Restless Legs Syndrome (Willis-Ekbom disease)

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    What is Restless Legs Syndrome?

    Restless legs syndrome (RLS), or Willis-Ekbom disease, is a nervous system disease that is characterised by uncomfortable sensations in the legs that causes an uncontrollable urge to move them. 

    RLS affects women more often than men, and though people of all ages can develop this disease, the more severe symptoms occur in older adults [1].

    How will having Restless Legs Syndrome affect me?

    RLS can be disruptive to your daily activities and greatly affect the way you live your life, with the potential to affect your concentration in work or at school.

    The sensations in your legs and urge to move them can make it difficult to fall asleep and remain asleep at night. Due to the lack of sleep at night, people with RLS can be fatigued, sleepy, and irritable or grumpy during the day. Sleep deficiency is further linked to depression, anxiety, obesity and heart disease, so people with RLS are at a higher risk of developing these conditions.

    What does Restless Legs Syndrome feel like?

    If you have RLS, you will experience uncomfortable sensations in your legs that make you want to move them. These sensations can range from prickling and itching to pulling or crawling. Usually, you will feel uncomfortable when you’re sitting or lying down, and this will worsen at night.

    In some cases, these sensations might affect your chest, arms and face too. You might also experience painful cramps in your legs, especially in the calves, and have involuntary jerking of your arms or legs whilst you’re sleeping, known as periodic limb movements in sleep (PLMS). A study showed that 88% of individuals with RLS reported at least 1 symptom relating to their sleep [1]. 

    What are the causes of Restless Legs Syndrome?

    In the majority of RLS cases, doctors are unable to pinpoint the exact cause of the syndrome, and it is referred to as idiopathic (no identifiable cause). It begins gradually, usually before the patient is 40 years old, and symptoms might disappear for long periods of time. The condition worsens with age. This is called Primary RLS.

    Secondary RLS suddenly develops after the age of 40, and is most associated with a few medical conditions or the use of some drugs used to treat colds, nausea and mental health conditions. Examples of these medical conditions include iron deficiency, multiple sclerosis, rheumatoid arthritis, anaemia and kidney failure.

    More than 60% of RLS cases are inherited, with most patients having a first-degree relative (parent, sibling or child) with the condition [2].

    Research has suggested that RLS is caused by the body having difficulty handling dopamine, which is a hormone that controls muscle movement and might cause involuntary leg movements. Some pregnant women also develop RLS temporarily, with 20% of women developing it during the third trimester [3]. Symptoms of RLS in pregnant women usually improve and are relieved after birth.

    How is Restless Legs Syndrome diagnosed?

    To confirm a diagnosis of RLS, your doctor might refer to your detailed medical history, family medical history, and analyse the symptoms you are experiencing, and try to rule out other possible medical conditions that might be causing your symptoms. You might also be referred to a neurologist to conduct further tests. The following diagnostic tests might be carried out:

    • Blood tests for haemoglobin levels, iron levels, liver and kidney function, blood glucose etc.
    • Electrocardiogram (ECG) 
    • Sleep tests if you have trouble sleeping, to diagnose if you have periodic limb movements in sleep.

    How is Restless Leg Syndrome treated?

    If RLS happens to be caused by an underlying condition, treating this condition might also relieve symptoms of RLS. However, if you have primary RLS, it must be managed in the long term, reducing the symptoms through medications and lifestyle changes. 

    Medications such as dopamine agonists, alpha-2 delta calcium channel ligands like gabapentin and pregabalin painkillers, sleep aids and levodopa (supplements the dopamine levels) can be prescribed to people suffering from RLS. Please remember to never self-medicate. If you suspect that you have narcolepsy, book an appointment with your doctor to run some tests and find out more about the treatment options available for you.

    Living with Restless Legs Syndrome

    Although this condition might sound serious and diagnosis might seem scary at first, don’t worry, because it can be successfully managed, so that you can minimise the impact it has on your everyday life.

    Some lifestyle changes you can make are not consuming caffeine, alcohol or tobacco, and avoiding exercising in the evening or before you sleep. You could stick to a regular bedtime routine, and ensure you have a comfortable sleeping environment. To relieve your symptoms, you can massage your legs, apply cold or hot compresses, take hot baths, stretch or go for a walk, or even do something that takes your mind away from the sensations like watching TV.

    Sources

    1. Bogan, R. K. (2006). Effects of restless legs syndrome (RLS) on sleep. Neuropsychiatric Disease and Treatment, 2(4), 513–519. https://doi.org/10.2147/nedt.2006.2.4.513
    2. Lavigne, G. J., & Montplaisir, J. Y. (1994). Restless legs syndrome and sleep bruxism: prevalence and association among Canadians. Sleep, 17(8), 739–743. https://pubmed.ncbi.nlm.nih.gov/7701186/
    3. Darvishi, N., Daneshkhah, A., Khaledi-Paveh, B., Vaisi-Raygani, A., Mohammadi, M., Salari, N., Darvishi, F., Abdi, A., & Jalali, R. (2020). The prevalence of Restless Legs Syndrome/Willis-ekbom disease (RLS/WED) in the third trimester of pregnancy: a systematic review. BMC Neurology, 20(1). https://doi.org/10.1186/s12883-020-01709-0
    4. Treatment For Restless Leg Syndrome, Causes and Twitching. Vein Treatment Center – Spider and Varicose Vein Treatment. Retrieved December 7, 2020, from https://www.veintreatmentclinic.com/vein-diseases/restless-leg-syndrome/
    5. Restless legs syndrome. (2017, October 24). Nhs.Uk. https://www.nhs.uk/conditions/restless-legs-syndrome/
    6. Restless Legs Syndrome – Symptoms and Causes. (n.d.). Sleep Foundation. Retrieved December 7, 2020, from https://www.sleepfoundation.org/restless-leg-syndrome
    7. Restless legs syndrome: MedlinePlus Genetics. (n.d.). Medlineplus.Gov. https://medlineplus.gov/genetics/condition/restless-legs-syndrome/