, they may move involuntarily.
There are many conditions which can mimic restless leg syndrome, including:
- Parkinson’s Disease.
- Muscle Diseases.
- Joint Conditions.
- Nerve Problems, such as peripheral neuropathy caused by diabetes (diabetic neuropathy).
- Circulation difficulties.
In children, restless leg syndrome is often misdiagnosed as “growing pains.”
What Causes Restless Leg Syndrome?
Research into the cause of RLS is ongoing. In most cases, doctors do not know the cause of restless legs syndrome; however, researchers have discovered gene variants that contribute to the risk for RLS. Nearly half of the people with RLS also have a family member with the condition. RLS may be related to abnormalities in brain chemicals (neurotransmitters) that help regulate muscle movements, or to abnormalities in the part of the central nervous system that controls automatic movements.
At one time, it was thought that a disease in the blood vessels or nerves in the legs was the cause of RLS, but both ideas have been rejected.
RLS can develop at any age, even during childhood. Research indicates restless leg syndrome appears to become more common as a person ages. Also, poor venous circulation of the legs (such as with varicose veins) can cause restless leg syndrome. The disorder is more common in women than men.
RLS can sometimes be caused by an underlying medical condition (secondary RLS); however, most of the time the cause is not apparent. The two most common medical conditions that can cause RLS are iron-deficiency anemia (low blood count) and peripheral neuropathy (damage to the nerves of the arms and legs, often caused by underlying conditions such as diabetes). Other factors associated with the development or worsening of restless legs syndrome include:
- Alcohol use.
- Amyloidosis (build-up of a starch-like substance in the body’s tissues and organs).
- Certain medications or substances, such as:
- Anticonvulsant drugs (such as Dilantin).
- Antidepressant drugs (including amitriptyline, Paxil).
- Beta-blockers (drugs often used to treat high blood pressure).
- Withdrawal from certain medications, such as vasodilator drugs (for example, Apresoline), sedatives, or antidepressants (for example, Tofranil).
- Chronic diseases. Certain chronic diseases and medical conditions, including Parkinson’s disease, kidney failure, and diabetes often include symptoms of RLS.
- Cigarette smoking.
- Hyper- or hypothyroidism (over- or underactive thyroid glands).
- Lyme disease.
- Parkinson’s disease.
- Pregnancy or hormonal changes. Some women experience RLS especially during the last trimester of pregnancy. Symptoms usually go away within a month after delivery.
- Rheumatoid arthritis and Sjögren syndrome.
- Sleep deprivation.
- Some tumors.
- Spinal nerve damage.
- Varicose veins.
- Vitamin and mineral deficiency, such as magnesium deficiency and vitamin B-12 deficiency.
What are the Symptoms of Restless Leg Syndrome?
Restless leg syndrome usually begins slowly, with the legs becoming more affected over time.
People with restless legs syndrome have uncomfortable sensations in their legs (and sometimes arms or other parts of the body). There is an irresistible urge to move the legs to relieve the sensations. The condition causes an uncomfortable, “itchy,” “pins and needles,” “creepy crawly” feeling, “throbbing,” or “pulling” deep in the legs, typically in the calves. Less frequently, restless leg syndrome can affect the arms.
Sometimes the sensations seem to defy description. Patients typically don’t describe the condition as a muscle cramp or numbness, just a desire to consistently move their legs. The sensation typically begins after the patient has been lying down or sitting for an extended period, such as in a car, airplane, or movie theater. The sensation of RLS often lessens with movement, such as stretching, wiggling the legs, pacing, or walking. Persistent RLS symptoms may worsen while lying down or sitting, and improve with activity; however, in severe cases, symptoms may not improve with movement.
Although RLS doesn’t lead to other serious conditions, symptoms can range from barely bothersome to incapacitating. Many people with RLS find it difficult to fall or stay asleep. The severity of RLS symptoms ranges from mild to intolerable – the symptoms can come and go, and the severity can vary. The symptoms are generally worse in the evening and at night.
Patients with severe RLS can experience an impairment in their quality of life, which can lead to depression. Insomnia may lead to excessive daytime drowsiness, but RLS may prevent the patient from taking a nap during the day.
