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, 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 at 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", which are 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.
- Identify any treatable secondary causes of RLS (e.g., iron repletion or levothyroxine).
- Avoid drugs and medications known to aggravate RLS.
- Encourage distraction activities, such as playing video games or crossword puzzles, which 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.