Affected individuals complain of restlessness, feeling of unpleasant sensation in their legs and calf muscles. Restless legs syndrome presents with the following signs and symptoms:

• Pain
• Itching
• Burning
• Gnawing
• Pulling
• Tugging
• Creeping 
• Crawling
• Periodic leg movement of sleep (PLMS) [6]
• Sleeping cycle disorders [7]

• Pain

  This pain is usually not eased by walking, and many patients complain that movement makes the pain worse. This pain is generally present most of the time and does not change during particular times of the day. [clinicaladvisor.com]

  Leg pain and discomfort are common complaints in any primary physician’s clinic. Two common causes of pain or discomfort in legs are nocturnal leg cramps (NLC) and restless leg syndrome (RLS). [doi.org]

  Although the neurobiological mechanism in the development of pain remains unclear, a range of non-dopaminergic structures likely mediated pain processing in DLB in the present case based on neuropharmacological results. [ncbi.nlm.nih.gov]

  Severe RLS may cause painful feelings. However, the pain usually is more of an ache than a sharp, stabbing pain. Children may describe RLS symptoms differently than adults. In children, the condition may occur with hyperactivity. [web.archive.org]

• Anemia

  Anemia, particularly cerebrospinal anemia, has been assumed a substantially causal factor in RLS symptoms for over half a century. Although the exact pathogenesis of the disorder remains elusive till this date. [symptoma.com]

  Rather than indicators of iron deficiency anemia (serum ferritin, serum iron, and hemoglobin) or pernicious anemia (vitamin B 12 ), it was reduced serum folate level that was associated with RLS in this sample of pregnant women. [doi.org]

  Rather than indicators of iron deficiency anemia (serum ferritin, serum iron, and hemoglobin) or pernicious anemia (vitamin B(12)), it was reduced serum folate level that was associated with RLS in this sample of pregnant women. [ncbi.nlm.nih.gov]

  Nearly all patients in end stage renal disease (the point where dialysis becomes necessary) have anemia. [davita.com]

  RLS is more common in people with anemia or kidney problems and who are pregnant. [nationaljewish.org]

• Fatigue

  If you have RLS, it is probably contributing to your MS-related fatigue by causing you to lose sleep. This is called secondary fatigue, as the tiredness is a result of symptoms or insomnia. [verywellhealth.com]

  Specific questionnaires were used in order to assess the health-related quality of life (HRQoL), fatigue levels, sleep quality, daily sleepiness, and depression symptoms of the patients. [ncbi.nlm.nih.gov]

  Pain can make sleeping difficult, and fatigue from a poor night’s sleep can exacerbate pain. The cycle repeats over and over, resulting in ever-worsening pain and fatigue. However, this cycle works the other way, too. [paindoctor.com]

  Dizziness, fatigue and sleepiness are among the possible side effects. [sharecare.com]

  Some exercises like ankle pumps and bridges help work the muscles to fatigued them out. This should help calm them down as well. [youtube.com]

• Excessive Daytime Sleepiness

  Compared with pregnant women without RLS, those with RLS were twice as likely to report poor sleep quality and poor daytime function, and they were also more likely to have excessive daytime sleepiness. [sciencedaily.com]

  Compared to women without RLS, those with RLS were more likely to have poor sleep quality (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.7-2.9), poor daytime function (OR 1.9, 95% CI 1.4-2.4), and excessive daytime sleepiness (OR 1.6, 95% CI 1.3 [ncbi.nlm.nih.gov]

  As many as 12.2 percent of people suffering from insomnia and 3.5 percent of those suffering from excessive daytime sleepiness may experience PLMD. [healthcommunities.com]

  PLMD is repetitive twitching or kicking of the lower or upper extremities during sleep, often interrupting nocturnal sleep and causing excessive daytime sleepiness. [merckmanuals.com]

• Nocturnal Leg Cramp

  Leg pain and discomfort are common complaints in any primary physician’s clinic. Two common causes of pain or discomfort in legs are nocturnal leg cramps (NLC) and restless leg syndrome (RLS). [doi.org]

  Leg pain and discomfort are common complaints in any primary physician's clinic. Two common causes of pain or discomfort in legs are nocturnal leg cramps (NLC) and restless leg syndrome (RLS). [ncbi.nlm.nih.gov]

  […] treatment or prevention of nocturnal leg cramps outweigh any potential benefits. [web.archive.org]

  […] associated with the use of neuroleptic medications; desire to move not necessarily associated with discomfort in the legs; symptoms are not worse at night Nocturnal leg cramps Sudden involuntary muscle contractions; palpable tightening of the leg muscles [aafp.org]

  Restless Legs Syndrome: an irresistible urge to move legs, usually as it gets closer to bedtime or with periods of inactivity. Restless legs syndrome is different from kicking at night, periodic limb movements, and nocturnal leg cramps. [sleepphones.com]

