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Restless Legs Syndrome

Restless legs syndrome (RLS), also known as Willis-Ekbom disease (WED), is a chronic neurological disorder which can be characterised by unpleasant sensations in the legs along with an uncontrollable urge to move them for relief.1

These sensations are often described by those living with RLS as throbbing, tugging or creeping and can come in varying severity. They can be uncomfortable, irritating or painful, and can ultimately have a serious effect on quality of life. Disturbed sleep can be caused by limb movements, which can be highly disruptive, and some people also experience impaired voluntary movement, also known as dyskinesias, during the daytime, usually when resting.2

We do not know exactly why people develop RLS but it is thought that disruptions within brain pathways that use the neurotransmitter dopamine play a role.2 These pathways are key to smooth muscle activity and movement. Evidence suggests that iron is important in the function of these neural circuits and that low iron levels within the brain could be a contributing factor.2 Additionally, it is thought that genetics could have a part to play as some gene variants are associated with increased risk of developing the condition.3

There are two types of RLS. Primary RLS which is idiopathic in nature and without a known cause which tends to be slow in onset, and secondary RLS which is usually associated with another condition, such as iron deficiency, and can come on more quickly.4

Who is affected by RLS?

It is thought that up to 10% of the UK population are affected by RLS with varying degrees of pain. Women are twice as likely to experience RLS than men, and it is more common in middle age although symptoms can manifest at any age – including childhood.4

What are the symptoms of RLS?

The main symptoms of RLS include urges to move due to uncomfortable sensations, motor restlessness, worsening of symptoms with relaxation and variability over the course of the day-night cycle. The disruptions to sleep can also cause chronic fatigue, therefore reducing daytime functioning and quality of life.5

How is RLS diagnosed?

There is not a test that can diagnose the condition, instead RLS diagnosis will be based on a patient’s symptoms, medical and family history and test results. Physicians will consider how symptoms such as itching and tingling have changed with time, and how sleep patterns are being affected. Blood tests may also be used to identify any underlying causes such as anaemia and diabetes, with iron in particular being looked at.6

How can we treat RLS?

There is no cure at present for RLS although there are a number of options available to help manage its symptoms. For those with mild variations of the condition, lifestyle changes can help. These include regular exercise, dietary changes and avoiding alcohol and nicotine. Individuals with moderate to severe symptoms may benefit from treatment in the form of:

  • Dopamine agonists
  • Hypnotics such as benzodiazepines
  • Opioids
  • Anticonvulsants7

 

References

1 What is RLS? RLS-UK https://www.rls-uk.org/what-is-rls/ (last accessed April 2018)

2 What is restless legs syndrome? National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Restless-Legs-Syndrome-Fact-Sheet (last accessed April 2018)

3 Restless legs syndrome. Genetics Home Reference. https://ghr.nlm.nih.gov/condition/restless-legs-syndrome#genes (last accessed April 2018)

4 Restless legs syndrome. NHS https://www.nhs.uk/conditions/restless-legs-syndrome/ (last accessed April 2018)

5 Diagnosis. RLS-UK. https://www.rls-uk.org/diagnosis/ (last accessed April 2018)

6 Diagnosis. Restless legs syndrome. NHS Choices. https://www.nhs.uk/conditions/restless-legs-syndrome/diagnosis/ (last accessed April 2018)

7 Treatment. RLS-UK. https://www.rls-uk.org/treatment/ (last accessed April 2018)