Restless Leg Syndrome

Medical Author : William C. Shiel Jr., MD, FACP, FACR

Medical Editor : Charles Patrick Davis, MD, PhD

A woman in bed with restless leg syndrome (RLS).

 

Restless leg syndrome facts

  • Restless leg syndrome is a condition marked by unpleasant leg sensations at bedtime.
  • Restless leg syndrome frequency leads to insomnia.
  • The cause of restless leg syndrome is unknown in most individuals, but many conditions have been associated with it.
  • Treatment of restless leg syndrome is directed toward any underlying illness, if known.
  • Medications are available for restless leg syndrome.

What is restless leg syndrome (RLS)?

Restless leg syndrome (RLS, restless legs syndrome) is a common cause of painful legs. The leg pain of restless leg syndrome typically eases with motion of the legs and becomes more noticeable at rest. Restless leg syndrome also features worsening of symptoms and leg pain during the early evening or later at night.

Restless leg syndrome is often abbreviated RLS; it has also been termed shaking leg syndrome. Nighttime involuntary jerking of the legs during sleep are also known as periodic leg/limb movement disorder.

 

A illustration portraying leg pain caused by restless leg syndrome (RLS).

What causes restless leg syndrome?

The cause of restless leg syndrome is unknown in most people. However, restless leg syndrome has been associated with

Some drugs and medications have been associated with restless leg syndrome including:

  • caffeine,
  • alcohol,
  • H2-histamine blockers (such as ranitidine [Zantac] and cimetidine [Tagamet]), and certain antidepressants (such as amitriptyline [Elavil, Endep]).

Occasionally, restless leg syndrome run in families. Recent studies have shown that restless leg syndrome appears to become more common as a person ages. Also, poor venous circulation of the legs (such as with varicose veins) can cause restless leg syndrome.

 

A senior woman rubbing her aching legs due to restless leg syndrome.

What are the symptoms of restless leg syndrome?

Many different symptoms are described by people with restless leg syndrome, for example:

  • leg pain,
  • cramps,
  • tingling,
  • itchy,
  • burning, and
  • aching.

The characteristic nighttime worsening of symptoms in persons with restless legs syndrome frequency leads to insomnia. Because of lack of sleep, children and some adults may be very drowsy, irritable, and aggressive during daytime hours.

Restless leg syndrome usually begins slowly. Over time, the legs become more affected. Less frequently, restless leg syndrome can affect the arms.

 

A doctor discussing symtoms with a male patient.

How is restless leg syndrome diagnosed?

The National Institutes of Health says that four criteria must be met for the diagnosis of RLS in a person (adult or child):

  • A strong urge to move your legs. This urge often, but not always, occurs with unpleasant feelings in your legs. When the disorder is severe, you also may have the urge to move your arms.
  • Symptoms that start or get worse when you're inactive. The urge to move increases when you're sitting still or lying down and resting.
  • Relief from moving. Movement, especially walking, helps relieve the unpleasant feelings.
  • Symptoms that start or get worse in the evening or at night.
    Illustration of nerves.

    Can other conditions mimic restless leg syndrome?

    There are many conditions which can mimic restless leg syndrome including:

    In children, restless leg syndrome is often misdiagnosed as "growing pains."
    Photo collage of a doctor performing a blood test ona patient, varicose veins on a leg, coffee, alcoholoc drink, cigarette, and women pwer walking for exercise.

    What is the treatment for restless leg syndrome?

    Treatment of restless leg syndrome is first directed toward any underlying illness, if known. For example:

    • Blood testing to reveal underlying iron deficiency anemia may reveal the underlying cause.
    • If varicose veins are thought to be the cause, then surgery to repair the circulation may be considered.
    • Reduction or elimination of caffeine, nicotine, and alcohol from a person's diet can be very helpful.
    • Stopping smoking can significantly diminish or prevent symptoms.
    • Getting better sleep and exercise can help some persons affected by restless legs.
    • Pregnant women who do not sleep well at night and other people with sleep disorders may develop RLS.
      An assortment of medication pills.

      What medications are used to treat restless leg syndrome?

      Medications used to treat restless leg syndrome include:

      • natural supplements (such as iron),
      • carbidopa-levodopa (Sinemet),
      • opioids (such as hydrocodone, or tramadol [Ultram] for intermittent symptoms),
      • carbamazepine (Tegretol, Tegretol XR, Equetro, Carbatrol),
      • clonazepam (Klonopin),
      • diazepam (Valium),
      • triazolam (Halcion),
      • temazepam (Restoril),
      • baclofen (Lioresal)
      • bromocriptine,
      • clonidine (Catapres, Catapres-TTS, Jenloga),
      • gabapentin (Neurontin),
      • gabapentin enacarbil (Horizant ER),
      • ropinirole (Requip), and
      • pramipexole (Mirapex).
        A woman taking a bath to ease her restless leg syndrome pain.

        Are there any remedies or complimentary/alternative treatments for restless leg syndrome?

        Other treatments that have been helpful for some patients include:

        • warm/cold baths,
        • electric nerve stimulation,
        • oral magnesium,
        • acupuncture, and
        • natural treatments such as quinine water at bedtime (tonic water).

        Unfortunately, some of the above mentioned medications may produce side effects, so patients are urged to discuss any conditions that arise after taking medication for RLS with their doctor.

        Anxiety may trigger or increase RLS symptoms according to some investigators. Consequently, many over-the-counter items such as lavender soap fumes or acupuncture, or other home remedies and natural treatments may reduce anxiety and thus reduce symptoms of RLS, according to anecdotal claims. However, there is no known cure for RLS and, in most people, any underlying cause should be ruled out by medical tests.

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