Restless Leg Syndrome

Restless leg syndrome (RLS, restless legs syndrome) is a common cause of painful legs. The leg pain of restless leg syndrome typically eases with the motion of the legs and becomes more noticeable at rest. Restless leg syndrome also features worsening symptoms and leg pain during the early evening or later at night.

Restless leg syndrome is often abbreviated as RLS; it has also been termed shaking leg syndrome. Nighttime involuntary jerking of the legs during sleep is also known as periodic leg/limb movement disorder.

The cause of restless leg syndrome is unknown to most people. However, restless leg syndrome has been associated with the following:

• Pregnancy
• Obesity
• Smoking
• Iron deficiency and anemia
• Nerve disease
• Polyneuropathy (which can be associated with hypothyroidism, heavy metal toxicity, toxins, and many other conditions)
• Other hormone diseases such as diabetes
• Kidney failure (which can be associated with vitamin and mineral deficiency)

Some drugs and medications have been associated with restless leg syndrome including:

• Caffeine
• Alcohol
• H2-histamine blockers (such as ranitidine [Zantac] and cimetidine [Tagamet]), and certain antidepressants (such as amitriptyline [Elavil, Endep])

Occasionally, restless leg syndrome runs in families. Recent studies have shown that restless leg syndrome appears to become more common as a person ages. Also, poor venous circulation of the legs (such as with varicose veins) can cause restless leg syndrome.

Many different symptoms are described by people with restless leg syndrome, for example:

• Leg pain
• Cramps
• Tingling
• Itchy
• Burning
• Aching

The characteristic nighttime worsening of symptoms in persons with restless legs syndrome frequency leads to insomnia. Because of lack of sleep, children and some adults may be very drowsy, irritable, and aggressive during daytime hours.

Restless leg syndrome usually begins slowly. Over time, the legs become more affected. Less frequently, restless leg syndrome can affect the arms.

Restless leg syndrome is relatively common during pregnancy, especially in the second half of pregnancy. While most medications used to treat restless leg syndrome have not been adequately studied in pregnant women, the non-medication treatments and techniques described above can be very helpful. Furthermore, avoiding caffeine, warm compresses, massage, and regular exercising according to the doctors' suggestions can be helpful.

The National Institutes of Health says that four criteria must be met for the diagnosis of RLS in a person (adult or child):

• A strong urge to move your legs. This urge often, but not always occurs with unpleasant feelings in your legs. When the disorder is severe, you also may have the urge to move your arms.
• Symptoms that start or get worse when you're inactive. The urge to move increases when you're sitting still or lying down and resting.
• Relief from moving. Movement, especially walking, helps relieve unpleasant feelings.
• Symptoms that start or get worse in the evening or at night.

Treatment of restless leg syndrome is first directed toward any underlying illness if known, which may include:

• Blood testing to reveal underlying iron deficiency anemia may reveal the underlying cause.
• If varicose veins are thought to be the cause, then surgery to repair the circulation may be considered.
• Reduction or elimination of caffeine, nicotine, and alcohol from a person's diet can be very helpful.
• Stopping smoking can significantly diminish or prevent symptoms.
• Getting better sleep and exercise can help some persons affected by restless legs.
• Pregnant women who do not sleep well at night and other people with sleep disorders may develop RLS.

Medications used to treat restless leg syndrome include:

• natural supplements (such as iron)
• carbidopa-levodopa (Sinemet)
• opioids (such as hydrocodone, or tramadol [Ultram] for intermittent symptoms)
• carbamazepine (Tegretol, Tegretol XR, Equetro, Carbatrol)
• clonazepam (Klonopin)
• diazepam (Valium)
• triazolam (Halcion)
• temazepam (Restoril)
• baclofen (Lioresal)
• bromocriptine
• clonidine (Catapres, Catapres-TTS, Jenloga)
• gabapentin (Neurontin)
• gabapentin enacarbil (Horizant ER)
• ropinirole (Requip)
• pramipexole (Mirapex)

Other treatments that have been helpful for some people with restless leg syndrome include:

• Warm/cold baths
• Electric nerve stimulation
• Oral magnesium
• Acupuncture
• Natural treatments such as quinine water at bedtime (tonic water)

Anxiety may trigger or increase RLS symptoms according to some researchers. Some people have experienced a decrease in anxiety by using over-the-counter (OTC) products and natural home remedies and naturopathic treatments for anxiety, for example, lavender soap fumes or acupuncture. These natural treatments may reduce symptoms of RLS. 

Some of these natural remedies reduce symptoms of restless leg syndrome and may cause side effects. Discuss any problems or side effects you have after using home remedies or alternative treatments for restless leg syndrome with your doctor.

There is no cure for restless leg syndrome; however, the condition usually responds well to home remedies and medications. The outlook is excellent for people with restless leg syndrome as long as it does not weaken or damage the function of the legs.

Many conditions can mimic restless leg syndrome including:

• Parkinson's disease
• Fibromyalgia
• Muscle diseases
• Joint conditions
• Nerve problems such as peripheral neuropathy caused by diabetes (diabetic neuropathy)
• Circulation difficulties

In children, restless leg syndrome is often misdiagnosed as "growing pains."