Restless legs syndrome

Last updated: August 9, 2022

Summarytoggle arrow icon

Restless legs syndrome (RLS), also referred to as Willis-Ekbom disease (WED), is a relatively common, neurological sleep disorder characterized by unpleasant sensations in the legs and a strong urge to move them. The urge increases during periods of rest, especially in the evenings, and may diminish with movement. Primary RLS is idiopathic and is often associated with a positive family history. Secondary RLS is less common and can result from a variety of underlying conditions, including iron deficiency, attention deficit hyperactivity disorder (ADHD), uremia, and Parkinson disease. Diagnostic tests are used to exclude secondary causes of RLS. Tests include ferritin levels, vitamin levels, autoantibody assays, thyroid profile, etc. Treatment for severe primary RLS includes alpha-2-delta calcium channel ligands, while secondary RLS is managed by treating the underlying cause. If left untreated, RLS can cause significant social and functional impairment.

Epidemiologytoggle arrow icon

  • RLS affects up to 15% of the general US population [1]
  • Sex: >
  • Peak incidence: 30–40 years of age (often misdiagnosed as growing pains in childhood) [2]

Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon

Pathophysiologytoggle arrow icon

Clinical featurestoggle arrow icon

  • Main clinical features [9]
    • A recurrent, uncomfortable urge to move the legs that is:
      • Typically relieved by movement
      • Begins and/or worsened with rest
    • Symptoms are worse in the evening and at night (may occur exclusively at night)
    • Can be accompanied by dysesthesias (e.g., pain, pins and needles, itching, tickling, or crawling sensations).
  • Other features

Diagnosticstoggle arrow icon

RLS is mainly a clinical diagnosis but additional testing may be indicated to rule out an underlying disease, including conducting laboratory tests, nerve conduction studies, polysomnogram, and needle electromyogram.

Treatmenttoggle arrow icon

Treatment for primary RLS is largely symptomatic. Treatment of secondary RLS depends on the underlying cause. Intermittent treatment may be necessary for recurrent cases with spontaneous remission.

Referencestoggle arrow icon

  1. Ramar K, Olson EJ. Management of common sleep disorders. Am Fam Physician. 2013; 88 (4): p.231-238.
  2. Ohayon MM, O'Hara R, Vitiello MV. Epidemiology of restless legs syndrome: a synthesis of the literature.. Sleep Med Rev. 2012; 16 (4): p.283-95.doi: 10.1016/j.smrv.2011.05.002 . | Open in Read by QxMD
  3. Xiong L, Montplaisir J, Desautels A, et al. Family study of restless legs syndrome in Quebec, Canada: clinical characterization of 671 familial cases.. Arch Neurol. 2010; 67 (5): p.617-22.doi: 10.1001/archneurol.2010.67 . | Open in Read by QxMD
  4. Weinstock LB, Bosworth BP, Scherl EJ, et al. Crohnʼs disease is associated with restless legs syndrome. Inflamm Bowel Dis. 2010; 16 (2): p.275-279.doi: 10.1002/ibd.20992 . | Open in Read by QxMD
  5. Weinstock LB, Walters AS, Mullin GE, Duntley SP. Celiac disease is associated with restless legs syndrome. Dig Dis Sci. 2009; 55 (6): p.1667-1673.doi: 10.1007/s10620-009-0943-9 . | Open in Read by QxMD
  6. Cotter PE, O'Keeffe ST. Restless leg syndrome: is it a real problem?. Therapeutics and clinical risk management. 2006; 2 (4): p.465-75.doi: 10.2147/tcrm.2006.2.4.465 . | Open in Read by QxMD
  7. Lee KA, Zaffke ME, Baratte-Beebe K. Restless Legs Syndrome and Sleep Disturbance during Pregnancy: The Role of Folate and Iron. J Womens Health Gend Based Med. 2001; 10 (4): p.335-341.doi: 10.1089/152460901750269652 . | Open in Read by QxMD
  8. Winkelman JW. Considering the causes of RLS. Eur J Neurol. 2006; 13 (s3): p.8-14.doi: 10.1111/j.1468-1331.2006.01586.x . | Open in Read by QxMD
  9. 2012 Revised IRLSSG Diagnostic Criteria for RLS. Updated: March 31, 2017. Accessed: March 31, 2017.
  10. Montplaisir J, Boucher S, Poirier G, Lavigne G, Lapierre O, Lespérance P. Clinical, polysomnographic, and genetic characteristics of restless legs syndrome: a study of 133 patients diagnosed with new standard criteria. Mov Disord. 1997; 12 (1): p.61-65.doi: 10.1002/mds.870120111 . | Open in Read by QxMD
  11. Marelli S, Galbiati A, Rinaldi F, et al. Restless legs syndrome/Willis Ekbom disease: new diagnostic criteria according to different nosology.. Arch Ital Biol. ; 153 (2-3): p.184-93.doi: 10.12871/0003982920152343 . | Open in Read by QxMD
  12. Happe S, Paulus W. [Neurophysiological and neuroimaging studies for restless legs syndrome and periodic leg movement disorder].. Nervenarzt. 2006; 77 (6): p.652, 654-6, 659-62.doi: 10.1007/s00115-005-2025-3 . | Open in Read by QxMD
  13. Allen RP, Picchietti DL, Auerbach M, et al. Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis-Ekbom disease in adults and children: an IRLSSG task force report.. Sleep Med. 2018; 41: p.27-44.doi: 10.1016/j.sleep.2017.11.1126 . | Open in Read by QxMD
  14. Silber MH, Buchfuhrer MJ, Earley CJ, et al. The Management of Restless Legs Syndrome: An Updated Algorithm. Mayo Clin Proc. 2021; 96 (7): p.1921-1937.doi: 10.1016/j.mayocp.2020.12.026 . | Open in Read by QxMD

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