Restless legs syndrome (RLS) is a neurological condition that is characterized by the irresistible urge to move the legs.

It is believed that 10 million adults and 1.5 million children and adolescents have RLS in the United States.

RLS symptoms often begin during childhood or adolescence.

About 35% of patients report RLS onset prior to age 20, and one in ten report that the syndromeappeared during the first decade of life.

Despite all of this, RLS remains underdiagnosed and undertreated.

Symptoms of   RLS include:

  • A strong urge to move your legs which you may not be able to resist. The need to move is often accompanied by uncomfortable sensations. Some words used to describe these sensations include: creeping, itching, pulling, creepy-crawly, tugging, or gnawing.
  • RLS symptoms start or become worse when you are resting. Often people will complain that they are fine until they are at their most peaceful, and just about ready to fall asleep
  • RLS symptoms get better when you move your legs. The relief can be complete or only partial but generally starts very soon after starting an activity. Relief persists as long as the motor activity continues.
  • RLS symptoms are worse in the evening especially when you are lying down. Activities that bother you at night do not bother you during the day.

Children with RLS:

  • May be uncomfortable, and irritable and may need understanding and support from the adults around them.
  • May have impaired intellectual or emotional function that is caused by the discomfort of RLS or the sleep disturbances it causes, and treatment can have a very positive impact on their lives.
  • May be able, with early treatment, to  prevent the progression of their symptoms with age.
  • May be difficult to diagnose, since they may not be able to describe the symptoms listed above in words.

It is important to consider the diagnosis of RLS in  children with mood, behavioral or sleep disturbances when there is a biological relative with RLS.

RLS can make it difficult to fall asleep or stay asleep. Many sufferers of RLS will also have PLMS (Periodic Limb Movements of Sleep). These are jerking movments that can occur up to every 20-30 seconds, at various intervals throughout the night. This may lead to partial awakenings that disrupt sleep, but that the person may not even be fully aware of. This disrupted sleep can result in significant adversity at work/school, in relatonships, and for your health.

Alternative/Complementary Treatments

Nutritional supplements: your doctor can also tell you whether certain dietary supplements may interfere with the way your prescription medications work or may pose health risks for you.

If blood tests show that you are deficient in any of the following nutrients, your doctor may recommend taking dietary supplements as part of your treatment plan:

  • Iron
  • Folic acid
  • Vitamin B
  • Magnesium

More research is needed to reliably establish the safety and effectiveness of all of these supplements in the treatment of RLS.

There is no research that links complementary and alternative therapies to the treatment of Restless Legs Syndrome.  Here are some descriptions of a few treatments that have assisted pain conditions and other related disorders.

Aromatherapy

Aromatherapy is the use of essential oils from plants to support and balance the mind, body and spirit. It has most been used by patients with cancer in an effort to improve quality of life and reduce stress and anxiety.  Some anecdotal reports exist to suggest that placing a small amount of lavendar oil on the temples with light massage can reduce migraine symptoms, and other reports suggest that lavendar applied to the pillow can assist with insomnia. None of these reports has been the subject of any published, controlled trials.

Massage Therapy:

There  is no documented research related to RLS and massage therapy. What may be helpful for persons with RLS are the reported outcomes of improved relaxation and decreased anxiety, which may improve quality of life. It is not known if timing of massage therapies could benefit outcomes related to sleep and RLS. Since massage therapy has shown to have effects on endorphins, which interact with opiate receptor neurons to reduce the intensity of pain, it may be possible to get some benefits from those RLS symptoms which may also respond to treatment with pharmacological opiates. Unfortunately, none of this has been researched and cannot be assumed or prescribed.

Acupuncture:

Acupuncture is one of the oldest healing practices in the world. It has been studied for a variety of conditions, including arm and shoulder pain, pregnancy-related pelvic and back pain, and temporomandibular joint (jaw) dysfunction. Although some studies have produced some positive results, more evidence is needed to determine the efficacy of acupuncture for any of these conditions.

