Restless Leg Syndrome
Restless Leg Syndrome (RLS) is described as a “creepy, crawly” sensation that occurs in the legs when patients are sitting or lying still, especially at bedtime. It is felt most often in the calves and relieved by movement. Lying down and trying to relax usually activates the symptoms. Although it occurs when a patient is awake, it can affect the ability to fall asleep and stay asleep and can result in extreme fatigue and excessive sleepiness during the day.
These sensations usually occur in the calf area, but may be felt anywhere from the thigh to the ankle. One or both legs may be affected. For some people, the sensations are also felt in the arms. People with RLS have an irresistible urge to move the affected limb when the sensations occur. Moving often relieves the limb discomfort.
RLS is classified as a movement disorder, as individuals must move their legs in order to gain relief from symptoms. RLS symptoms are generally worse at night with a symptom-free period in the early morning. Other triggering situations are periods of inactivity characterized by sitting for long periods of time, such as during long car trips, during a movie or long-distance flights.
RLS occurs in both men and women, although the incidence is about twice as high in women. It may begin at any age. Many individuals who are severely affected are middle-aged or older. The symptoms typically become more frequent and last longer with age.
Certain chronic diseases may cause "secondary RLS,” such as kidney failure, diabetes and peripheral neuropathy. Individuals with Parkinson’s disease often have RLS as well. Treating the underlying condition may help with RLS symptoms.
Although there is no specific test for RLS, there are four basic criteria for diagnosing the disorder:
- Symptoms that are worse at night and are absent or negligible in the morning.
- A strong and often overwhelming need or urge to move the affected limb(s).
- Sensory symptoms that are triggered by rest, relaxation, or sleep.
- Sensory symptoms that are relieved with movement.
Physicians focus largely on the individual’s history and description of his/her symptoms, triggers and relieving factors. In addition, a neurological and physical exam and list of current medications may be helpful.
Laboratory tests may be performed to rule out other conditions. Blood tests can identify iron and vitamin deficiencies as well as other medical disorders associated with RLS. In some cases, sleep studies may identify other causes of sleep disruption that may impact management of the disorder.
RLS can be treated. Moving the affected limb(s) may provide temporary relief. Sometimes RLS can be controlled by finding and treating an associated medical condition.
Certain lifestyle changes and activities may reduce symptoms with mild to moderate cases. Among these changes are decreased use of caffeine, alcohol, and tobacco; vitamin supplements; changes to sleep patterns; a program of moderate exercise; and massaging the legs, taking a hot bath, or using a heating pad or ice pack.
Medications are also usually helpful, but there is not a single medication that works for all individuals with RLS.