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Restless legs syndrome


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Restless legs syndrome

Restless Legs Syndrome (RLS), also known as Ekbom syndrome after the Swedish doctor Karl-Axel Ekbom who first used the term restless legs syndrome, is a condition characterised by a compelling and overwhelming urge to move the legs, usually accompanied or caused by unpleasant or painful sensations in the legs. These uncomfortable sensations are more common in the evening than during the day and typically occur when the person is resting.

Over 1.5 million adults (approximately 3% of the adult population) in the UK are known to have RLS, but the true figure is likely to be 5-10% of the adult population, as many people do not report their symptoms to their doctor.

RLS can affect people of all ages but is more likely to develop in those over the age of 45, with symptoms becoming more severe and more frequent as the person gets older. Women are more likely to be affected by RLS than men.


In most cases, the cause of RLS is unknown and this is referred to as primary or idiopathic RLS. Primary RLS appears to run in families with about half of people affected having a close family member such as a parent who also had the condition. Primary RLS tends to appear before the age of 45 and develops slowly.

Although the exact cause of primary RLS is not known, the compelling urge to move the legs is thought to be triggered by an imbalance of dopamine, a naturally occurring chemical messenger in the nervous system that controls movement. Levels of dopamine in the brain are thought to fall at night and this could explain why symptoms often appear in the evening.

In other cases, RLS may be a symptom of some other underlying medical condition and this is referred to as secondary RLS. Causes of secondary RLS include iron deficiency anaemia or chronic diseases such as diabetes, kidney failure and Parkinson's disease. Certain medicines used to control nausea, psychiatric illnesses or high blood pressure may also cause symptoms of RLS to appear. Sometimes, women nearing the end of their pregnancy will develop secondary RLS.


RLS is characterised by strong, irresistible urge to move the legs because of uncomfortable or even painful sensations. This urge to move and the sensations may be:

  • Worse when resting, for example when lying down or sitting
  • Helped by movement, such as walking or stretching
  • Worse, or only occur, in the evening or at night

Symptoms vary between individuals. For some the symptoms are mild. They experience little distress and are able to continue with life normally. For others the symptoms can be severe, occurring more than twice a week and, although not life-threatening, can be extremely distressing.

Severe symptoms may cause significant sleep disturbance, leading to daytime tiredness and affecting normal daily functioning. RLS may have an impact on work, personal life and general activities. RLS can strain relationships if the partner's sleep is disturbed by the person's kicking leg movements at night.


If symptoms of RLS are moderate or severe and are causing distress or interfering with sleep, there is a type of medicine called a dopamine agonist that may help. The dopamine agonists used in the UK are pramipexole, ropinirole and rotigotine. These drugs work in a similar way to the natural chemical transmitter dopamine and so help to correct the imbalance that is thought responsible for RLS.

If the pain in the legs is particularly severe, other medicines used to treat nerve pain such as carbamazepine, gabapentin or pregabalin may be used, or drugs such as benzodiazepines may be used to try to relax the leg muscles.

When to consult your pharmacist

There are no over the counter remedies for the specific treatment of RLS. Simple analgesics such as paracetamol may be used to ease pain and some preparations may be used to help sleep, but if your symptoms are particularly severe, your pharmacist will advise you to see your doctor.

If you have recently developed symptoms of RLS talk to your pharmacist. Your pharmacist will ask you to describe your symptoms and will check if you are taking any medicines that may be the cause.

When to consult your doctor

Go to see your doctor if you have any of the symptoms described above, particularly if the symptoms are disturbing your life. RLS is a recognised medical condition and it can be treated.

When you see your doctor, explain your symptoms fully saying:

  • How they make you feel
  • When you experience them
  • If there is anything that makes you feel better, or worse
  • What effect they have on your everyday life
  • If they prevent you falling asleep or cause you to wake up at night

You should also tell your doctor if anyone else in your family is or has been affected in a similar way.

If your doctor decides that you have primary or idiopathic RLS, then it is likely that one of the dopamine agonists or one of the other medicines described above will be prescribed.

If your doctor thinks that you have secondary RLS, then the underlying condition will be treated, for example by giving iron supplements to correct iron deficiency anaemia, or changing your medicine if your doctor thinks that RLS may be a side effect.

Living with RLS

For those whose symptoms of RLS are mild, a few simple lifestyle changes can help. Take regular daily exercise, but avoid strenuous exercise late at night as this may make symptoms worse.

Cut down on tea, coffee and alcohol and, if you smoke, make every effort to stop.

Eat a well balanced diet, rich in fresh fruit and fresh vegetables. In some cases a deficiency in iron, folate, or magnesium may contribute to RLS. By eating a wide variety of fresh foods, you should get the vitamins and minerals you need.

Try to improve your sleeping habits by going to bed at the same time each night and getting up at the same time each morning.

Massaging the legs, taking a warm bath, applying a warm compress or ice pack may also help ease symptoms.

Useful Tips
  • Exercising, walking and stretching regularly
  • Avoiding caffeine-containing products – e.g. tea and coffee
  • Reducing alcohol intake
  • Stopping smoking
  • Taking hot or cold baths
  • Using a whirlpool bath
  • Rubbing affected legs
  • Relaxation techniques
  • Keeping yourself occupied during long periods of sitting down – e.g. by doing a crossword puzzle
  • Have a healthy sleep pattern:
  • Ensure that your sleeping environment is quiet and comfortable
  • Try to go to sleep and wake up at the same time each day
  • Do not exercise before going to bed
  • Avoid daytime napping

Reviewed on 27 May 2011