Restless Legs Syndrome

Overview

Restless legs syndrome, also known as Willis-Ekbom Disease, is a neurological condition that causes an irresistible urge to move the legs, often accompanied by uncomfortable sensations.

Restless legs syndrome is a sleep disorder triggered by resting and attempting to sleep. It is also a movement disorder, as people with restless legs syndrome are forced to move their legs to find relief from symptoms.

Signs and Symptoms

People with restless legs syndrome feel an irresistible urge to move. It is paired with uncomfortable sensations in their lower limbs that are not like normal sensations experienced by people without the disorder. The sensations in their legs are often difficult to define but may be described as aching, throbbing, pulling, itching, crawling, or creeping.

These sensations less commonly affect the arms, and rarely the chest or head. Although the sensations can occur on just one side of the body, they most often affect both sides and can also alternate between sides. The sensations range in severity from uncomfortable, to irritating, to painful.

Because moving the legs (or other affected parts of the body) relieves discomfort, people with restless legs syndrome often keep their legs in motion to minimize or prevent the sensations. They may pace the floor, constantly move their legs while sitting, and toss and turn in bed.

A classic feature of restless legs syndrome is that the symptoms are worse at night with a distinct symptom-free period in the early morning, allowing for more refreshing sleep at that time. Some people with restless legs syndrome have difficulty falling asleep and staying asleep. They may also note a worsening of symptoms if their sleep is further reduced by events or activity.

Restless legs syndrome symptoms may vary from day to day, in severity and frequency, and from person to person. In moderately severe cases, symptoms may happen once or twice a week and often make it hard to sleep, which can affect daily life. In severe cases, the symptoms occur more than twice a week and result in major sleep disruption and make it hard to function during the day.

People with restless legs syndrome can sometimes experience remissions, which are spontaneous improvements over a period of weeks or months before symptoms reappear. This usually occurs during the early stages of the disorder. In general, however, symptoms become more severe over time.

People who have both restless legs syndrome and an associated medical condition tend to develop more severe symptoms rapidly. In contrast, those who have restless legs syndrome that is not related to any other condition show a very slow progression of the disorder, particularly if they experience onset at an early age.

Related Health Effects

People with restless legs syndrome may also experience the following:

• Changes in mood
• Exhaustion and daytime sleepiness
• Trouble concentrating
• Memory issues (impaired memory)
• Decreased productivity
• Depression and anxiety

Most people with restless legs syndrome also experience periodic limb movement of sleep (PLMS), which causes involuntary leg (and sometimes arm) twitching or jerking movements during sleep. These movements typically happen every 15 to 40 seconds and can last throughout the night.

Untreated moderate to severe restless legs syndrome can lead to about a 20 percent decrease in work productivity. Restless legs syndrome can also make traveling difficult.

People with Parkinson’s disease have an increased risk of developing restless legs syndrome, as both conditions affect the same part of the brain, called the basal ganglia, which uses a chemical called dopamine to control movement. However, a diagnosis of restless legs syndrome does not indicate the onset of Parkinson’s disease or another neurological disease.

Causes and Risk Factors

In most cases, the cause of restless legs syndrome is unknown, which is called primary restless legs syndrome. However, restless legs syndrome has a genetic component and can be found in families where the onset of symptoms is before age 40. Specific gene variants have been associated with restless legs syndrome. Evidence indicates that low levels of iron in the brain also may be responsible for restless legs syndrome.

Considerable evidence also suggests that restless legs syndrome is related to a dysfunction in the basal ganglia, one of the sections of the brain that controls movement. The basal ganglia use a brain chemical called dopamine to produce smooth, purposeful muscle activity and movement. When these pathways do not work properly, the body may move without the person wanting it to.

Restless legs syndrome also appears to be related to or accompany the following factors or underlying conditions:

• End-stage renal disease and hemodialysis
• Iron deficiency
• Certain medicines that may aggravate symptoms, such as antinausea drugs (for example, prochlorperazine or metoclopramide), antipsychotic drugs (for example, haloperidol or phenothiazine derivatives), antidepressants that increase serotonin (for example, fluoxetine or sertraline), and some cold and allergy medicines that contain older antihistamines (for example, diphenhydramine)
• Use of alcohol, nicotine, and caffeine
• Pregnancy, especially in the last trimester; in most cases, symptoms usually disappear within four weeks after delivery
• Neuropathy (nerve damage)
• Sleep deprivation and other sleep conditions like sleep apnea

Prevention Guidance

Reducing or completely eliminating certain risk factors may relieve symptoms of restless legs syndrome. These factors include alcohol, nicotine, caffeine, and certain medications.

