Restless Legs Syndrome
What is RLS?
Irresistible Urge to Move Your Legs
Restless legs syndrome, or RLS, is a very common disorder that often occurs in families, due to inherited problems with a neurochemical called dopamine. RLS also may result from other conditions, such as diabetes, kidney disease, neuropathy, anemia, and even nervous system trauma.
Those suffering from untreated RLS report difficulty falling asleep or staying asleep because of the unpleasant feelings in the legs or arms and the twitching and kicking that often disrupts sleep.
Excessive daytime sleepiness, hypertension, depression, attention deficit/hyperactivity disorder (ADHD), and substance abuse have all been associated with RLS and may be the result of untreated RLS.
How is RLS Diagnosed?
RLS is a syndrome that can be caused by dopamine dysfunction in the central nervous system. Dopamine is a neurochemical that regulates sensation and movement through the spinal cord. When this system is disrupted, whether due to trauma or an inherited dopamine deficiency, the results are the same: (1) an urge to move the legs with or without an uncomfortable sensation that (2) gets worse in the evening and (3) with rest, and that is (4) temporarily relieved by movement or rubbing.
Diagnosis is made by a full sleep history including medications and foods that can exacerbate RLS, as well as diagnostic testing such as ambulatory leg monitoring, serum testing, and detailed neurological examination. When RLS occurs without an associated condition, such as diabetes, the cause is often genetic and passed down from generation to generation. Up to 10 percent of people may have the genes for RLS, and ongoing studies among researchers at FusionSleep, Emory University and collaborators in Iceland are uncovering these links.
Signs & Symptoms
One or more of the following are indications of RLS:
- Irresistible urge to move the legs
- Uncomfortable feelings or pains in the legs
- Symptoms are worse at rest in the evening
- Symptoms are better with movement
These difficult-to-describe symptoms occur more often in the evening or night and may be temporarily relieved by rubbing, movement, or massage. People with RLS are noted by bed partners to kick during the night and to have periodic leg movements during wake which can seem like a “nervous habit.” RLS affects children, adolescents, adults, and the elderly and is more common in women.
Studies of patients with RLS have demonstrated a clear link between RLS and hypertension. The cause for this may be related to the recurrent periodic leg movements that usually accompany RLS during sleep, and which often result in arousals that inappropriately activate the “fight or flight” response during sleep.
Children with ADHD are much more likely to have RLS, at a rate of up to 40 percent in some studies. Research indicates that alterations in dopamine systems in the central nervous system are the root cause for RLS, and these systems are implicated in the expression of ADHD. Treatment studies of children with RLS and ADHD have illustrated a clear link between these disorders, since dopamine therapy not only results in resolution of RLS symptoms, but also in the symptoms of ADHD.
How is RLS Treated?
Therapy for RLS has made major advances in the quality of life for RLS patients, as well as in our understanding of the biology of this disorder. Dopamine medications have been approved by the FDA to treat RLS and are very well tolerated and effective. Therapy also involves diagnosing and treating iron deficiency since this can lead to problems with dopamine production and usage in the central nervous system.