• Nausea

  Placebo comparisons showed a significantly higher incidence of nausea for pramipexole (p<0.01), whereas nausea, vomiting, dizziness, and somnolence were significantly higher for ropinirole (all p<0.01). [ncbi.nlm.nih.gov]

  But, development of nausea during the day often prevents the individuals from taking a short nap. [symptoma.com]

  Other possible side effects can include nausea, dizziness and headaches. If you experience nausea while taking a dopamine agonist, you may be given medication to help with this (antiemitic medication). [nhs.uk]

  […] disease and kidney failure Diabetes Peripheral neuropathy (a type of nerve dysfunction in the peripheral nervous system) Rheumatoid arthritis Multiple sclerosis Secondary RLS is sometimes a side effect of certain medications, such as those used to treat: Nausea [everydayhealth.com]

• Vomiting

  Placebo comparisons showed a significantly higher incidence of nausea for pramipexole (p<0.01), whereas nausea, vomiting, dizziness, and somnolence were significantly higher for ropinirole (all p<0.01). [ncbi.nlm.nih.gov]

  They include nausea, vomiting, itching, difficulty urinating, and increased pain sensitivity. Some RLS studies have reported new or worsening sleep apnea with long-term use. Drug interactions. [consumerreports.org]

  Side effects include dizziness, nausea, vomiting, constipation and the risk of addiction. Anticonvulsant drugs such as gabapentin (Neurontin) and gabapentin enacarbil (Horizant) may also help reduce the sensory disturbances associated with RLS. [sharecare.com]

  There’s also a trend away from using medications that increase dopamine levels in the brain — medications like pramipexole (Mirapex) or ropinirole (Requip) — as a first option, in part because they can have side effects that include nausea, vomiting, [womentowomen.com]

  Side effects of many anti-seizure drugs include nausea, vomiting, heartburn, increased appetite with weight gain, hand tremors, irritability, and temporary hair thinning and hair loss. [mountsinai.org]

• Restless Legs Syndrome

  Restless legs syndrome presents with the following signs and symptoms: Pain Itching Burning Gnawing Pulling Tugging Creeping Crawling Periodic leg movement of sleep (PLMS) Sleeping cycle disorders Diagnosis of restless legs syndrome primarily begins with [symptoma.com]

  Restless legs syndrome Other names Willis–Ekbom disease (WED),[1] Wittmaack–Ekbom syndrome Sleep pattern of a person with restless legs syndrome (red) versus a healthy sleep pattern (blue) Specialty Sleep medicine Symptoms Unpleasant feeling in the legs [en.wikipedia.org]

  Causes of restless leg syndrome There are two categories of restless leg syndrome; primary and secondary. Primary restless leg syndrome has no known cause, although doctors suspect that genes can play a role, and often begins before the age of 40. [diabetes.co.uk]

  KEYWORDS: restless legs syndrome; sleep disorder [ncbi.nlm.nih.gov]

• Leg Cramp

  Leg pain and discomfort are common complaints in any primary physician’s clinic. Two common causes of pain or discomfort in legs are nocturnal leg cramps (NLC) and restless leg syndrome (RLS). [doi.org]

  Leg pain and discomfort are common complaints in any primary physician's clinic. Two common causes of pain or discomfort in legs are nocturnal leg cramps (NLC) and restless leg syndrome (RLS). [ncbi.nlm.nih.gov]

  The unpleasant feelings from RLS aren't the same as the leg cramps many people get at night. Leg cramps often are limited to certain muscle groups in the leg, which you can feel tightening. [web.archive.org]

• Insomnia

  KEYWORDS: Clinical; Gender; Insomnia; Restless legs; Review; Sleep apnoea [ncbi.nlm.nih.gov]

  Between dialytic parameters only dialysis shift was related to insomnia (OR, 2.02; CI 95, 1.46–2.80; P Table 3. Insomnia symptoms Questions a Level 1 insomnia ( n = 269, 48.7%) Level 2 insomnia ( n = 283, 51.3%) 1. [doi.org]

• Akathisia

  Our finding of secondary RLS and akathisia as manifestations of acute pontine infarction provides information that assists in understanding the common anatomical and pathophysiological basis of RLS and akathisia. [ncbi.nlm.nih.gov]

  Greater awareness of potential causes of RLS, and its differentiation from akathisia and illness related agitation might help in reducing the distress associated with it and improving patient compliance in patients using atypical antipsychotic agents. [doi.org]

• Myoclonus

  PURPOSE OF REVIEW: This article provides an update on six sleep-related movement disorders: restless legs syndrome (RLS), periodic limb movement disorder, sleep-related leg cramps, bruxism, rhythmic movement disorder, and propriospinal myoclonus, with [ncbi.nlm.nih.gov]

