What is Restless Legs Syndrome? What Are Its Symptoms?

Restless legs syndrome is a common condition, affecting approximately 10% of the population [1]. Restless legs syndrome is an impulsive and neurological movement disorder that occurs in the legs while at rest or when immobile. The disturbing symptoms tend to decrease with movement but may intensify in the evening or at night. Genetic or environmental factors are considered underlying causes of the disease. It is known that symptoms worsen, especially in patients with iron deficiency. The symptoms typically develop during rest, particularly during sleep at night, and include the urge to move, sleep disturbances, and concentration problems.

What is Restless Legs Syndrome?

Restless legs syndrome, also known as Willis-Ekbom disease, is a chronic and progressive movement disorder. The disease was first described by Willis in 1683, and the term "restless leg" was coined by neurologist Karl-Axel Ekbom in 1945. Ekbom defined restless legs syndrome as "a sensory symptom and motor disorder that occurs in body limbs during rest." The disease is characterized by an urge to move the legs, accompanied by uncomfortable sensations and sleep problems. The frequency of restless legs syndrome has been found to be 7.3% in women and 3% in men [3]. It is also known to be the most common movement disorder during pregnancy.

Restless legs syndrome can affect individuals of all ages and genders, including children, but its prevalence is higher in middle-aged individuals. The prevalence of the disease in the general population can range from 1% to 15%, and about 2% of children are affected by restless legs syndrome [2]. Restless legs syndrome can be classified into two types. The first type, known as early-onset, is diagnosed before the age of 45, usually due to genetic predisposition, and progresses slowly. In late-onset, the disease progresses rapidly, and the diagnosis is made after the age of 45.

What Are the Symptoms of Restless Legs Syndrome?

One-third of individuals with restless legs syndrome require medical treatments to control their symptoms. Patients often report that their symptoms occur or worsen during actions that do not require movement, such as lying down or sitting. The discomfort and pain tend to increase with immobility. Individuals with restless legs syndrome often have difficulty describing their symptoms. However, the following symptoms are generally observed and help in diagnosing the condition:

• Unpleasant sensations in the legs that trigger an urge to move,
• Throbbing, pain, itching, tingling, and pulling sensations in the legs,
• These symptoms rarely affect the arms,
• Sensations that worsen during rest,
• Discomfort in the legs that temporarily disappears with movement,
• A twitching sensation in the legs during the evening or sleep,
• Sleep disturbances, difficulty falling asleep and staying asleep,
• The urge to get out of bed to move the legs during sleep,
• Fatigue and a strong desire to sleep during the day,
• Behavioral and mood changes,
• Repetitive behaviors such as foot tapping,
• Attention deficits and concentration problems,
• Difficulty remembering things,
• Depression and anxiety.

What Causes Restless Legs Syndrome?

The exact cause of restless legs syndrome is not fully understood. It is believed to be related to the functioning of the basal ganglia, which are responsible for movement in the brain. The basal ganglia use a hormone called dopamine to regulate body movements. If these ganglia do not receive enough dopamine, they cannot efficiently regulate movements as they should, which can lead to restless legs syndrome. The potential causes of restless legs syndrome are briefly outlined below:

• Genetics: There is a genetic predisposition to restless legs syndrome. A family history of the disease in parents or siblings increases the risk for an individual.
• Iron Deficiency: Symptoms of restless legs syndrome are thought to be related to low iron levels in the body. In some cases, correcting iron deficiency can lead to the improvement of symptoms.
• Medications: The use of certain drug groups can either cause or worsen restless legs syndrome. It is important to mention any medications during consultations with a doctor.
• Pregnancy: Hormonal changes and iron or vitamin deficiencies during pregnancy can worsen the symptoms of restless legs syndrome. In some cases, the syndrome can appear during the first pregnancy or especially in the third trimester. The symptoms often disappear after childbirth.
• Kidney Failure: Anemia, which is commonly associated with kidney failure, can occur. Kidney dysfunction can lead to decreased iron stores, which, along with other changes in body chemistry, may cause or worsen the syndrome.
• Spinal Cord Issues: Restless legs syndrome is a neurological condition. Damage or injury to the spinal cord can lead to the development of the disease. Additionally, spinal cord anesthesia increases the risk of the condition.
• Peripheral Neuropathy: Factors such as diabetes can sometimes cause nerve damage in the hands and feet.
• Rheumatic Diseases: Conditions like fibromyalgia, osteoarthritis, and rheumatoid arthritis can sometimes occur alongside restless legs syndrome.
• Type 2 Diabetes Mellitus: Another condition that increases the frequency of restless legs syndrome is diabetes mellitus. In diabetic patients, restless legs syndrome can develop in 17-27% of cases [2].
• Multiple Sclerosis: Restless legs syndrome and multiple sclerosis are two conditions that may occur together, and they are considered secondary causes of one another.

