The term “restless legs syndrome” (RLS) can’t quite convey how troublesome this neurological disorder can be to the millions of people who have the condition. People with RLS have likened the tumult in their lower limbs to darting jolts of electrical current, a creepy-crawly feeling or an aching sensation.
- Although RLS may sound merely bizarre, it is a serious disorder, affecting an estimated 10 to 19 percent of elderly adults. Because affected individuals feel compelled to move their legs while at rest, RLS hampers their ability to sleep. In fact, RLS can cause more severe sleep deprivation than almost any other sleep disorder.
- What is RLS? RLS is a neurologic disorder marked by uncomfortable feelings in the lower limbs that are heightened by inactivity and relieved by movement. The leg discomfort usually begins in the evening and worsens at night for most people as they attempt to sleep. Though movement promptly relieves the discomfort, symptoms return as soon as the person sits or lies down again.
- Some cases of RLS can result from conditions that include iron deficiency, kidney failure, peripheral neuropathy or pregnancy. But in most cases the cause is unknown.
- Low brain levels of dopamine, a chemical that helps transmit nerve impulses, are thought to play a critical role in causing RLS, as are low blood and brain levels of iron. RLS patients have lower than normal levels of ferritin (an iron-storage protein) in their cerebrospinal fluid and decreased iron levels in regions of the brain rich in dopamine- producing nerve cells. Because iron is required for dopamine synthesis, low brain iron levels may lead to dopamine deficiency and, perhaps, RLS.
What works for RLS? Therapy for mild to moderate RLS is directed primarily at relieving symptoms. Some patients can ease symptoms with lifestyle measures, such as taking a hot bath, exercising on a stationary bike before bedtime and avoiding caffeine, alcohol and nicotine. Most RLS patients, however, eventually require medication and should be managed, at least initially, by a neurologist familiar with RLS.
- Because RLS may be caused or exacerbated by low iron stores, iron supplements (ferrous sulfate) are recommended for all RLS patients. Ferrous sulfate is usually combined with vitamin C to aid in absorption.
- Dopaminergic drugs, which are also used for Parkinson’s disease, are effective for many RLS patients. They work by increasing levels of dopamine in the brain. Unfortunately, extended use of these drugs is associated with symptom augmentation — symptoms worsen and appear earlier and earlier in the day. If augmentation develops while taking one drug, another dopaminergic drug can be substituted.
Information from Johns Hopkins Health Alerts