  Heiman EM, Christie M (1986) Lithium-aggravated nocturnal myoclonus and restless legs syndrome. Am J Psychiatry 143: 1191–1192 PubMed Google Scholar 34. [doi.org]

  They also are called (nocturnal) myoclonus, which describes frequent or involuntary muscle spasms. Periodic limb movement was formally described first in the 1950s, and, by the 1970s, it was listed as a potential cause of insomnia. [healthcommunities.com]

  Restless legs syndrome differs from nocturnal myoclonus syndrome in that in the latter condition the individual does not report adverse sensory stimuli and it is primarily a sleep-associated movement disorder. [icd9data.com]

  Reports of patients with myoclonus follow, however, myoclonus appears to be treatment-resistant on both aggressive immunosuppression and GFD. [dx.doi.org]

• Somnolence

  Placebo comparisons showed a significantly higher incidence of nausea for pramipexole (p<0.01), whereas nausea, vomiting, dizziness, and somnolence were significantly higher for ropinirole (all p<0.01). [ncbi.nlm.nih.gov]

  Dizziness and somnolence are the most common adverse effects. However, use of this drug to treat RLS has not been extensively studied. [merckmanuals.com]

• Agitation

  Greater awareness of potential causes of RLS, and its differentiation from akathisia and illness related agitation might help in reducing the distress associated with it and improving patient compliance in patients using atypical antipsychotic agents. [doi.org]

  These might include dizziness, visual disturbances, agitation, seizures, mental clouding, depression, euphoria and other reactions. [consumerreports.org]

  Stress often plays a role in agitating RLS, so any treatments that help reduce stress can help alleviate your symptoms. Relaxation techniques, such as breathing and meditation, can help reduce your stress level. [healthline.com]

  Restless Leg Syndrome and Anxiety Anxiety, agitation, and stress can also trigger restless legs at night. Mood disorders can occur due to sleep deprivation, which can strongly resemble or even cause anxiety. [vivehealth.com]

Diagnosis of restless legs syndrome primarily begins with a detailed history of sleep pattern of the affected individuals. In addition, individuals with such a syndrome must meet the following criteria given by International Restless Legs Syndrome Study Group:

• Individuals have a very strong desire to move the legs due to uncomfortable sensations. The sensations that cause compulsive movement of the legs include tingling, itching, gnawing, creeping and crawling.
• The symptoms tend to worsen when the individual is either taking rest or sitting; in other words when the legs are in resting position, the symptoms get severe.
• Symptoms generally are relieved by carrying out activities such as walking, moving or stretching.

In addition, to the above mentioned criteria, certain blood tests like ferritin levels may also be carried out to rule out organic other causes [8]. Nerve conduction and electromyographic studies may prove to be useful even with a normal neurologic exam [9].

• Iron Decreased

  Studies of iron in people with RLS have demonstrated low cerebrospinal fluid iron levels ( Earley 2000 ), low iron concentrations in the substantia nigra on magnetic resonance imaging ( Allen 2004 ), and decreased substantia nigra iron stores on autopsy [doi.org]

Treating underlying conditions can in majority of the cases correct the condition. However, when restless legs syndrome presents as a sole problem then the treatment regime involves medications along with changes in lifestyle factors. For mild symptoms the doctors may advice some light exercises clubbed with massage and certain relaxation techniques. These methods in a great way help effectively manage the mild symptoms of RLS.

In case of severe symptoms, medications are prescribed to help individuals sleep comfortably and manage other symptoms. The commonly prescribed medications include ropinirole, gabapentin, opioids and clonazepam [10].

If left untreated, RLS can lead to severe mental and physical exhaustion. Numerous people with this condition describe serious consequences in their daily lives, including job difficulties, relationship problems, and a lack of mental acuity. Additionally, others have reported difficulty concentrating, poor memory, and an inability to perform simple activities of daily living. Untreated RLS may also cause problems while traveling and can result in depression.

Complications

Restless legs syndrome seldom causes any serious life threatening conditions. However, the symptoms often get severe during the night hours making life miserable for the affected individuals. Many individuals complain of sleep disturbances during night time, which in turn causes drowsiness during the day. But, development of nausea during the day often prevents the individuals from taking a short nap.

Sleep disturbance also gravely affects the concentration of the individuals and when experienced for long periods, can cause psychiatric disturbances as well.

In many situations, the cause of RLS is unidentified. There may be a genetic basis for it, however, since it is often noted to run in families when the symptoms are first noted before age 40. Research has also shown that a cerebral iron deficiency may have in influence on RLS [2]. Additionally, there is substantial support from scientific studies that seems to indicate a connection between dysfunction in the brain’s basal ganglia circuits and RLS. Interference in these neural conduits often leads to uncontrolled movements.