There is evidence that people’s attitudes about acupuncture can affect outcomes. In a 2007 study, researchers analyzed data from four clinical trials of acupuncture for various types of chronic pain. Participants had been asked whether they expected acupuncture to help their pain. In all four trials, those with positive expectations reported significantly greater pain relief.

There is no documented research related to RLS and acupuncture. If one of the suspected biomechanisms for the effectiveness of acupuncture to treat pain is correct (the release of endorphins) then it may be possible to get some benefits from those RLS symptoms that also respond to treatment with opiates. Unfortunately, none of this has been researched and cannot be assumed or presribed.

Causes

The causes of RLS have not been fully elicited, but research is ongoing. It is suspected that there are several overlapping causes of the condition, and that it is due to an imbalance of Dopamine in the brain, a neurotransmitter that send messages to control muscle movement.

Heredity
RLS runs in families in up to half the people with RLS, especially if the condition started at an early age. Researchers have identified sites on the chromosomes where genes for RLS may be present.

Pregnancy
Pregnancy or hormonal changes may temporarily worsen RLS signs and symptoms. Some women experience RLS for the first time during pregnancy, especially during their last trimester. However, for most of these women, signs and symptoms usually disappear quickly after delivery.

Related conditions
For the most part, restless legs syndrome isn’t related to a serious underlying medical problem. However, RLS sometimes accompanies other conditions, such as:

  • Peripheral neuropathy. This damage to the nerves in your hands and feet is sometimes due to chronic diseases such as diabetes and alcoholism.
  • Iron deficiency. Even without anemia, iron deficiency can cause or worsen RLS. If you have a history of bleeding from your stomach or bowels, experience heavy menstrual periods or repeatedly donate blood, you may have iron deficiency.
  • Kidney failure. If you have kidney failure, you may also have iron deficiency, often with anemia. When kidneys fail to function properly, iron stores in your blood can decrease. This, along with other changes in body chemistry, may cause or worsen RLS.
  • ADHD The possible association wtih ADHD is being investigated

Treatment

There is currently not a cure for RLS, but there are some medications and lifestyle interventions that can help diminish symptoms. Most medications used to treat RLS are not recommended for women who are pregnant.

1. Medications for RLS:

  • Dopaminergic agents,
    • Two drugs, ropinirole (Requip) and pramipexole (Mirapex), are approved by the Food and Drug Administration for the treatment of moderate to severe RLS.
    • Doctors commonly also use other Parkinson’s drugs to treat restless legs syndrome, such as a combination of carbidopa and levodopa (Sinemet). People with RLS are at no greater risk of developing Parkinson’s disease than are those without RLS. Side effects of Parkinson’s medications are usually mild and include nausea, lightheadedness and fatigue.
  • Sedatives
    • clonazepam and other benzodiazepines may help a person with RLS sleep better at night. But these medications don’t eliminate the leg sensations, and they may cause daytime drowsiness.
  • Anticonvulsants
    • Certain epilepsy medications, such as gabapentin (Neurontin), may work for some people with RLS.
  • Pain relievers
    • Narcotic medications can relieve mild to severe symptoms, but they may be addicting if used in too high doses. Some examples include codeine, oxycodone (Roxicodone), the combination medicine oxycodone and acetaminophen (Percocet, Roxicet), and the combination medicine hydrocodone and acetaminophen (Lortab, Vicodin).

2. Your physician can evaluate your medications to see if any of them are exacerbating your symptoms

3. Lab evaluations may reveal deficiency of iron or other vitamins that, if treated, either with supplements or an improved diet could help to decrease your symptoms.

4. Exercise can help diminish symptoms.

5. Maintaining a regular pattern of sleeping and waking can diminish symptoms.

6. You may choose to find other coping strategies to deal with RLS

  • Keep a sleep diary, to help you understand factors which improve and worsen your symptoms
  • When you have the urge to move, find ways to do so, to help distract you from your symptoms
  • Some people have modified their work environment by using drafting tables or counters so that they can stand and move when necessary
  • Massage and stretching may help you cope.
  • Consider joining a support group for RLS