Other symptoms of RLS include involuntary, repetitive, periodic, jerking limb movements that occur either while asleep, or while awake and at rest. These movements are called “periodic leg movements of sleep” or “periodic limb movement disorder,” and are experienced by as many as 90% of RLS patients.
In some cases, RLS symptoms do not occur every night, but come and go. These patients may go weeks or months without symptoms (called remission) before the symptoms return.
How is Restless Leg Syndrome Diagnosed?
There is no medical test to diagnose RLS; however, doctors may use blood tests and other exams to rule out other conditions. The diagnosis of RLS is based on a patient’s symptoms and answers to questions concerning family history of similar symptoms, medication use, the presence of other symptoms or medical conditions, or problems with daytime sleepiness.
In most people, poor sleep and daytime sleepiness are the most bothersome symptoms of RLS. Because, many patients do not link their sleep problem with the strange sensations in their legs.
Sleep disturbances have many different causes. Your healthcare provider may ask you detailed questions, including current and prior medical problems, family medical problems, medications, work history, travel history, personal habits, and your lifestyle. Your health care provider will also look for signs of an underlying cause for your sleep problem.
RLS cannot be diagnosed with a lab test or an imaging study. However, certain blood tests can help identify underlying medical conditions (anemia and metabolic disorders) that may be linked to RLS. If there are signs of nerve problems (like neuropathy), needle electromyography and nerve conduction studies may be done. Polysomnography (sleep testing) may be necessary to diagnose the sleep disturbances and determine if there are periodic limb movements. This is important for patients who continue to suffer significant sleep disturbances despite relief of RLS symptoms with treatment.
How is Restless Leg Syndrome Treated?
There are no cures for primary RLS. However, treatments can help control the condition, decrease symptoms, and improve sleep. Treatment for secondary RLS (RLS caused by another medical problem) involves treating the underlying cause.
The initial treatment of RLS is to avoid substances or foods that may cause or worsen the problem. In addition, a review of all medications will help determine if drug interaction could be causing the symptoms. Any underlying medical conditions, such as anemia, diabetes, nutritional deficiencies, kidney disease, thyroid disease, varicose veins, or Parkinson’s disease should be treated. For some people, these treatments are all that is needed to relieve RLS symptoms.
Medications may be helpful in treating RLS, but the same drugs are not effective for everyone. In fact, a drug that relieves symptoms for one person may worsen the symptoms in another person. In other cases, a drug that works for a while may lose its effectiveness over time. Drugs for treating primary RLS do not cure the condition, but only relieve symptoms. Patients whose RLS symptoms occur sporadically may be prescribed medication only when they have symptoms.
For patients with mild to moderate RLS, lifestyle changes, such as a regular exercise program, establishing consistent sleep patterns, and eliminating or decreasing the use of caffeine, alcohol, and tobacco, may be helpful.
Other non-drug RLS treatments include:
- Avoid caffeine. Sometimes cutting back on caffeine may help restless legs. Try to avoid caffeine-containing products such as chocolate, coffee, tea, soft drinks, and other caffeinated beverages.
- Change the temperature. Try a cool shower or soaking in a warm bath before bedtime to relax muscles. Experiment with either a heating pad or an ice pack on the legs. Sometimes the change in temperature helps.
- Electrical stimulation. Sometimes stimulating the feet and toes with vibrations or electrical impulses can give relief from RLS symptoms. Some patients have success when doing this a few minutes before going to bed.
- Exercise. Regular, mild activity during the day may help. Sometimes, a short walk or simple stretching exercises before bed can be helpful. However, avoid strenuous exercise, even if it’s early in the day. Too much (or too vigorous) exercise can worsen RLS symptoms.
- Good sleep routine. Try going to bed at the same time every night and getting up at the same time every morning. Fatigue tends to worsen RLS symptoms. To get deep sleep, it may help to go to bed a little later and get up later. Keep your bedroom cool, dark, and comfortable. Keep the TV and computer out of the bedroom.
- Iron supplements. Iron supplements are recommended for individuals with low or low-normal blood tests to help relieve RLS symptoms. However, take iron supplements only with medical supervision, and after a doctor has checked your blood-iron level.
