What are the causes of restless legs syndrome?

Restless legs (RLS) is caused by genetics, illness, lifestyle, medication and pregnancy.
Restless legs (RLS) is caused by genetics, illness, lifestyle, medication and pregnancy.

Restless legs syndrome (RLS) is a condition that causes people to compulsively move their legs, especially when they are at rest. 

The following are the causes of RLS

  • Genetics: Parents with RLS can pass it down to their children. Up to 92% of patients with RLS have a first-degree relative with the disorder. These patients tend to develop symptoms earlier in life (before age 45) than those with RLS without the genetic link.
  • Chronic diseases: Certain long-term medical conditions include RLS symptoms such as iron deficiency, Parkinson’s disease, kidney failure or renal diseasediabetes and peripheral neuropathy.
  • Lifestyle: Excess use of alcohol, tobacco and caffeine may cause RLS. Lack of sleep can trigger symptoms or make RLS worse.
  • Medications: Some drugs might make symptoms worse, including anti-nausea medicines, antipsychotics, some antidepressants and cold and allergy medications that have antihistamines.
  • Pregnancy: Some women have RLS during pregnancy, especially in the last trimester. Symptoms usually go away within a month after delivery.

Many researchers suggest that abnormalities in a certain neurotransmitter (dopamine) in the brain and spinal cord (central nervous system) play some causative role. Neurotransmitters, including dopamine, are chemicals that regulate the transmission of nerve impulses.

What is restless legs syndrome?

Restless legs syndrome (RLS) is considered a sleep and nervous system disorder. It is a condition that causes an uncontrollable urge to move the legs because the person feels an uncomfortable sensation in the legs. It typically happens while resting when sitting or lying down. It also causes sensations described as creeping, itching, pulling, crawling, tugging, throbbing, burning or gnawing in the legs. Moving eases the unpleasant feeling temporarily. Due to this condition, patients may have disturbed sleep or may not be able to sit for long periods of time. RLS, also known as Willis-Ekbom disease, can begin at any age and generally worsens with age. It can interfere with daily activities. RLS is more common in women and especially in middle-aged people. 

How is restless legs syndrome treated?

There are treatments available that can help control the symptoms, so patients may get a good night’s sleep. Patients must discuss treatment options  with their doctor. Supplementation or medications are usually helpful, but no single medication effectively manages restless legs syndrome (RLS) for all individuals. Trials of different drugs may be necessary. In addition, medications taken regularly may lose their effect over time or even make the condition worse, making it necessary to change medications. Treatment options for RLS include the following

  • Lifestyle changes: Certain lifestyle changes and activities may provide some relief in people with mild-to-moderate symptoms of RLS. These steps include avoiding or reducing the use of alcohol and tobacco, changing or maintaining a regular sleep pattern, following a program of moderate exercise, massaging the legs, taking a warm bath or using a heating pad or an ice pack. A foot wrap that puts pressure underneath the foot and another that is a pad that delivers vibration to the back of the legs is usually helpful in treating RLS symptoms. Aerobic and moderate-intensity leg-stretching exercises may provide some relief from mild symptoms.
  • Iron: For individuals with low ferritin and transferrin saturation in blood, a trial of iron supplements is recommended as the first treatment. Iron supplements are available overthe- counter. A common side effect is upset stomach, which may improve when using a different type of iron supplement or stool softeners. In some people, iron supplementation may be given through an intravenous (IV) line to boost iron levels and relieve symptoms.
  • Dopaminergic drugs: These act on the neurotransmitter dopamine in the brain (examples include Mirapex [pramipexole] and Neupro [rotigotine]).
  • Benzodiazepines: This is a type of sedative that may help with sleep, but the drugs can cause daytime drowsiness.
  • Narcotic pain relievers: These may be helpful in treating symptoms of RLS.
  • Anticonvulsant or antiseizure drugs: These are becoming the first-line prescription drugs for those with RLS. These drugs can reduce sensory disturbances such as creeping, crawling and nerve pain. Dizziness, fatigue and sleepiness are among the possible side effects (examples include Neurontin [gabapentin] and Lyrica [pregabalin]).

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What is the prognosis for people with restless legs syndrome?

There are medications and therapies that can control the disorder, minimize symptoms and increase periods of restful sleep. Patients must discuss all possible options with their doctor. Symptoms may gradually worsen with age, although the decline may be somewhat faster for individuals who also suffer from an associated medical condition. Some individuals have remissions in which symptoms decrease or disappear for days, weeks, months or years although symptoms often eventually reappear.

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Medically Reviewed on 8/27/2020
References
Medscape Medical Reference
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