Restless Legs Syndrome

Restless legs syndrome (RLS), also known as Willis–Ekbom disease, is a neurological condition in which a person experiences a strong urge to move the legs. This urge is often accompanied by uncomfortable sensations in the legs, such as tingling, burning, crawling, or a creeping feeling beneath the skin.

Symptoms worsen when lying down or sitting and typically intensify in the evening and at night. Movement—such as walking or stretching the legs—temporarily alleviates the discomfort, but the sensation returns when movement stops. For this reason, the condition disrupts sleep, leading to daytime fatigue.

Symptoms and diagnosis

Diagnosis is based on patient history rather than definitive laboratory tests. Four essential criteria are typically evaluated: an urge to move the legs associated with uncomfortable sensations; symptoms worsening when at rest; improvement with movement; and worsening in the evening and at night. Other conditions that cause similar sensations must be ruled out, such as nerve pain, diabetic neuropathy, and bone pain.

Causes and risk factors

The exact cause remains unclear, though much research points to dysfunction in the brain's dopamine system and iron levels in brain tissue. Associated conditions include low iron (iron deficiency anemia), kidney disease, pregnancy (particularly in the third trimester), and certain medications such as antidepressants and antihistamines. The condition also runs in families, suggesting a genetic component.

Management

Treatment first addresses underlying causes: blood iron levels are checked and iron supplementation given if deficient. Lifestyle measures include maintaining a regular sleep schedule, reducing caffeine and alcohol, and moderate exercise. When symptoms are severe, medications are used, including dopamine agonists and gabapentin. Long-term use of dopamine medications can lead to worsening symptoms (augmentation), so medical monitoring is necessary.