Restless Leg Syndrome

No one knows exactly why restless leg syndrome occurs. People who suffer from restless leg syndrome have uncontrollable urges to move their legs. A feeling of discomfort in the leg prompts the need for movement.

For some people, these sensations may be the result of nerve damage. The sensations may also be caused by decreased blood flow through some vessels in the legs. These leg movements often occur after a person has gone to bed, making sleeping difficult. When the urge to move the leg happens during the day, a person may have to get up and walk around to relieve the discomfort.

A person with restless leg syndrome experiences unusual sensations that usually occur in the legs but sometimes are present in the arms and trunk. The sensations:

• are described as burning, itching, crawling, pulling, or tugging but are rarely painful
• occur when the person is inactive and usually get worse at night
• cause an irresistible urge to move the legs
• are relieved by leg movements
• cause jerking movements of the legs when the person is sleeping and occasionally when the person is awake
• can occasionally cause restless movements of the feet or toes in the evening, when a person is sitting or lying down
• can make falling asleep difficult and can awaken the person from sleep
• contribute to fatigue and drowsiness during the day, since the person is not getting a good night's sleep

Many people do not think of this sensation in the legs as painful. The symptoms may worsen during periods of emotional upset or stress.

While the exact cause of restless leg syndrome is unknown, its tendency to run in families suggests a strong genetic link. In a recent study of identical twins, of 12 pairs in which one twin had restless leg syndrome, in 10 cases the other twin did as well.

Restless leg syndrome is also more common in:

• people who are 40 years of age or older
• individuals who are under a lot of stress
• pregnant women, especially in the third trimester of pregnancy
• people with disorders of nerves that supply the muscles and skin, called peripheral nerve diseases
• people with claudication, a leg pain that occurs when the person is walking, due to poor circulation
• people with anemia, a low red blood cell count. Many times, the anemia is caused by a low level of iron or folic acid in the person's body.
• people with certain diseases and conditions, such as Parkinson's disease, rheumatoid arthritis, chronic renal failure, diabetes, and alcoholism

The symptoms of restless leg syndrome seem to be worsened by food and drinks that are high in caffeine.

There is no reliable way to prevent restless leg syndrome. Controlling diseases and conditions that contribute to the syndrome can help limit the intensity of the symptoms. Reducing stress levels may also help decrease symptoms.

A complete history and physical examination is the first step in diagnosing restless leg syndrome. Often, a person will need tests to rule out other problems such as peripheral nerve disease and pain that results from poor circulation to the leg muscles.

The most common long-term effect of restless leg syndrome is difficulty sleeping. Insomnia can reduce a person's quality of life and also lead to other problems such as depression, violence, and motor vehicle crashes and other injuries..

Restless leg syndrome is not contagious but does tend to run in families.

Treatment of restless leg syndrome begins with correction of any underlying disease or condition. For example, iron or folic acid supplements may be given to correct anemia. The healthcare professional will work with the person to treat other disorders such as rheumatoid arthritis, poor circulation to the legs, and diabetes.

Lifestyle changes may help relieve the intensity of the symptoms of restless leg syndrome. A balanced diet following the food pyramid may be supplemented with vitamins and iron. Food and drinks containing caffeine, such as coffee, tea, and chocolate, should be avoided.

Moderate exercise can contribute to better sleep habits. Because sleep is often disrupted in a person with restless leg syndrome, good sleep habits are important.

Some guidelines for good sleep include:

• Choosing a cool, comfortable, quiet environment for sleep.
• Going to bed at the same time every night.
• Getting up at the same time every morning

While the symptoms of restless leg syndrome cannot be completely eliminated, some people get relief from:

• relaxation techniques, such as biofeedback, yoga, or meditation
• stress management
• acupressure
• walking or stretching
• a hot or cold bath
• hot or cold packs
• massaging the legs

Certain medications, including levodopa/carbidopa (i.e., Sinemet), ropinirole (i.e., Requip), Pramipexole (i.e., Mirapex) or tranquilizers such as clonazepam (i.e., Klonopin) or lorazepam (i.e., Ativan), can also be helpful. Occasionally, low doses of narcotic pain medications, such as codeine or oxycodone, can help relieve the symptoms of restless leg syndrome.

Side effects of the medications used to treat restless leg syndrome include stomach upset and allergic reaction to the medication. Drowsiness and difficulty concentrating are side effects of narcotics and tranquilizers. These medications can also be addictive. Levodopa/carbidopa may cause nausea, headache, and loss of appetite.

Treatment of restless leg syndrome is lifelong. Often, the person can improve his or her quality of life by making appropriate lifestyle changes.

Restless leg syndrome is monitored through periodic visits to the healthcare professional to discuss symptoms and appropriate treatment. Any new or worsening symptoms should be reported to the healthcare professional.