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NeurologicalICD-10: G25.81Affects 5–10% of the adult population in the US and Europe

Restless Legs Syndrome

Also known as: RLS, Willis-Ekbom Disease

Restless legs syndrome (RLS) is a neurological sensorimotor disorder characterized by an irresistible urge to move the legs, usually accompanied by uncomfortable sensations described as crawling, tingling, aching, or pulling. Symptoms typically worsen during periods of rest or inactivity and in the evening or nighttime, significantly impairing sleep quality. RLS affects approximately 5–10% of the adult population.

Symptoms

Uncomfortable sensations in the legs (crawling, tingling, pulling, aching)
Irresistible urge to move the legs
Symptoms that worsen at rest and improve with movement
Symptoms that are worse in the evening and at night
Difficulty falling or staying asleep
Involuntary leg movements during sleep (periodic limb movements — PLMS)
Daytime fatigue and sleepiness

Causes

  • Dysfunction in the brain's dopamine pathways
  • Iron deficiency in the brain (even with normal blood iron levels)
  • Genetic factors (multiple RLS susceptibility genes identified)
  • Secondary causes: pregnancy, kidney failure, peripheral neuropathy, iron deficiency anemia

Risk Factors

  • Family history of RLS (over 50% of primary RLS patients have a family history)
  • Iron deficiency (ferritin <50–75 ng/mL)
  • Pregnancy (especially the third trimester)
  • Chronic kidney disease or dialysis
  • Peripheral neuropathy
  • Certain medications (antidepressants, antihistamines, antipsychotics can worsen RLS)

Diagnosis

  • Clinical diagnosis based on five essential criteria from the International RLS Study Group (IRLSSG)
  • Serum ferritin level (check for iron deficiency — treat if <75 ng/mL)
  • Polysomnography to assess periodic limb movements if diagnosis is uncertain
  • Nerve conduction studies if peripheral neuropathy is suspected

Treatment

  • Iron supplementation if ferritin is below 75 ng/mL
  • Alpha-2-delta ligands (gabapentin enacarbil, pregabalin) — preferred first-line
  • Dopamine agonists (pramipexole, ropinirole, rotigotine) — used cautiously due to augmentation risk
  • Lifestyle measures: regular exercise, warm baths, leg massage
  • Avoiding caffeine, alcohol, and nicotine
  • Opioids (low-dose) for severe refractory cases

Prevention

  • Maintain adequate iron stores through diet or supplementation
  • Regular moderate exercise (avoid intense exercise close to bedtime)
  • Good sleep hygiene practices
  • Avoid medications that can trigger or worsen RLS when possible

When to See a Doctor

  • Uncomfortable leg sensations regularly disrupting sleep
  • Persistent daytime sleepiness affecting work or safety
  • Symptoms not improved with lifestyle changes
  • Symptoms starting or worsening during pregnancy

Frequently Asked Questions

Related Conditions

Insomnia

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Narcolepsy

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Parkinson's Disease

Neurological

Peripheral Neuropathy

Neurological

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