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]

• 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]

• 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]

• Nocturnal Awakening

  As a result, they have difficulty falling asleep, repeated nocturnal awakenings, or both. Symptoms may be worsened by stress. [merckmanuals.com]

  Association of EDS, frequent nocturnal awakening, morning headache and transient memory or concentration disturbances (TMCD) with OSAS OR a 95% CI a P EDS No 1 b Yes 2.43 1.26–4.69 0.007 Frequent nocturnal awakening No 1 b Yes 1.61 1.01–2.72 0.04 Morning [doi.org]

• Snoring

  Snoring Many pregnant women start snoring because of nasal congestion, and the increase in abdominal girth and the uterus pressing on the diaphragm. [web.archive.org]

  Medical sleep disorders such as obstructive sleep apnoea (apnea), insomnia, snoring, restless legs syndrome and narcolepsy contribute to high blood pressure, diabetes and heart disease. [healthdirect.gov.au]

  Patients with snoring and witnessed apneas may have obstructive sleep apnea, which is diagnosed using overnight polysomnography. Continuous positive airway pressure is the most common and effective treatment for obstructive sleep apnea. [ncbi.nlm.nih.gov]

  Snoring and obstructive sleep apnea A wide variety of products and devices have been advertised in the lay press and on the Internet as potential “cures” for chronic snoring. Most have little or no scientific support. [doi.org]

• Pruritus

  In this review, we specifically highlight common troublesome symptoms affecting dialysis patients: insomnia, restless legs syndrome, and uremic pruritus. [ncbi.nlm.nih.gov]

  Sleep disorders, restless legs syndrome, and uremic pruritus: diagnosis and treatment of common symptoms in dialysis patients. Am J Kidney Dis. 2017;69(1):117-128. PMID: 27693261 www.ncbi.nlm.nih.gov/pubmed/27693261. [mountsinai.org]

  Lerma, Are restless legs syndrome, pruritus or hiccoughs surrogates for inadequate dialysis?, Seminars in Dialysis, 24, 4, (406-407), (2011). [doi.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]

• Muscle Spasm

  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]

  Muscle spasms usually affect the quadriceps (the large muscles on the front of the thigh), causing the lower leg to straighten. In fact, some extensor spasms can be so sudden and strong that the person can fall out of a chair or bed. [verywellhealth.com]

  Magnesium deficiency often results in symptoms of anxiety, muscle spasms, muscle twitching, sleep disorders, nausea, fatigue, and depression. [natural-alternative-therapies.com]

  Anticonvulsants: These treat pain, muscle spasms, neuropathy, and daytime symptoms. Neurontin, or gabapentin, is a popular anticonvulsant. [medicalnewstoday.com]

• Leg Pain

  Administering gabapentin enacarbil also improved the continuous leg pain that occurred in conjunction with the development of RLS. [ncbi.nlm.nih.gov]

  Restless leg syndrome (RLS, restless legs syndrome ) is a common cause of painful legs. The leg pain of restless leg syndrome typically eases with motion of the legs and becomes more noticeable at rest. [medicinenet.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]

• Fear

  By JEN GUNTER Photo Credit iStock Doctors Treating a Patient With a Nightmarish Condition She had lost all of her skin and I feared I had helped make her last weeks an unrelenting horror show, until our chance reunion. By ALESSANDRA COLAIANNI, M.D. [nytimes.com]

  "She's eight, and has growing pains, and I fear that the two are linked." In fact, there is no connection between growing pains and RLS. But RLS is sometimes mis-diagnosed in children as growing pains. [theguardian.com]

  (Some people with RLS fear that they have a serious neurological disorder.) If the symptoms are troublesome then one or more of the following remedies for restless legs may be advised. [patient.info]

• Kidney Failure

  While blood tests may be administered to rule out secondary causes, such as kidney failure, there is otherwise no medical test to diagnosis restless leg syndrome. [diabetes.co.uk]

  Kidney transplants (but not dialysis) relieve RLS linked to kidney failure. Treatments for RLS include lifestyle changes and medicines. Some simple lifestyle changes often help relieve mild cases of RLS. [web.archive.org]

  Kidney failure. If you have kidney failure, you may also have iron deficiency, often with anemia. When kidneys don't function properly, iron stores in your blood can decrease. This and other changes in body chemistry may cause or worsen RLS/WED. [mayoclinic.org]

  Other risk factors for RLS include taking certain medications like anti-nausea drugs or antipsychotics, being pregnant or having a chronic disease like kidney failure and diabetes. WebMD has more information on restless legs syndrome. [cbsnews.com]

• Renal Insufficiency

  RLS is associated with Parkinson’s disease, diabetes, renal insufficiency, iron deficiency anemia, peripheral neuropathy, and multiple sclerosis. The focus of this article is the association between RLS and venous insufficiency. [centerforvein.com]

  Renal Insufficiency. Gabapentin is excreted through the renal system. B. Liver Insufficiency. None. C. Systolic and Diastolic Heart Failure Watch for inadequate drug clearance. D. Coronary Artery Disease or Peripheral Vascular Disease None. E. [clinicaladvisor.com]

  However, we were not able to evaluate how many dialysis patients reported RLS symptoms before the renal insufficiency, in order to differentiate idiopathic from uraemic forms. Despite this limitation, our previous statement seems to be notable. [doi.org]

  In comparison, secondary RLS might remit once the underlying condition (pregnancy, iron deficiency, chronic renal insufficiency) is resolved [40–42]. [bmcneurol.biomedcentral.com]

• 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]

• Irritability

  In the older age-onset patients, misdiagnoses also included skin irritation, arthritis, and malingering. A total remission of symptoms of a month or more was present in at least 15% of the individuals in all groups surveyed. [ncbi.nlm.nih.gov]

  A recent study published in the journal Sleep Medicine investigated whether or not patients with irritable bowel syndrome (IBS) and bacterial overgrowth developed RLS. CONCLUSIONS: IBS and SIBO are common in RLS. [glutenfreesociety.org]

  Clinical Neuroscience Publishers, London, 1990, pp 43-78 Beard interpreted the symptoms as "one of the myriad results of spinal irritation". Hermann Oppenheim (1858-1919): Lehrbuch der Nervenkrankheiten. 7th edition, S. [whonamedit.com]

  As a result, suffers often find they are irritable throughout the day, with low mood and low energy. Symptoms vary from person to person, so you might have restless leg syndrome and find it doesn’t impact your life too much. [magnopulse.com]

• Hyperactivity

  Attention-deficit/hyperactivity disorder (ADHD) is frequently accompanied with sleep disorders such as obstructive sleep apnea, periodic limb movement disorder, restless legs syndrome (RLS), and circadian rhythm disorder. [ncbi.nlm.nih.gov]

  […] contents Figures & tables Video Audio Supplementary Data Cite Citation Samuele Cortese, Eric Konofal, Michel Lecendreux, Isabelle Arnulf, Marie-Christine Mouren, Francesca Darra, Bernardo Dalla Bernardina, Restless Legs Syndrome and Attention-Deficit/Hyperactivity [doi.org]

• Headache

  BACKGROUND: Recent studies have shown a significant association between restless legs syndrome (RLS) and primary headache disorders. Nevertheless, information regarding the association between tension-type headache (TTH) and RLS is limited. [ncbi.nlm.nih.gov]

  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]

• 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]

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].

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.