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Restless legs syndrome (RLS, Wittmaack-Ekbom's syndrome, or sometimes referred to as Nocturnal myoclonus) is a neurological disorder characterized by unpleasant burning, creeping or tugging sensations in the legs and an uncontrollable urge to move when at rest in an effort to relieve these.  These range in severity from uncomfortable to irritating to painful.

One of the cardinal or most distinctive aspects of RLS is that lying down and trying to relax actually sets off symptoms. Not unexpectedly, folks with RLS have difficulty falling asleep and staying asleep. Naturally when RLS is not dealt with, it can lead to daytime fatigue and exhaustion.

In 2003, a National Institutes of Health (NIH) consensus panel modified their existing RLS criteria as follows:

(1) RLS is defined as an urge to move the limbs with or without sensations that

(2) worsens at rest

(3) improves with activity

(4) worsens in the evening or night.

According to the NIH consensus panel, RLS can be either primary or secondary.

Primary RLS is considered idiopathic or with no known cause, and typically begins before sufferers’ reach 40 to 45 years of age, and has been known to occur as early as the first year of life. Onset is often slow with symptoms disappearing for months or even years. It is often progressive and gets worse with ager.

Secondary RLS frequently has a sudden onset, occurs after age 40, may be manifest on a daily basis from the “get go”, and is most often associated with specific medical conditions or the use of certain drugs such as anti-nausea drugs (prochlorperazine or metoclopramide), anti-seizure drugs (phenytoin or droperidol), antipsychotic drugs (haloperidol or phenothiazine derivatives), and some cold and allergy medications. The medical conditions most often linked to secondary RLS  is iron deficiency (20% of all RLS cases) plus  varicose veins, folate deficiency, uremia, diabetes, peripheral neuropathy, thyroid challenges, Parkinsonism, pregnancy, some autoimmune diseases and conditions such as rheumatoid arthritis. Not unexpectedly, RLS is eliminated by treatment of the causative disease or condition, and/or halting use of the problematic drug or substance.

RLS affects as many as 12 million Americans and occurs in both men and women., although the incidence may be slightly higher in women.  More than 80 percent of people with RLS also experience a condition called periodic limb movement disorder (PLMD). PLMD is typified by involuntary leg twitching or jerking movements while a RLS sufferer is asleep, something that takes place every 10 to 60 seconds, sometimes throughout the night. Unlike RLS, PLMD movements are involuntary.

At least one published study indicates that people with RLS, especially the elderly, may have an increased risk of developing cardiovascular disease (April 10, 2007, issue of Neurology).

The study was conducted at the University of Montreal's Sacré-Coeur Hospital and involved ten people with untreated RLS, who spent a night in a sleep laboratory where their leg movements and blood pressure (BP) was monitored at intervals.

Researchers found blood pressure rates during leg movements rose by an average of 20 points systolic (top or first number – 120/80 being normal), and by an average of 11 points e diastolic (bottom or second number).

In addition, the scientists discovered that BP changes increased with age and in those with a longer history of RLS.

Experts have also found that caffeine, alcohol, and tobacco may aggravate or trigger symptoms in patients who are predisposed to develop RLS. Some studies, in fact, have revealed that a reduction or complete elimination of such substances relieves symptoms in some instances.

There is no curative drug or treatment for RLS. The standard or conventional approach is aimed at symptomatic relief. Dopaminergic agents such as Pramipexole (Mirapex®), pergolide (Permax®), ropinirole (Requip®), bromocriptine (Parlodel®), levodopa with carbidopa (Sinemet®) are used to manage severa symptoms; as is diazepam (Valium®) and clonazepam (Klonopin®); and the opiate drugs codeine and oxycodone.

Smoking, alcohol and tobacco use cessation are also typically recommended.

There are studies that indicate that up to 8% of people with reactive hypoglycemia have RLS. In such instances, RLS symptoms have not unexpectedly improved following dietary changes that help keep blood-sugar levels on an even keel. Among the dietary changes researchers have found of merit: A sugar-free, high-protein diet along with frequent snacking and at least one night-time snack or meal. Readers interested in a dietary approach of this sort should check out Guide to Living Longer and Healthier

For people with RLS whose family includes other sufferers, genetics is most likely a contributing player. Researchers have noted that these folks appear to have an unusually high requirement for folate. The amount of folic acid required, however, to relieve symptoms typically is in the mega-dose range (5,000 - 30,000 mcg daily). Folate should only be taken in such large quantities if ordered and supervised by a physician.

For those interested in a low dose, time release form of folate there is NUTRACENE

RLS patients who have or are at increased risk of developing heart disease might want to acquaint themselves with HEARTROL and CARDIUM.

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4. Davis BJ, Rajput A, Rajput ML, et al. ‘A randomized, double-blind placebo-controlled trial of iron in restless legs syndrome,’ Eur Neurol 2000;43:70–5.

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6. Botez MI. ‘Neuropsychological correlates of folic acid deficiency: facts and hypotheses’ in “Folic Acid in Neurology, Psychiatry and Internal Medicine,” New York: Raven Press, 1979.