Restless legs syndrome Dr Rob Hicks This neurological movement disorder of the limbs is more common after middle age.

In this article

What is restless legs syndrome (RLS)?

Causes and risk factors

Treatment and recovery

RLS, also known as Ekbom's syndrome, can cause tingling, discomfort and sometimes outright pain in the legs. However most people with the condition find it hard to describe – they simply have an almost irresistible urge to move their legs which isn’t painful but is distressing. Very occasionally the arms are affected too.

In 1995 the International Restless Legs Syndrome Study Group defined four basic elements necessary for a diagnosis of RLS:

• A compelling urge to move the limbs, usually associated with sensory changes.
• Limb restlessness, with floor pacing, tossing and turning in bed, and rubbing the legs.
• Symptoms that are worse or exclusively present at rest with variable relief on activity.
• A regular pattern of symptoms, which are present in the evening and at night, and usually relieved by dawn.

Although the exact cause of restless legs syndrome is unknown, it’s now recognised as a neurological movement disorder of the limbs which is often related to a sleep disorder. Most of those affected also have a problem known as periodic leg movements of sleep (PLMS), where there are involuntary forceful dorsiflexions (downward movements) of the foot every 20-40 seconds throughout sleep.

Recent research has suggested that RLS may be linked to abnormalities in brain receptors for dopamine, natural opiates and other transmitter chemicals. Overactivity of the sympathetic nervous system has also been blamed.

RLS can run in families. It may be associated with deficiencies or iron, folate or magnesium. It is also linked to neuropathy (disease of the nerves), kidney disease, anaemia, Parkinson’s disease and a number of other conditions. It is also more common during pregnancy.

Restless legs syndrome is thought to affect between two to 15 per cent of the population, with women being affected more often than men. Many people with restless legs syndrome find they go through periods when they don't have symptoms.

It's more likely to occur as a person gets older and is most common after middle age, when it tends to get progressively worse, disrupting sleep and impairing daytime performance. It rarely occurs in children.

Treatment of an underlying cause for RLS, such as iron deficiency anaemia, may lead to resolution of symptoms. When no specific cause can be identified, lifestyle management and drug treatments may help to control symptoms.

Lifestyle

• Diet is important in RLS. A good balanced diet to ensure all nutritional requirements are met can help reduce the risk of RLS. Those at risk or whose diet is unreliable may want to consider taking a daily multivitamin. Caffeine, nicotine and alcohol can all aggravate RLS and should be avoided as far as possible.
• Regular exercise. Moderate exercise every day helps some people.
• Physical stimulation of the legs such as massage, hot or cold baths, jacuzzi baths or electrical stimulation of the feet and toes before bedtime (for example, using a TENS machine) can help.
• Sleep. Any efforts to improve the general quality of sleep may be beneficial.
• A variety of different medicines may be tried. Drugs which stimulate dopamine receptors in the brain, similar to those used in Parkinson’s disease, may be effective in reducing symptoms of RLS.
• However, some medicines can cause or aggravate RLS – these should be identified and stopped if possible.

Emotional support and reassurance that it doesn't develop into a more serious disease is important.

This article was last medically reviewed by Dr Trisha Macnair in July 2009.