Restless legs syndrome (RLS)

Restless legs syndrome (RLS) or Wittmaack–Ekbom syndrome is a neurological disordercharacterized by an irresistible urge to move one's body to stop uncomfortable or odd sensations. It most commonly affects the legs, but can affect the arms, torso, and even phantom limbs. Moving the affected body part modulates the sensations, providing temporary relief.
                                                                  (or)

Restless leg syndrome is a disorder in which there is an urge or need to move the legs to stop unpleasant sensations.

Causes, incidence, and risk factors

Restless leg syndrome (RLS) occurs most often in middle-aged and older adults. Stress makes it worse. The cause is not known in most patients.

RLS may occur more often in patients with:

• Peripheral neuropathy
• Chronic kidney disease
• Parkinson's disease
• Pregnancy
• Iron deficiency
• Use of certain medications

A form of RLS may be passed down in families. This may be a factor when symptoms start at a younger age. The abnormal gene has not yet been identified.

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

Symptoms

RLS leads to sensations in the lower legs that make you uncomfortable unless you move your legs. These sensations:

• Usually occur at night when you lie down, or sometimes during the day when you sit for long periods of time
• May be described as creeping, crawling, aching, pulling, searing, tingling, bubbling, or crawling
• May last for 1 hour or longer
• Sometimes also occur in the upper leg, feet, or arms

You will feel an irresistible urge to walk or move your legs, which almost always relieves the discomfort.

Most patients have rhythmic leg movements during sleep hours, called periodic limb movement disorder (PLMD).

All of these symptoms often disturb sleep. Symptoms can make it difficult to sit during air or car travel, or through classes or meetings.

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

Signs and tests

There is no specific examination for restless leg syndrome. The health care provider will not usually find any abnormalities, unless you also have peripheral nerve disease. Blood tests (CBC and serum ferritin) may be done to rule out iron deficiency anemia, which in rare cases can occur with restless leg syndrome.

Examination and testing may be used to rule out other disorders with similar symptoms.

Treatment

There is no known cure for restless leg syndrome.

Treatment of restless leg syndrome (RLS) is first directed toward any underlying cause. While primarily idiopathic, factors/conditions that may cause RLS include anemia and low iron levels, diabetes, renal dysfunction, Parkinson's disease, peripheral neuropathy, and certain medications (eg, antinausea drugs, antiseizure drugs, antipsychotics). Caffeine, alcohol, and tobacco have also been associated with RLS and reduced intake may relieve symptoms.

NON-ERGOT DOPAMINE AGONISTS (eg, pramipexole, ropinirole) may provide symptomatic relief of RLS. They have high specificity and full agonist activity at dopamine receptors with greater binding affinity for the D₃ than the D₂ or D₄ receptors. It is believed that these non-ergot dopamine agonists alleviate the mild striatal presynaptic dopaminergic dysfunction that may be involved in the pathogenesis of RLS. A risk of falling asleep while performing activities of daily living is associated with this class of drugs; use caution.
Pramipexole and ropinirole differ in their routes of metabolism and excretion. Ropinirole is extensively metabolized by the CYP450 pathway and dosage adjustments may be required in patients taking concomitant CYP1A2 inducers or inhibitors. Pramipexole is eliminated via the kidneys, thus, caution should be used when prescribing this agent to patients with renal insufficiency

Treatment is aimed at reducing stress and helping the muscles relax. The following techniques may help:

• Warm baths
• Gentle stretching exercises
• Massage

Low doses of pramipexole or ropinirole (Requip) can be very effective at controlling symptoms in some people.

If your sleep is severely disrupted, your health care provider may prescribe medications such as Sinemet (an anti-Parkinson's medication), gabapentin and pregabalin, or tranquilizers such as clonazepam. However, these medications may cause daytime sleepiness.

Patients with iron deficiency will receive iron supplements.

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

Expectations (prognosis)

Restless leg syndrome is not dangerous or life-threatening, and it is not a sign of a serious disorder. However, it can be uncomfortable and disrupt your sleep.

Complications

Insomnia may occur.

Prevention

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