Restless Leg Syndrome (RLS), also known as Willis-Ekbom disease, is a neurological disorder characterized by an irresistible urge to move the legs. This urge is frequently accompanied by uncomfortable sensations, described as crawling, aching, tingling, or throbbing, primarily in the legs, though sometimes affecting the arms. These sensations typically emerge or worsen during periods of rest or inactivity, particularly in the evening or at night. The discomfort often finds temporary relief through movement, such as walking or stretching. This condition can significantly disrupt sleep, leading to daytime fatigue, reduced productivity, and a diminished quality of life.
Lifestyle Adjustments for RLS
Managing RLS often begins with non-pharmacological strategies that can alleviate symptoms and improve overall well-being. Establishing a consistent sleep schedule and practicing good sleep hygiene are foundational steps. This involves maintaining a cool, quiet, and dark bedroom environment, and avoiding stimulating activities or screens before bedtime.
Engaging in regular, moderate exercise, such as walking, cycling, or swimming, can help reduce RLS symptoms by improving circulation and reducing stress. However, avoid intense exercise close to bedtime, as it can stimulate the body and potentially worsen symptoms. Avoiding common triggers like caffeine, alcohol, and nicotine is also beneficial, as these substances can exacerbate RLS symptoms. Other helpful techniques include warm baths or cold packs, leg massages, and stretching exercises, which can relax muscles and provide temporary relief. These modifications can complement other treatment approaches.
Medication Approaches
When lifestyle adjustments are insufficient, medications can help manage RLS symptoms. Dopaminergic agents, such as ropinirole, pramipexole, and the rotigotine patch, work by affecting dopamine levels in the brain, a chemical messenger involved in muscle movement. Dopaminergic agents were once first-line treatments for moderate to severe RLS, but their long-term use can lead to augmentation. Augmentation is a worsening of RLS symptoms, often manifesting as an earlier onset of symptoms during the day, increased severity, or spread to other body parts, and can occur with continued use or increasing doses.
Alpha-2 delta ligands, such as gabapentin and pregabalin, are now often preferred as first-line treatment for chronic RLS, especially when dopaminergic agents are ineffective or not tolerated. They are useful for RLS with painful neuropathic symptoms. Side effects like dizziness, sedation, and weight gain can occur.
Iron supplementation is an important medication approach for individuals with low iron stores, even if they are not anemic. Blood tests, particularly serum ferritin levels, should be checked, with a target of 75 micrograms per liter or above for symptom improvement. Oral iron supplements, such as ferrous sulfate, are often prescribed, sometimes with vitamin C to enhance absorption. In cases of severe iron deficiency or when oral supplements are not effective, intravenous iron therapy may be considered.
For severe RLS, low-dose opioids (e.g., oxycodone, codeine) or benzodiazepines (e.g., clonazepam) may be considered. These are reserved for specific situations due to dependence concerns and potential side effects, and are not typically first-line treatments. Opioids effectively manage severe symptoms, and addiction is rare at low doses. Benzodiazepines can improve sleep quality but are not a primary treatment for RLS symptoms.
Addressing Underlying Causes
RLS can be a secondary condition, caused or worsened by other medical conditions or certain medications. Addressing these issues can alleviate or resolve RLS symptoms.
Low iron stores, even without anemia, are strongly linked to RLS. Chronic kidney disease, particularly in dialysis patients, can cause or worsen RLS. Nerve damage, such as peripheral neuropathy from conditions like diabetes, is also associated with RLS. Treating these conditions often improves RLS symptoms.
Certain medications can induce or worsen RLS. Common culprits include some antidepressants (SSRIs, SNRIs), antihistamines, anti-nausea drugs, and certain cold and allergy medications. These drugs can interfere with dopamine activity or neurological pathways. Patients experiencing RLS after starting new medications should consult their doctor about adjustments or alternative treatments.
RLS is common during pregnancy, affecting 10-34% of pregnant women, often peaking in the third trimester. Most pregnancy-related RLS symptoms resolve spontaneously after delivery.
Emerging Therapies
Research continues to explore newer therapies for RLS. Non-pharmacological devices are gaining attention as treatment options. These include vibratory pads and pneumatic compression devices (PCDs). PCDs, which apply intermittent pressure to the legs, show promise in reducing RLS symptoms and improving quality of life, potentially by enhancing circulation. Some devices are prescription-only and designed for moderate to severe RLS.
Investigations are also exploring new drug candidates and alternative therapies. While these approaches show promise in preliminary research, they are not yet widely adopted or standard practice. Patients interested in these options should discuss them with a healthcare provider to determine suitability and potential benefits.