Restless Legs Syndrome

Introduction

Restless legs syndrome (RLS), also known as Willis-Ekbom disease (WEB), is a common sleep-related movement disorder characterized by an often unpleasant or uncomfortable urge to move the legs that occurs during periods of inactivity, particularly in the evenings and is transiently relieved by movement.

• Often, patients cannot describe their symptoms, but may describe the sensation as creeping, crawling, itching, burning, searing, tugging, pulling, drawing, aching, hot and cold, electric current–like, restless or painful.
• In half of RLS cases, both arms and legs are affected. Only arm symptoms are rare, and sometimes just one side is affected.

RLS can occur at age, but it tends to get more frequent as people age.

Risk Factors

Family history and genetics

Low iron stores

Uremia secondary to renal failure

Neuropathy related to a variety of underlying causes, including diabetes, alcohol, amyloid, motor neuron disease, poliomyelitis, and radiculopathy

Pregnancy, especially in the third trimester

Certain diseases, e.g. multiple sclerosis, Parkinson disease, spinal cord disease

Certain medications, e.g. first-generation antihistamines (e.g. diphenhydramine, chlorpheniramine, hydroxyzine), dopamine receptor antagonists (e.g. prochlorperazine, metoclopramide) and certain antidepressants (e.g. mirtazapine and SSRIs).

Management

Most cases of restless legs syndrome are mild and do not require intervention.

• The primary goals of therapy are to alleviate or eliminate RLS symptoms and improve daytime function, sleep and quality of life.

Mild, infrequent symptoms may respond to lifestyle changes alone, mainly physical exercise and good sleep practices.

• Excluding iron deficiency is crucial, as it can cause and aggravate restless leg syndrome.

However, if lifestyle changes are insufficient, drug therapy may be needed.

• Dopaminergic drugs, e.g. levodopa/benserazide, levodopa/carbidopa.
• Gabapentinoids, e.g. gabapentin, pregabalin.
• Dopamine agonists, e.g. pramipexole, ropinirole, rotigotine.

Supplements

Magnesium and vitamin B6 supplements can be effective in reducing RLS symptoms and improving sleep quality.

External Links

• UpToDate - Management of restless legs syndrome and periodic limb movement disorder in adults
• Mayo Clinic - Restless legs syndrome
  
• Therapeutic effects of magnesium and vitamin B6 in alleviating the symptoms of restless legs syndrome: a randomized controlled clinical trial, 2022