Restless legs syndrome is a rather troublesome condition, manifested by a compulsion to move the legs constantly, often during sleep. Treatment of the disorder is strictly dependent on the immediate cause. Restless legs syndrome statistically occurs in 1 in 10 cases.

What is restless legs syndrome?

Restless legs syndrome (RLS), also known as Wittmaack-Ekbom syndrome, Willis-Ekbom disease or Ekbom disease, is a common condition, affecting around 15 per cent of people. The risk of developing restless legs syndrome increases with age, and it is worth mentioning that women are more likely to complain of the condition than men. Restless legs syndrome is generally noted in adults, between 20 and 30 years of age. It causes unpleasant sensations in the legs and an irresistible urge to move them.

Symptoms usually occur in the late afternoon or evening and are often most severe at night when a person is resting, such as sitting or lying in bed. They can also occur when someone is inactive and sitting for long periods of time (for example, when travelling by plane or watching a film). Symptoms usually become more frequent and last longer with age. Restless legs syndrome can affect mood, concentration, performance at work and school and personal relationships. If left untreated, it can lead to an approximate 20 per cent decrease in work performance and, moreover, can lead to depression and anxiety.

It is understood that more than 80 per cent of people with restless legs syndrome, experience periodic limb movements in sleep (PLMS). Characteristic of PLMS are involuntary movements of the legs (and sometimes the arms) during sleep, which usually occur every 15 to 40 seconds, sometimes throughout the night. It is worth noting that, despite developing PLMS and most people with restless legs syndrome, the syndrome does not occur in most people with PLMS.

Restless legs syndrome – symptoms

Restless legs syndrome causes the patient to have an irresistible urge to move their legs (or even their arms or body).

The feeling is often difficult to define, but can be described as aching, throbbing, pulling or itching. However, it rarely affects parts of the body other than the legs. Although the sensations may only occur on one side of the body, most often both sides are affected. The sensations range in severity from unpleasant to annoying to painful. People suffering from restless legs syndrome try to keep their legs moving, as it is movement that relieves the discomfort. To do this, sufferers walk, move their legs while sitting or toss and turn in bed.

Characteristic of restless legs syndrome is an increase in symptoms at night, causing problems with falling asleep and with sleep in general. Symptoms seem to disappear in the early morning. The symptoms themselves can vary, in terms of severity and frequency, from day to day.

In moderate cases, symptoms of restless legs syndrome occur once, sometimes twice a week, but in severe cases, symptoms of restless legs syndrome occur more than twice a week and cause bothersome interruptions in sleep and impairment of daytime function.

Furthermore, it is important to know that in the case of restless legs syndrome, there are periods of improvement lasting weeks or months when the patient does not experience symptoms of the disease. This usually happens in the early stages of the disease. Unfortunately, the symptoms worsen over time. In addition, it is assumed that people who suffer from other conditions in addition to restless legs syndrome develop more severe symptoms more quickly. Those who only have restless legs syndrome, on the other hand, seem to be in a better situation, as the disease develops more slowly in them, especially if the patients are of a young age.

Restless legs syndrome – causes

Restless legs syndrome usually occurs unrelated to other diseases and is then referred to as idiopathic (approx. 80% of cases). When the condition is caused by other diseases, it is called secondary syndrome (approx. 20% of cases).

Restless legs syndrome may have a genetic basis (certain gene variants have been linked to the disease). Evidence suggests that low brain iron levels may also be responsible for restless legs syndrome. In addition to this, scientists believe that restless legs syndrome may be related to dysfunction of the basal nuclei, the parts of the brain responsible for controlling movement. These use dopamine, which is needed to produce smooth, purposeful muscle activity and movement. Disruption of these pathways often results in involuntary movements.

It is assumed that people with Parkinson’s disease, another disorder of dopamine pathways in the basal nuclei, have an increased chance of developing restless legs syndrome.

In addition, restless legs syndrome, may be associated with or may accompany:

  • end-stage renal failure and haemodialysis;
  • iron deficiency;
  • certain medications that may exacerbate the symptoms of restless legs syndrome, such as anti-nausea drugs (e.g. prochlorperazine, metoclopramide), antipsychotics (e.g. haloperidol, phenothiazine derivatives), serotonin-increasing antidepressants (e.g. fluoxetine, sertraline) and certain cold and allergy medications that contain older antihistamines (e.g. diphenhydramine);
  • use of alcohol, nicotine and caffeine;
  • pregnancy, especially in the last trimester; in most cases, symptoms usually resolve within 4 weeks after delivery;
  • neuropathy.

Furthermore, sleep disorders and conditions such as sleep apnoea can also exacerbate or trigger symptoms in some individuals. Reducing or completely eliminating these factors can alleviate the symptoms of restless legs syndrome.