How is Restless Leg Syndrome Diagnosed?

To diagnose Restless Leg Syndrome (RLS), specialists will request a complete medical and genetic history following a physical examination. Since there is no specific test to diagnose RLS, healthcare professionals may perform neurological examinations and blood tests to rule out other conditions and understand the cause of the symptoms. Sleep tests and studies may also be recommended to assess sleep conditions. Diagnosing RLS in children can be more difficult due to the challenge of children not being able to fully express their symptoms and feelings. Additionally, symptoms of RLS may resemble those of common childhood conditions such as Attention Deficit Hyperactivity Disorder (ADHD) or growing pains, making the diagnosis more challenging. Doctors may inquire about the following during the diagnosis of RLS:

• Does the patient feel the urge to move their legs due to pain or discomfort?
• Do symptoms tend to increase or start during periods of rest or inactivity?
• Is there partial or complete relief during stretching, walking, or exercise?
• Do symptoms usually appear or worsen in the evening or at night?
• What medical conditions in the patient's history could contribute to these symptoms?

What Helps Restless Leg Syndrome?

To manage mild restless leg symptoms, certain practices may be implemented based on a doctor's advice. The goal is not to treat the underlying cause of RLS but to alleviate the bothersome symptoms. These symptoms can negatively affect daily life, cause difficulty falling asleep, or impair sleep quality. Some helpful suggestions for managing RLS include:

• Engaging in regular exercises like cycling, brisk walking, or using a stationary bike may help control symptoms.
• Stretching exercises and light massages during the day.
• Establishing good sleep habits, such as avoiding watching TV or using computers and phones before bed, can improve sleep quality and prevent symptom worsening.
• Soaking the legs in a warm bath, applying a heating pad, or using cold compresses can provide temporary relief from discomfort.
• Relaxing exercises such as meditation or yoga can help reduce overall stress. It is also recommended to consult a mental health professional if needed.

How is Restless Leg Syndrome Treated?

In some cases, treating underlying medical conditions like iron deficiency can help alleviate RLS symptoms. Iron supplements can be administered orally or intravenously to address iron deficiency. The use of iron supplements should always be under medical supervision, with the doctor monitoring blood iron levels. Some medications used to treat RLS or the underlying conditions may not be suitable during pregnancy. Therefore, it is recommended to provide comprehensive information about your pregnancy and overall health to your doctor for better treatment planning.

Various medications are prescribed to reduce leg discomfort. While most of these medications are developed to treat other conditions, they can also be helpful in treating RLS. The most common drugs used in medical treatment are those that increase dopamine levels in the brain. These are typically prescribed for moderate to severe RLS. Other prescribed medications may include calcium channel blockers, muscle relaxants, sleep medications, and opioids for managing severe symptoms. Depending on the patient's symptoms and their severity, one or more medications may be combined for treatment.

How to Prevent Restless Leg Syndrome?

There is no known way to prevent RLS. However, treating underlying health issues and making lifestyle changes to reduce stress are some preventive measures that can be taken.

Managing Restless Leg Syndrome can be difficult, as it negatively affects the quality of life, the ability to fall asleep, and maintain sleep. If you or someone you know is experiencing symptoms of RLS, it is advisable to consult a specialist, such as a neurologist, for a more comprehensive understanding of the symptoms, diagnosis, and treatment options.