Restless leg syndrome (RLS) is a condition in which the person develops an urge to move in order to relieve discomforting symptoms or sensation, usually arising in the legs. Although physicians use the term "restless", most people with the condition describe it more as a tenseness, tightness or creepy - crawly or burning feeling. Usually the sensation is most severe in the evenings and brought on by rest or relaxation, and relieved by movement including stretching, massaging, bicycling the legs or walking about.

The symptoms usually come on gradually after age 20 and may fluctuate over time, becoming more noticeable or aggravating in the 50's and 60's. They usually interfere with falling asleep or may waken the sufferer at night. They may be accompanied by periodic leg movements in sleep, usually consisting of extension of the big toe and flexion of the ankle, knee and hip.

On most occasions RLS occurs spontaneously and is of unknown cause. It can, however, be associated with other conditions including kidney insufficiency, peripheral neuropathy, sciatica, Parkinson's disease, iron deficiency, low thyroid state, rheumatoid arthritis, vitamin deficiency of B12 or folate, spinal cord disease, multiple sclerosis or even pregnancy. Some drugs also tend to bring on or exacerbate the symptoms such as caffeine, alcohol, some anti depressants and some anti psychotic and anti nausea medications.

Several other conditions can resemble RLS including akathisia which is a generalized restlessness that occurs both during the day and at night, leg cramps, and the syndrome of "painful legs and moving toes" which also tends to occur throughout the day.

Several non-medical treatments have been advocated for RLS including vein surgery, transcutaneous nerve stimulation, acupuncture, and herbal remedies. There is no clear evidence to show that any of these treatments are effective.

There are several medications which have been reported as effective in suppressing RLS symptoms, but again there are few formal studies to compare effectiveness. These drugs generally fall into 4 categories, including dopamine agonists (example, ropinirole, pergolide), opiates (example: Oxycodone), benzodiazepines (example: clonazepam), and anticonvulsants (example: Gabapentin or Carbamazepine).

The first step is to consult your physician to ensure the diagnosis is correct and to review your medications and make sure that other causes of RLS have been excluded. Reduce caffeine and alcohol intake. Since symptoms fluctuate, if medication is used, it should be kept to the minimum dose that suppresses symptoms to a tolerable limit.

Dr. R. O'Brien

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