Diagnosis

There is no specific diagnostic test for restless legs syndrome. The condition is diagnosed by a doctor’s evaluation based on five basic clinical criteria:

• Moving the legs at least partly relieves the urge, even if only for a short time
• The urge to move the legs starts or gets worse during rest or inactivity
• The urge to move the legs is at least temporarily and partially or totally relieved by movements
• The urge to move the legs starts or is aggravated in the evening or night
• The above four features are not due to any other medical or behavioral condition

A physician will focus largely on the person’s descriptions of symptoms, their triggers and relieving factors, as well as the presence or absence of symptoms throughout the day. A neurological and physical exam, plus information from the person’s medical and family history and list of current medicines, may be helpful. A person may be asked about frequency, duration, and intensity of symptoms; if movement helps to relieve symptoms; how much time it takes to fall asleep; any pain related to symptoms; and any tendency toward daytime sleep patterns and sleepiness, disturbance of sleep, or daytime function.

Laboratory tests may rule out other conditions such as kidney failure, iron deficiency anemia, or pregnancy that may be causing symptoms of restless legs syndrome. Blood tests can identify iron deficiencies as well as other medical disorders associated with restless legs syndrome.

In some cases, a detailed overnight sleep study (like a polysomnography-a test that records the individual’s brain waves, heartbeat, breathing, and leg movements during an entire night) may identify the presence of other causes of sleep disruption, such as sleep apnea, which may impact management of the disorder. Periodic limb movement of sleep during a sleep study can support the diagnosis of restless legs syndrome but is not exclusively seen in people with restless legs syndrome.

Diagnosing restless legs syndrome in children may be especially difficult, since it may be hard for children to describe what they are experiencing, when and how often the symptoms occur, and how long symptoms last. Pediatric restless legs syndrome can sometimes be misdiagnosed as “growing pains” or attention deficit hyperactivity disorder (ADHD).

Treatment and Management

Restless legs syndrome has no cure, but treatment can help manage symptoms. The first step in treatment is to address anything that could be making restless legs syndrome symptoms worse, including treating other conditions the person has, such as diabetes, neuropathy, sleep apnea, or iron deficiency. If symptoms are mild, do not produce significant daytime discomfort, or do not affect a person’s ability to fall asleep, the condition does not have to be treated.

Lifestyle Changes

Certain lifestyle changes and activities may provide some relief in people with mild to moderate symptoms of restless legs syndrome. These steps include:

• Avoiding or decreasing the use of alcohol, nicotine, and caffeine
• Changing or maintaining a regular sleep pattern
• A program of moderate exercise
• Massaging the legs, taking a warm bath, or using a heating pad or ice pack
• Using foot wraps that put pressure underneath the foot
• Using vibration pads that deliver vibration to the back of the legs

Aerobic and leg-stretching exercises of moderate intensity also may provide some relief from mild symptoms.

The FDA approved a new technology called tonic motor activation (TOMAC) to reduce symptoms and improve sleep quality. The system consists of devices worn on the lower legs that activate the muscles, mimicking the sensation of movement, reducing the discomfort caused by restless legs syndrome, and improving sleep. NINDS provided funding for the development of the FDA-approved TOMAC treatment for restless legs syndrome.

Doctors also may prescribe medicines for restless legs syndrome, such as:

• Anti-seizure medicines: Gabapentin enacarbil or pregabalin for moderate to severe restless legs syndrome
• Iron supplements
• Opioids: For severe restless legs syndrome cases that don’t respond to other treatments
• Benzodiazepines: To treat anxiety, insomnia, or muscle spasms

Living With Restless Legs Syndrome

Restless legs syndrome is generally a lifelong condition for which there is no cure. However, current therapies can control the disorder, minimize symptoms, and increase periods of restful sleep. Symptoms may gradually worsen with age, although the decline may be somewhat faster for individuals who also have an associated medical condition.

Some individuals have remissions, which are periods in which symptoms decrease or disappear for days, weeks, months, or years, although symptoms often eventually reappear.

Find Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on restless legs syndrome.

Community Support

The following organizations provide information and support for people with restless legs syndrome:

• Restless Legs Syndrome Foundation
• National Organization for Rare Disorders (NORD)
• National Sleep Foundation
• American Sleep Association

Note: This resource list is for informational purposes only. It is not comprehensive, and an organization’s inclusion does not constitute an endorsement by NIH.

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.

NIH supports research on neurological diseases such as restless legs syndrome. Research is ongoing on the direct causes of restless legs syndrome, which may include brain pathways involving dopamine signaling and movement, and genetics.

NIH also supports research on why the use of dopamine agents to treat restless legs syndrome, Parkinson’s disease, and other movement disorders can lead to impulse control disorders, with aims to develop new or improved treatments that avoid this adverse effect.

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.