Restless legs syndrome (RLS) is a condition that causes an uncontrollable urge to move the legs, usually because of an uncomfortable sensation. It typically happens in the evening or nighttime hours when you’re sitting or lying down. Moving eases the unpleasant feeling temporarily.
Restless legs syndrome, also known as Willis-Ekbom disease, can begin at any age and generally worsens as you age. It can disrupt sleep, which interferes with daily activities.
Simple self-care steps and lifestyle changes may help relieve symptoms. Medications also help many people with RLS.
Risk factors of RLS
RLS can develop at any age, even during childhood. The condition is more common with increasing age and more common in women than in men.
RLS usually isn’t related to a serious underlying medical problem. However, it sometimes accompanies other conditions, such as:
- Peripheral neuropathy. This damage to the nerves in the hands and feet is sometimes due to chronic diseases such as diabetes and alcoholism.
- Iron deficiency. Even without anemia, iron deficiency can cause or worsen RLS. If you have a history of bleeding from the stomach or bowels, experience heavy menstrual periods, or repeatedly donate blood, you may have iron deficiency.
- Kidney failure. If you have kidney failure, you may also have iron deficiency, often with anemia. When kidneys don’t function properly, iron stores in the blood can decrease. This and other changes in body chemistry may cause or worsen RLS.
- Spinal cord conditions. Lesions on the spinal cord as a result of damage or injury have been linked to RLS. Having had anesthesia to the spinal cord, such as a spinal block, also increases the risk of developing RLS.
- Parkinson’s disease. People who have Parkinson’s disease and take certain medications called dopaminergic agonists have an increased risk of developing RLS.
Medications for RLS
Medication is a key treatment for moderate to severe RLS.
Dopaminergic drugs are typically the first medications prescribed. They’re effective in relieving RLS symptoms, but they can cause side effects and other problems .
Other types of drugs can also help relieve RLS symptoms without causing these same types of problems.
Dopaminergic drugs increase the release of dopamine in your brain. Dopamine is a chemical that helps enable normal body movements .
Dopaminergic drugs likely help relieve RLS symptoms because the condition is associated with problems in the body’s production of dopamine.
Three dopaminergic medications have been approved by the U.S. Food and Drug Administration (FDA) to treat moderate to severe primary RLS:
- pramipexole (Mirapex)
- ropinirole (Requip)
- rotigotine (Neupro)
While dopaminergic drugs have been shown to help improve RLS symptoms, long-term use can actually worsen symptoms. This phenomenon is called augmentation. To help delay this problem, doctors typically prescribe the lowest possible dose of these drugs .
In addition, these drugs can become less effective over time. To help delay or prevent both of these problems, your doctor may prescribe a combination of dopaminergic drugs with other types of drugs to treat RLS .
A fourth drug that’s been approved by the FDA to treat RLS is called gabapentin (Horizant). This is an antiseizure medication .
It’s not entirely understood how gabapentin works to relieve RLS symptoms, but studies show it to be effective.
In one study, 24 people with RLS were treated with gabapentin or a placebo for six weeks. Those treated with gabapentin had improved sleep and reduced leg movements from RLS, while those treated with a placebo did not.
Another study compared the use of gabapentin with the use of ropinirole (one of the drugs approved by the FDA to treat RLS). Eight people with RLS took each of the drugs for four weeks, and both groups achieved similar levels of relief from RLS symptoms .
Benzodiazepines are drugs used to treat anxiety and sleep problems. Clonazepam (Klonopin) and other types of these drugs are often prescribed for people with RLS in combination with other drugs.
While these drugs may not relieve RLS symptoms themselves, their benefit of improved sleep can be very helpful for people with RLS.
Opioids are typically used to treat pain. In some cases, usually when other medications aren’t helpful or cause augmentation, opioids can be used carefully in low doses to help treat RLS .
Prolonged-release oxycodone/naloxone (Targinact) is one opioid that could help relieve RLS symptoms and improve sleep . However, because of the newer guidelines being developed for the use of opioids, this should be a last resort.
As with all opioids, use of these drugs should be carefully overseen by a doctor, due to their risk of misuse and dependence.