Restless legs syndrome
Restless legs syndrome (RLS), also known as known as Willis-Ekbom disease, is a neurological disorder characterized by an uncomfortable sensation in the legs that triggers an urge to move them.
Symptoms
Besides being compelled to move the legs in order to ease their unpleasant sensation, other symptoms of the RLS are (1):
Crawling or creeping sensation in the feet, calves and thighs; sometimes it also involves the arms.
The unpleasant sensation occurs more commonly before falling asleep or during the sleeping period.
RLS can coexist with another related but distinct neurological disorder called periodic limb movements which involves involuntary jerking of the legs and arms.
Prevalence
RLS might be present in 7% to 10% of the US population, it affects people at any age, and women more than men (2), (3).
The symptoms vary in intensity and frequency; sometimes less than once a week, in chronic cases more than two days in the same week (3).
Causes
In many cases the cause of RLS is unknown. In some it is due to disorders such as iron deficiency, chronic renal failure or a genetic alteration (4).
Restless legs syndrome is also associated with pregnancy, affecting around 1 in 5 women during the final trimester. The exact cause of this connection is not fully understood. In most cases, the symptoms tend to subside after childbirth (1).
Diagnosis
The International Restless Legs Syndrome Study Group (IRLSSG) has criteria to diagnose the syndrome that include the sensations in the legs, the relationship with periods of rest, the relieving activities, the time period of occurrence and the presence of other health conditions (5).
Nevertheless, the diagnosis is not made solely on the symptoms or a specific test, but by analyzing a set of variables including the symptoms, medical and family history, physical exam, and some laboratory results related to iron deficiencies (4).
It is also important to identify Augmentation, that is, any increase in symptom severity, or symptoms occurring earlier and often spreading from the legs to the arms or other parts of the body (4).
Quality of Life
RLS impacts patients' sleep and quality of life, since it results in fatigue and sleepiness during the day, and affects memory and the ability to focus on a task (2).
Treatment
Some individuals with RLS manage their symptoms effectively with massage or warm baths, without the need of medications.
For those who need pharmacotherapy, the first-line treatments include iron replacement (for those with low iron levels), or prescribed medications such as gabapentin, pregabalin, and dopamine agonists like pramipexole, ropinirole, and rotigotine.
For those who don’t tolerate oral iron and/or experience severe symptoms due to augmentation, the second-line options involve opioids or intravenous iron infusions.
There is a pressing need for innovative treatments and a stronger pipeline of new, biologically targeted therapies (4).
References
1. NHS. Restless legs syndrome [Internet]. https://www.nhs.uk/conditions. 2022. Available from: https://www.nhs.uk/conditions/restless-legs-syndrome/symptoms/
2. Yale Medicine. Restless Legs Syndrome (RLS) [Internet]. https://www.yalemedicine.org/. 2024. Available from: https://www.yalemedicine.org/conditions/restless-legs-syndrome
3. Mitterling T, Heidbreder A, Stefani A, Fritz J, Ulmer H, Poewe W, et al. Natural course of restless legs syndrome/Willis–Ekbom disease: long-term observation of a large clinical cohort. Sleep Med. 2015 Oct 1;16(10):1252–8.
4. Gossard TR, Trotti LM, Videnovic A, St Louis EK. Restless Legs Syndrome: Contemporary Diagnosis and Treatment. Neurotherapeutics [Internet]. 2021 Jan 1 [cited 2024 Sep 14];18(1):140. Available from: /pmc/articles/PMC8116476/
5. Allen RP, Picchietti DL, Garcia-Borreguero D, Ondo WG, Walters AS, Winkelman JW, et al. Restless legs syndrome/Willis–Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria – history, rationale, description, and significance. Sleep Med. 2014 Aug 1;15(8):860–73. Assessed and Endorsed by the MedReport Medical Review Board