- Other supplements. There’s not a lot of research to confirm the helpfulness of taking other supplements, but some patients report getting relief from RLS symptoms by taking folic acid, magnesium, or vitamin B12.
- Massage. Rubbing the calf muscles may help ease the pain and symptoms. A massage just before bed may help the patient get a better night’s sleep.
- Natural treatments. Sometimes, quinine (tonic) water or other herbal supplements at bedtime may help relieve RLS symptoms. Be sure to discuss any natural treatments for RLS with your doctor.
- Smoking. Stopping smoking can significantly diminish (or prevent) RLS symptoms.
- Stress relief. Stress can worsen RLS symptoms. Find ways to relax and calm anxiety (acupuncture, deep breathing, yoga, meditation, progressive muscle relaxation, or tai chi).
- Vibrating pad. The vibrations from a vibrating pad counter-stimulates the legs while in bed. It is thought this provides the same relief as walking to stop the RLS sensation.
There are studies showing some people with RLS have a form of venous insufficiency such as varicose veins. The vein clinic at Novus Spine & Pain Center offers several minimally invasive procedures to treat varicose veins which may help relieve RLS symptoms. These treatments include:
- Compression therapy. A simple and effective means of improving blood flow in the lower limbs by strengthening vein support with special stockings.
- Endovenous ablation. An image-guided, minimally invasive treatment using radiofrequency or laser energy to cauterize (burn) and close off varicose veins.
- Endovenous thermal ablation (laser therapy). A technique that uses a laser or high-frequency radio waves to create intense, targeted heat to close up a varicose vein or incompetent vein.
- Microphlebectomy. A technique to remove varicose veins by making several tiny incisions (cuts) in the skin through which the varicosed vein is removed. Stitches are not usually required.
- Phlebectomy. A minimally-invasive surgical procedure that removes surface varicose veins.
- RF ClosureFAST. The use of radiofrequency (RF) energy to heat and seal veins for patients with chronic venous insufficiency (CVI).
- Sclerotherapy. The injection of a solution directly into a that irritates the lining of a blood vessel, causing it to collapse and stick together and the blood to clot. Over time, the vessel is not as visible.
- Venaseal. A method of sealing superficial varicose veins using an adhesive agent.
What is the Prognosis for Patients with Restless Leg Syndrome?
RLS is generally a life-long condition for which there is no cure, and the symptoms of RLS may gradually worsen with age. Some patients will experience remissions (periods in which symptoms decrease or disappear for a time), although symptoms usually reappear. If RLS symptoms are mild and do not produces significant daytime discomfort, or do not affect an individual’s ability to fall asleep, the condition may not have to be treated.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and features a vein clinic that treats restless leg syndrome. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.
Restless Leg Syndrome Tests and Clinical Trials
There are ongoing RLS tests, and clinical trials to help prevent, detect, treat, or manage RLS. Links to some clinical trials are:
Throughout the U.S. and Worldwide (ClinicalTrails.gov)
National Institute of Neurological Disorders and Stroke (NINDS.nih.gov)
Mayo Clinic Clinical Trials (Mayo Clinic)
Center Watch (CenterWatch.com)
RLS Clinical Trials (Restless Leg Syndrome Foundation, Inc.)
Restless Leg Syndrome Resources
American Academy of Sleep Medicine
2510 North Frontage Road
Darien, IL 60561
National Sleep Foundation
1010 N. Glebe Road, Ste. 310
Arlington, VA 22201
Restless Leg Syndrome Foundation, Inc.
3006 Bee Caves Rd D206
Austin, TX 78746
Restless Legs Syndrome (WebMD)
Restless Legs Syndrome (National Institue of Neurological Disorders and Stroke)
Restless Legs Syndrome (Mayo Clinic)
Restless Legs Syndrome (Johns Hopkins)
Restless Leg Syndrome (MedicineNet.com)
Understanding RLS (Restless Leg Syndrome Foundation)
How Relaxis Works (MyRelaxis.com)
Restless Legs Syndrome (Wikipedia)
Treating Varicose Veins Can Ease RLS Symptoms (HeathGrades.com)