Restless leg syndrome

Alternative names
Nocturnal myoclonus; RLS

Definition
Restless leg syndrome is a Sleep Disorder characterized by leg discomfort during sleep, which is only relieved by frequent movements of the legs.

Causes, incidence, and risk factors

Restless leg syndrome (RLS) occurs most often in middle-aged and older adults. It is worsened by stress. The cause is not known.

The disorder consists of sensations in the lower legs that make the person uncomfortable unless the legs are moved. The sensations usually occur shortly after going to bed but may also occur during the daytime.

The abnormal sensations occasionally occur in the upper leg, the feet or the arms in addition to the lower leg. In some cases, no other medical or neurological condition is identified. However, restless leg syndrome may occur in patients with peripheral neuropathy or other neurological disorders.

There is an irresistible urge to walk or move the legs to relieve the discomfort, resulting in periodic episodes of leg movements during early sleep stages. The symptoms may last for 1 hour or longer.

Restless leg syndrome can result in a decreased quality of sleep (Insomnia) with subsequent daytime sleepiness, anxiety or Depression, and confusion or slowed thought processes from lack of sleep.

Symptoms

     
  • Sleeping difficulty  
  • Persistent leg movements during sleep hours  
  • Irresistible urge to move the legs  
  • Abnormal sensation in the legs (occasionally, feet, thighs, arms)       o Creeping sensations or discomfort (not pain, not cramps) relieved by movement of the legs       o May occur during the day       o Worse when lying down

Note: Symptoms may be worse during stress or emotional upset.

Signs and tests

There is no specific examination for restless leg syndrome. No structural or other abnormalities are usually discovered unless peripheral nerve disease is also present. A blood test may be done to rule out anemia, which rarely has been associated with restless leg syndrome.

Examination and testing may be used to rule out other disorders that may cause similar symptoms, especially disorders associated with claudication of the legs.

Treatment

There is no known cure for restless leg syndrome.

Minimizing stress and promoting muscle relaxation are often helpful in reducing episodes of restless leg syndrome. Warm baths, gentle stretching exercises, massage or similar techniques may promote muscle relaxation.

If sleep is severely disrupted, medications such as Sinemet (an anti-Parkinson’s medication) or tranquilizers such as clonazepam may be helpful to some people, but they may worsen daytime sleepiness in others. Low doses of Pramipexole, a dopamine agonist, has been found to be very effective in controlling symptoms in some people.

Sometimes low doses of narcotics will relieve symptoms of restless leg syndrome as well.

Expectations (prognosis)
Restless leg syndrome is not dangerous or life-threatening and does not indicate a serious disorder. It can be uncomfortable and can disrupt sleep.

Complications
Insomnia may occur.

Calling your health care provider
Call for an appointment with your health care provider if symptoms of restless leg syndrome are present and sleep is disrupted.

Prevention
Techniques to promote muscle relaxation and stress reduction may reduce the incidence of restless leg syndrome in people prone to the condition.

Johns Hopkins patient information

Last revised: December 4, 2012
by Amalia K. Gagarina, M.S., R.D.

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