What are RLS symptoms?

Restless legs syndrome is an unpleasant sensation that is often hard to describe. Words sometimes used are tingling, itching, creeping, crawling, jittery, burning, or grabbing. RLS affects calves more often than feet or thighs, and is usually bilateral. Being still for long periods brings it on, and moving around helps.

RLS symptoms are usually worse in early evening or later at night, and may cause insomnia.

RLS is present in about 10-15% of US, Canadian, and European populations, but is less common in Asia. RLS affects African-Americans less than white persons. RLS affects women about twice as often as men. Women who have not borne children have the same risk as men.

Restless leg syndrome is often reported during pregnancy. It most often occurs in the third trimester, and resolves with delivery. RLS affects 25-40% of pregnant women.

The Sleep Heart Health Study showed more stroke or heart disease occurring in those with RLS than those without. There was a correlation between greater frequency or severity of RLS symptoms and occurrence of cardiovascular disease. RLS itself most likely does not cause heart disease. We do know, however, that interrupted sleep can be a risk factor for heart problems.

RLS is more common in smokers.

Causes of RLS

Most cases of RLS are primary, which means that it runs in families, and is most likely genetic. RLS is familial in 25-75% of cases. Several genes have been identified, both dominant and recessive.

There are also several causes of secondary RLS, one of the most common of which is peripheral neuropathy.

Secondary RLS can be caused by:

• peripheral neuropathy
• iron deficiency
• folate deficiency
• magnesium deficiency
• diabetes mellitus
• Lyme disease
• lumbosacral radiculopathy (pinched nerve root)

• rheumatoid arthritis
• Vitamin B12 deficiency
• Sjögren syndrome
• uremia (kidney failure)
• pregnancy
• medications (these can cause or make worse existing symptoms of RLS)

diphenhydramine (present in many over-the-counter medications)
SSRI antidepressants
lithium
beta blockers
antidopamine medications (many antipsychotics, some nausea medications)

• alcohol

• caffeine

Restless Legs Syndrome and Advances In Treatment

Treatments for RLS start with self-help measures, such as hot or cold baths, whirlpool baths, exercise, limb massage, and avoidance of any triggers. There are also several medication treatments. It’s important to work with your doctor to make sure you don’t have one of the conditions that cause secondary RLS.

References:

1. Manconi M, Govoni V, De Vito A, et al. Restless legs syndrome and pregnancy. Neurology. 2004;63(6):1065-1069.
2. Winkelman JW, Shahar E, Sharief I, Gottlieb DJ. Association of restless legs syndrome and cardiovascular disease in the Sleep Heart Health Study. Neurology. 2008;70(1):35-42.
3. Walters AS, Hickey K, Maltzman J, et al. A questionnaire study of 138 patients with restless legs syndrome: The `Night-Walkers’ survey. Neurology. 1996;46(1):92-95.
4. Young, WB, Piovesan, EJ, Biglan, KM. Restless Legs Syndrome and Drug-Induced Akathisia in Headache Patients. CNS Spectrums. 2003; 8(6):450-456.
5. Hornyak M, Grossmann C, Kohnen R, et al. Cognitive behavioral group therapy to improve patients scoping strategies with restless legs syndrome: a proof-of-concept trial. J Neurol Neurosurg Psychiatry 2008;79:823–825.