Restless Leg Syndrome (RLS) is a neurologic disorder characterized by unpleasant sensations in the legs causing an uncontrollable urge to move when at rest in an effort to relieve those feelings. Between 2-15% of the population have RLS, with a peak incidence between 40 and 60 years of age and a 1:2 male:female ratio. It occurs more frequently in end-stage renal disease patients on chronic hemodialysis (up to 60%, depending on the series), and in patients with Parkinson’s disease (up to 20%) than in the general public. RLS disrupts sleep, can lead to excessive daytime sleepiness, depression, and a decreased quality of life.
The etiology of primary
RLS is unknown although it is thought to be a genetic disorder involving either central or peripheral dopaminergic pathways.
causes of RLS are polyneuropathies, diabetes mellitus, rheumatoid arthritis, Sjogren’s syndrome, and fibromyalgia, renal failure, pregnancy, iron deficiency, and hypo- or hyperthyroidism. Drugs that worsen RLS symptoms are nicotine, caffeine, alcohol, SSRIs, SNRIs, neuroleptic agents, metoclopramide, and sedating antihistamines.
Criteria for diagnosis:
- an urge to move the legs
- temporary relief with movement
- onset or worsening of symptoms with rest or inactivity
- worsening or onset of symptoms in the evening or night.
Patients describe symptoms of trouble falling asleep, trouble getting back to sleep; patients or their bed partners may also report "periodic limb movements of sleep": stereotyped, repetitive flexion movements (‘jerking’) of the legs and occasionally arms, exacerbated when patients lie down for prolonged periods.
RLS is a clinical diagnosis for which there is not a confirmatory diagnostic test.
It should be differentiated from
- akathisia, a constant and generalized feeling of motor restlessness not associated with leg discomfort or rest.
- peripheral neuropathies, lumbosacral radiculopathy, and ordinary leg cramps by its circadian rhythm, relief with movement, and the prominence of pain symptoms in non-RLS syndromes.
- Identificate any treatable secondary causes of RLS (e.g. with iron repletion or levothyroxine)
- Avoid drugs and medications known to aggravate RLS.
- Encourage distraction activities such as playing video games or crossword puzzles can decrease symptoms during wakeful periods.
First line agents: dopamine agonists pramipexole, ropinirole.
Second or third line agents: benzodiazepines, opioids, gabapentin, carbamazepine.
See reference for more information.
Adapted from Johnson J and Arnold R. Restless leg syndrome. Palliative Care Network of Wisconsin. Fast facts and concepts #217. Bleeding management in hospice settings. Internet. Accessed on January 5, 2018.