Restless legs syndrome (RLS) is characterized by unpleasant sensations in the legs. The person experiences an intense urge to move their legs to alleviate the symptoms. RLS is most acute in the evening and during the night, improving when the patient gets out of bed and moves around. In very rare cases it also affects the arms.
RLS is diagnosed based on clinical symptoms meeting four criteria:
- Urge to move the legs.
- Unpleasant sensations when idle.
- Movement, walking and stretching improve symptoms.
- The symptoms are more acute in the evening or during the night.
RLS can lead to sleeping disorders and insomnia, resulting in sleepiness during the day, headaches, exhaustion and depression. The intensity of the condition may vary greatly. RLS is more common in adults and in old age, but it has also been observed in children.
Many RLS patients have trouble describing the sensation they experience in their legs. Often, the excruciating sensations are described as burning, tingling, pressing, stinging, cramp-like or shooting pains, pulling, etc. The symptoms occur mainly in the evening and when at rest, such as when sitting in front of the television or in bed. The symptoms improve temporarily when performing physical activities or stretching exercises.
Causes of RLS
Usually it is not possible to determine the exact cause of RLS, in which case it is referred to as idiopathic RLS. Known causes of RLS:
- Disorders of the central iron and dopamine metabolism system
- Genetic disposition
- Serious kidney disorders
- Thyroid diseases
- Rheumatic diseases
- Adverse effects of medications (neuroleptics, antidepressants, etc.)
RLS risk factors include pregnancy , particularly during the third trimester, diabetes, gluten intolerance (celiac disease) and neurological disorders, such as polyneuropathy.
RLS is diagnosed based on information provided by the patient in terms of the four criteria listed above. Depending on the symptoms, blood tests as well as a testing of nerve functions may be required.
Possible differential diagnoses include akathisia (restlessness while sitting, adverse effects of medications), cramping of the calves during the night, leg pain, ADHD, polyneuropathy and vascular diseases.
If the syndrome occurs as a result of another condition, i.e. is secondary, the cause should be treated. In the case of an iron deficiency, for example, the patient will be given ironorally or intravenously. Any medications that are the cause should be discontinued or changed if possible.
Medications prescribed for RLS merely treat symptoms. Drugs which are also effective for treating Parkinson’s disease and that increase levels of neurotransmitter dopamine in the spinal cord are prescribed. Dopaminergic treatment is the preferred course of therapy for minor to moderate RLS.
If the main issue is sleep disorders, the patient will be prescribed sleep aids and muscle relaxants. There are many other medications that may be used for specific treatments.
Physical exercise, stretching and massage can sometimes temporarily alleviate symptoms. Performing exercises during the day has also proven effective in some cases. Good sleep hygiene is recommended: avoiding heavy meals in the evening, not consuming alcohol and nicotine, performing activities to tire oneself out, avoiding napping, establishing sleep rituals, dark bedrooms, not keeping phones or alarm clocks next to the bed.