Research has shown that patients who suffer from Parkinson’s disease, which is also characterized by dysfunction in the basal ganglia, frequently have restless legs syndrome. Although scientists do not know conclusively if these components actually cause RLS, there appears to be a definite connection between these issues and RLS: Chronic diseases such as peripheral neuropathy, diabetes, and renal failure, the use of certain antipsychotic, antidepressant, antihistamine, and anti-nausea medications or being in the last trimester of pregnancy. Lack of restorative sleep and alcohol use may also cause RLS symptoms in some patients.

Restless legs syndrome is a rather common disorder, approximately one in ten people suffer from restless legs syndrome. Various studies regarding the prevalence of RLS in women versus men have been inconclusive.

About 25-30% of individuals with anemia, renal failure, or late-stage pregnancy that exhibit some form of impairment of iron hemostasis are likely to develop restless legs syndrome [3]. Patients who are pregnant or have renal failure may not necessarily also have anemia. The diminished state of serotonin ferritin transporters in the brainstem may give rise to RLS [4].

However, intravenous and oral iron therapy may significantly relieve RLS symptoms in many of these individuals, whether there is substantiated anemia or not. Anemia, particularly cerebrospinal anemia, has been assumed a substantially causal factor in RLS symptoms for over half a century. Although the exact pathogenesis of the disorder remains elusive till this date [5].

The exact etiology behind the development of RLS is not very well understood and therefore, no guidelines have been postulated to prevent the development of such a syndrome. Researchers however state that making certain lifestyle changes can in a great way help manage the symptoms effectively.

Restless legs syndrome (RLS) is a neurological condition described as aching, crawling, cramping, or other unpleasant feelings in the lower extremities frequently accompanied by an overpowering compulsion to move one’s legs [1]. These symptomsare usually more prominent when someone is resting and may become more severe at night. As reported by patients, paresthesia and/or dysesthesia may range in severity from slightly unpleasant to extremely agonizing.

Definition

Restless legs syndrome (RLS), a neurological disorder is characterized by development of unpleasant sensations in the legs and calf muscles. The sensations include feeling of creeping, tingling, tugging and pain. These symptoms are known to get worse when the legs are in resting position. Also, the condition gets severe during the night hours disrupting the sleep of the affected individuals.

Cause

The exact cause behind the development of RLS is not yet known. However, the RLS can accompany certain disease conditions such as anemia, Parkinson’s disease, peripheral neuropathy and other chronic disease conditions.

Symptoms

Symptoms of RLS include creeping, gnawing, crawling, tugging, tingling and pain in the legs and calf muscles. The symptoms tend to get severe during the night hours when the individual is at rest.

Diagnosis

Diagnosis of RLS comprises of gathering a detailed history of the symptoms experienced by the patient. In addition, information about the sleep pattern is also gathered. Blood tests are done to rule out underlying conditions. 

Treatment

Treatment of RLS is geared towards making certain life style changes to cope with the mild symptoms. Severe forms of symptoms are managed with medications and lifestyle changes.

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 5th. Arlington, VA: American Psychiatric Association; 2013:410-3.
2. Restless legs syndrome. Detection and management in primary care. National Heart, Lung, and Blood Institute Working Group on Restless Legs Syndrome. Am Fam Phys. Jul 1 2000; 62(1):108-14.
3. Winkelman JW. Considering the causes of RLS. Eur J Neurol. Oct 2006; 13 Suppl 3:8-14.
4. Jhoo JH, Yoon IY, Kim YK, Chung S, Kim JM, Lee SB. Availability of brain serotonin transporters in patients with restless legs syndrome. Neurology. Feb 9 2010; 74(6):513-8.
5. Takaki J, Nishi T, Nangaku M, et al. Clinical and psychological aspects of restless legs syndrome in uremic patients on hemodialysis. Am J Kidney Dis. Apr 2003; 41(4):833-9.
6. Krueger BR. Restless legs syndrome and periodic movements of sleep. Mayo Clin Proc. Jul 1990; 65(7):999-1006.
7. Restless legs syndrome. Detection and management in primary care. National Heart, Lung, and Blood Institute Working Group on Restless Legs Syndrome. Am Fam Phys. Jul 1 2000; 62(1):108-14.
8. Hening WA. Restless Legs Syndrome. Curr Treat Options Neurol. Sep 1999; 1(4):309-319.
9. Ferreri F, Rossini PM. Neurophysiological investigations in restless legs syndrome and other disorders of movement during sleep. Sleep Med. Jul 2004; 5(4):397-9.
10. Bogan RK, Bornemann MA, Kushida CA, Trân PV, Barrett RW. Long-term maintenance treatment of restless legs syndrome with gabapentin enacarbil: a randomized controlled study. Mayo Clin Proc. Jun 2010; 85(6):512-21.