Restless legs syndrome (RLS) is a prevalent and underdiagnosed condition characterized by:

• An urge to move legs due to unpleasant sensations

described as “creepy-crawly,” internal itch or pain

• The urge to move legs increasing with inactivity

or rest

• Sensations relieved by moving or stretching

the legs

• Symptoms worsening in the evening

Untreated RLS can significantly disturb sleep and produce insomnia. It can also be associated with a condition called Periodic Limb Movement Disorder (PLMD), which is characterized by movement of legs during sleep throughout the night frequently associated with awakening.

The symptoms of RLS worsen when people tend to relax at the end of the day. RLS may run in families. It may worsen with time so that moving does not relieve symptoms. Although the legs are more traditionally involved, the condition may affect the arms also. Patients with severe RLS can usually recall the earlier course of the disease when they could alleviate the pain by movement or when the disease affected the legs only.

Children may also suffer from RLS. Diagnosis of RLS in children requires special expertise because they are not able to verbalize the symptoms well. RLS in children may be misdiagnosed as “growing pains”. A family history of RLS helps toward the diagnosis in children.

RLS is diagnosed by history and clinical examination. Blood testing may reveal contributing conditions. Overnight sleep study in a sleep lab is needed to see the effects of the syndrome on sleep. The sleep study may reveal the delay in sleep onset due to RLS and help estimate the actual sleep time. Sleep study shows if leg movements occurred during sleep and if they were associated with awakenings (PLMD). Patients may be unknowingly waking several times during the night due to the disturbing leg movements, leading to tiredness and sleepiness during the day.

Identification and treatment of contributing factors to RLS helps relieve the symptoms. Pregnancy-related RLS usually improves after delivery. Medications of different classes are used to treat RLS, the most common being used today are the dopamine receptor agonists which compound the action of brain chemical dopamine.

Restless legs syndrome is a treatable condition. Its correct management helps toward a refreshing nightly sleep and a healthy, productive lifestyle.

The cause remains uncertain in many cases, but some factors contributing to RLS include:

• pregnancy

• anemia

• iron deficiency

• kidney failure

• smoking

• certain medications

• nerve diseases

• diabetes

• hypothyroidism

Shameela Ahmed, M.D., is a graduate of

Dow University of Health Sciences,

Karachi, Pakistan. She completed a residency in neurology from Loyola University Medical Center. Her fellowship was in clinical neurophysiology from the University of Tennessee, Memphis, with emphasis on neuromuscular diseases and electromyography. She is a board-certified neurologist and a clinical neurophysiologist.