Restless Leg Syndrome (aka Willis-Ekbom Disease or RLS) is an irresistible urge to move the legs
that is normally accompanied by uncomfortable sensations that are mainly felt in the lower
extremities. The urge to move the legs is partially or totally relieved by movement and tends to
begin or worsen during periods of rest, especially during the evening or at night. Activities such
as travelling by car or plane and watching movies may also worsen symptoms due to remaining
inactive for long periods of time, so getting up to walk or exercise may relieve the discomfort.
Unfortunately, the uncomfortable, and sometimes painful, sensations recur once the
movement ceases.
The uncomfortable sensations normally experienced by those with RLS are difficult to describe
but often reported as aching, throbbing, pulling, itching, crawling, or creeping. Although these
symptoms normally occur in one or both legs, they may sometimes affect the arms or the chest.
Individuals with RLS often report that they pace the room, constantly move their legs while
sitting, and even toss and turn in bed. Thankfully, there is a symptom-free period in the early
morning that allows these individuals for a more refreshing sleep!
Not only do individuals with RLS have a hard time falling asleep, but they also tend to be
exhausted during the day. With minimal and low quality sleep throughout the night, people
with RLS tend to experience affected mood, concentration, job and school performance,
personal relationships, impaired memory, and a failure to accomplish daily tasks. Additionally,
research suggests that those with untreated RLS can experience about a 20% decrease in work
productivity and may contribute to depression and anxiety.
Within the United States alone, about seven to 10% of the population have RLS. Research
shows that women are more likely to develop RLS, with their risk being positively correlated
with number of births. Other risk factors include genetic predisposition, age, and lifestyle
factors, such as lack of physical activity, cigarette smoking, alcohol intake, obesity, and coffee
intake. RLS may also occur as a result of another condition such as iron deficiency, sleep apnea,
end stage renal disease, pregnancy, or neuropathy. Certain medications such as anti-nausea
drugs, antipsychotics, antidepressants that increase serotonin, and some cold and allergy
medication may impact development of RLS as well.
Since RLS is a movement disorder, it is related to the dysfunction of the basal ganglia, a section
of the brain that controls movement by using dopamine. Dopamine is an essential
neurotransmitter that produces smooth and purposeful muscle movement, and the disruption
of this pathway may result in involuntary movements. Research suggests that drugs that
increase dopamine may offer therapeutic benefits to patients with RLS. Despite the short-term
benefits of dopamine increasing drugs, long term use may lead to augmentation, where RLS
symptoms worsen, so alternative drugs are often used when possible.
To help control symptoms, it is best to treat associated medical conditions such as peripheral
neuropathy, diabetes, or iron deficiency. Medications may also be helpful, but they often lose
their effect over time or may worsen symptoms, so changing medications often is necessary. It
may also be helpful to incorporate lifestyle changes such as decreasing alcohol and tobacco use,
exercising, maintaining sleep hygiene, massaging legs, taking warm baths, using heating or ice
packs, legs stretching, using pressured foot wraps, or even investing in vibration pads for the
feet!
Sarah Hassan
Assessment Team Member