Conditions Restless Legs Syndrome

Restless legs syndrome is a neurological disorder that triggers an urge to move the legs.

People with restless legs syndrome (RLS) feel an uncomfortable tingling, itching, or pulling sensation in the legs. They also have a strong need to move their legs. The symptoms primarily occur in the evening and while resting, and subside – at least temporarily – when the person moves their legs.

They can therefore disrupt sleep and impair quality of life. To alleviate them, various treatments can be considered – with or without medication. 

People with Restless Legs Syndrome (RLS) experience an unpleasant feeling in their legs and a strong urge to move them. They describe the feeling as a tingling, itching, a feeling of tightness, or of pulling deep in their legs. However, the symptoms of restless legs vary from person to person and are often difficult to describe. In rare cases, the thighs, arms, or chest are also affected. 

Other typical sensations include: 

• pulling
• tingling
• itching
• pain
• throbbing
• sensation of heat 

The symptoms only occur while resting. Walking or other leg movements temporarily improve them. Rubbing or massage also alleviates the symptoms. These uncomfortable sensations are at their worst in the evenings and at night, typically starting shortly after going to bed, and can make getting to sleep more difficult.

During sleep, some people with restless legs frequently move their legs involuntarily, and less often their arms as well. Experts also refer to it as “Periodic Limb Movements of Sleep” (PLMS). As a result, people with restless legs syndrome also have more trouble staying asleep. During the day, they may then be exhausted, irritable and have difficulty concentrating. Restless legs syndrome can also affect mental health – even to the point of depression.

The exact causes of Restless Legs Syndrome (RLS) are unknown. Several factors likely play a role, especially a genetic predisposition and changes in the nervous system. 

People with restless legs syndrome often have a disturbed iron metabolism in the central nervous system due to which insufficient iron is available in the brain – even though iron deficiency often cannot be detected in the blood. Another known cause is an imbalanced dopamine level. Dopamine is a chemical messenger in the brain responsible for the transmission of nerve impulses. It is important for movement, among other things. 

Restless legs syndrome can also occur under the following circumstances:

• during pregnancy 
• while taking certain medications, such as some beta-blockers or antidepressants
• in other diseases such as chronic kidney weakness, migraine, Parkinson’s disease, multiple sclerosis or irritable bowel syndrome

Restless Legs Syndrome (RLS) is common. It occurs in around 3 to 10 percent of people in Europe and North America. In approximately 1.3 percent of all adults in Germany, the symptoms are so severe that they interfere with daily life and warrant treatment. 

RLS can occur at any age. It becomes more common with increasing age. Women have RLS about twice as often as men. It is less common in children.

In restless legs syndrome, the symptoms are initially mild and often intensify over the course of years. Initially, they appear exclusively in the evening and at night during periods of rest. Over time, they may also occur during the day when the legs are at rest. In severe cases, symptoms may also affect the arms.

If an underlying condition is responsible for the restless legs, the symptoms disappear once that condition is successfully treated. In pregnant women with restless legs, too, the symptoms usually disappear on their own after childbirth.

Restless legs syndrome with an undetermined cause does not usually heal on its own. However, various treatments can alleviate the symptoms.

The initial examinations can usually be performed in the general practitioner’s practice. From there, patients can be referred to other specialist practices, such as for neurology or sleep medicine. 

The doctor makes the diagnosis based on the symptoms. These are an urge to move and an unpleasant sensation in the legs. It is characteristic of these symptoms that 

• they appear or worsen at rest
• subside as soon as and for as long as the individual is in motion 
• increase over the course of the day or occur only in the evening and at night
• cannot be explained by another medical condition 

The doctor will also ask whether other medical conditions are present and which medications are being taken. Additionally, blood is drawn to determine iron, kidney, and thyroid levels. Further investigations – for example in a sleep lab – may follow if the diagnosis is unclear, or to rule out other conditions.

Additionally, an L-Dopa test can be performed. This involves taking a single dose of the medication levodopa (L-Dopa). If symptoms rapidly decrease after taking the medication, this points to restless legs syndrome. 

The goal of treatment is to reduce symptoms to a minimum so they interfere as little as possible with daily life and sleep. 

If another condition that can contribute to restless legs is present at the same time, it is important to treat that condition first. 
If you are taking medications that worsen the symptoms, the doctor may be able to prescribe a different medication. 

If symptoms become severe enough to interfere with an individual’s daily routine and sleep quality, medication is an option. Depending on the situation, the following medications are available:

• Iron tablets or iron infusions
• Dopamine agonists: these replicate the effect of dopamine on the brain.
• Anticonvulsants such as gabapentin or pregabalin: these are drugs to relieve cramp and are also used with epilepsy.
• Opioids if the symptoms cannot be sufficiently alleviated by other medication.