Introduction to Restless Legs Syndrome

Restless Legs Syndrome (RLS, Willis-Ekbom disease) is a neurological condition characterised by throbbing, pulling, creeping or other unpleasant sensations in one or both legs, often accompanied by an irresistible urge to move them. The symptoms are often activated at night, and when lying down or otherwise relaxing. Moving the affected limbs relieves the symptoms.[1]

Causes of Restless Legs Syndrome

In many cases the cause of RLS is unknown, however it is often found in families suggesting a possible genetic link.
There is evidence suggesting RLS is related to a dysfunction in the brains basal ganglia circuits that use dopamine. People with Parkinson's disease which is another disorder of this type often also experience RLS.
RLS may also be caused by chronic diseases such as kidney failure, diabetes and peripheral neuropathy. Treating these conditions often relieves the symptoms.
Some medications may trigger or aggravate symptoms including antinausea drugs, antipsychotics, antidepressants affecting serotonin and antihistamines. Discontinuing these medications often relieves symptoms. Patients should always consult with their doctor before discontinuing prescribed drugs.
Pregnancy may trigger symptom, these normally disappear within a month of delivery.
RLS is often reported by people experiencing opioid withdrawal. In these cases the RLS often subsides after the acute withdrawal period ends, but in some cases it has been reported to persist.[2]

Symptoms & Types/Variations of Restless Legs Syndrome

Uncomfortable sensations in one or both legs, particularly while sitting or lying down, accompanied by an irresistible urge to move the affected limb/s. Occasionally the condition may affect parts of the body other than the legs.
People experiencing symptoms often need to keep the affected body part/s in perpetual motion in order to alleviate the symptoms. This can be seen in pacing, tossing and turning in bed or otherwise continually moving the affected area.
Symptoms often become worse at night.
Symptoms can vary in intensity from vaguely irritating to physically painful.
The frequency of symptoms can vary from less than once a week to daily.
Due to the distracting nature of the condition and it's tendency to manifest at night and while lying down, RLS is often accompanied by insomnia.

Treatments for Restless Legs Syndrome

Natural

Stress, fatigue and muscle tenseness may worsen symptoms. Techniques to reduce these factors such as exercise, meditation, yoga, massage, warm baths and applying warm or cold compresses may contribute to relieving symptoms.[3]
Regular physical activity has been shown to improve the severity of symptoms. [4]
High caffeine or alcohol intake is known to precipitate onset of symptoms and should therefore be avoided, particularly before bed time [5].

Pharmaceuticals and supplements

Dopamine agonists that are used to treat Parkinson's disease have been shown to be effective in reducing symptoms of RLS. The US food and drug administration has approved ropinirole, pramipexole and rotigotine for the treatment of moderate to severe RLS. Long term use of these medications may however cause worsening of the symptoms through augmentation.
Gabapentin enacarbil, a prodrug to the anticonvulsant gabapentin is approved by the US food and drug administration for treatment of RLS.
Benzodiazapines may be prescribed off-label to assist with relaxation and sleep for mild cases.
Opioids may be prescribed off-label to diminish pain in severe cases.
Anticonvulsants such as Gabapentin and Pregabalin can be prescribed off-label to alleviate some symptoms.
A daily dose of 800mg valerian root extract showed improvement in the severity of symptoms in a study. [6]
Iron supplements may be of benefit to those with low levels.
Vitamin C, D and E supplements may be of benefit to those with low levels.
The dopaminergic agents amantadine and selegiline may be effective treatments but the level of effectiveness has not been established. [7]
Levodopa and Cabidopa/Levodopa (Sinemet)have been used to effectively treat the symptoms of RLS but extended use is also shown to cause worsening through augmentation [8].
Bupropion has been shown in a randomised controlled trial to be an effective treatment [9]

The Dangers & Health Risks of Restless Legs Syndrome

More than 80% of people experiencing RLS also suffer from a condition known as periodic limb movement of sleep (PLMS). This is characterised by leg twitching or jerking at night, often causing the individual to wake prematurely and repeatedly.
RLS is often accompanied by insomnia due to the difficulty achieving sleep onset because of the distracting nature of the symptoms.

The Latest Medical Information on Restless Legs Syndrome

Morbidity Rate

RLS is not a fatal condition, however associated insomnia and other psychological conditions can be caused or worsened by RLS which may in turn lead to serious consequences.

References

1. ^National Institute of Neurological Disorders and Stroke. (2010). Restless Legs Syndrome Fact Sheet.
2. ^Ghosh, A. Basu, D. (2014). Restless Legs Syndrome in Opioid Dependent Patients. Indian Journal of Psychological Medicine, 36(1), 85-87.
3. ^Mitchell, U. H. (2011). Nondrug-related aspect of treating Ekbom disease, formerly known as restless legs syndrome. Dove Press Journal: Neuropsychiatric Disease and Treatment. 4 May 2011.
4. ^Bega, D., & Malkani, R. (2016). Alternative treatment of restless legs syndrome: an overview of the evidence for mind–body interventions, lifestyle interventions, and neutraceuticals. Sleep Medicine, 17, 99-105. doi:10.1016/j.sleep.2015.09.009
5. ^Klingelhoefer, L., Cova, I., Gupta, S., & Chaudhuri, K. R. (2014). A review of current treatment strategies for restless legs syndrome (Willis-Ekbom disease). Clinical Medicine, 14(5), 520-524. doi:10.7861/clinmedicine.14-5-520
6. ^Cuellar, N. (2009). Valeriana officinalis (valerian) may help patients with restless legs syndrome. Focus on Alternative and Complementary Therapies, 14(3), 179-180. doi:10.1211/fact.14.3.0007
7. ^Littner, M. R., Kushida, C., McDowell Anderson, W., Bailey, D., Berry, R. B., Hirshkowitz, M., … Wise, M. (2004). Practice Parameters for the Dopaminergic Treatment of Restless Legs Syndrome and Periodic Limb Movement Disorder. Sleep, 27(3).
8. ^Trenkwalder, C., & Paulus, W. (2004). Levodopa in the treatment of restless-legs syndrome. FOCUS ON PARKINSON’S DISEASE, 16, 49-52.
9. ^Bayard, M., Bailey, B., Acharya, D., Ambreen, F., Duggal, S., Kaur, T., … Tudiver, F. (2011). Bupropion and Restless Legs Syndrome: A Randomized Controlled Trial. The Journal of the American Board of Family Medicine, 24(4), 422-428. doi:10.3122/jabfm.2011.04.100173