▶️ Restless Legs Syndrome (RLS) is a condition that causes an uncontrollable urge to move the legs, usually because of an uncomfortable sensation. It typically happens in the evening or nighttime hours when you're sitting or lying down. Moving eases the unpleasant feeling temporarily.

– Restless legs syndrome, also known as Willis-Ekbom disease, can begin at any age and generally worsens as you age. It can disrupt sleep, which interferes with daily activities.

– The exact cause of RLS is not known, but it may be related to an imbalance of the brain chemical dopamine, which sends messages to control muscle movement.

Some factors that may increase the risk of RLS include:

• Family History: RLS can run in families, especially if the condition starts before age 40. Researchers have identified sites on the chromosomes where genes for RLS may be present.

• Iron Deficiency: Low levels of iron or the incorrect use of iron in the brain are the main causes of RLS. Several conditions may affect iron levels, such as kidney failure, peripheral neuropathy, diabetes, Parkinson's disease, rheumatoid arthritis, and iron deficiency anemia.

• Pregnancy: RLS is common during pregnancy, particularly from week 27 until birth. In most cases, the symptoms disappear within four weeks of giving birth.

• Kidney Disease: People with chronic kidney disease or end-stage renal disease may have low iron levels and reduced dopamine production, which can trigger RLS.

• Medications: Some drugs can worsen or cause RLS, such as antihistamines, antidepressants, antipsychotics, lithium, and some anti-nausea drugs.

– The main symptom of RLS is an urge to move the legs, usually accompanied by uncomfortable sensations. These sensations are often described as crawling, creeping, pulling, throbbing, aching, itching, or electric. They usually occur on both sides of the body, but sometimes they alternate or affect only one side. The sensations are worse at rest and improve with movement. They are also more severe in the evening and at night.

– Other symptoms of RLS may include:

• Difficulty falling asleep or staying asleep.

• Daytime sleepiness or fatigue.

• Reduced concentration or memory.

• Mood changes or depression.

• Periodic limb movements of sleep (PLMS), which are involuntary jerks or twitches of the legs or arms during sleep.

The diagnosis of RLS is based on the following criteria, established by the International Restless Legs Syndrome Study Group.

The Criteria requires that:

1). You have a strong, often irresistible urge to move the legs, usually accompanied by uncomfortable sensations.

2). Your symptoms start or get worse when you're resting, such as sitting or lying down.

3). Your symptoms are partially or temporarily relieved by activity, such as walking or stretching.

4). Your symptoms are worse at night.

– Symptoms can't be explained solely by another medical or behavioral condition.

Your provider may conduct a physical and a neurological exam and order blood tests to check your iron levels and rule out other possible causes for your symptoms. You may also be referred to a sleep specialist for a sleep study if another sleep disorder such as sleep apnea is suspected.

The treatment of RLS depends on the severity and frequency of your symptoms, as well as the underlying cause if any.

Some general strategies to manage RLS include:

• Lifestyle changes: These include avoiding or limiting alcohol, caffeine, nicotine, and other stimulants; quitting smoking; exercising regularly but not too close to bedtime; eating a balanced diet rich in iron, folate, and magnesium; maintaining a healthy weight; practicing good sleep hygiene; avoiding activities that worsen symptoms; and engaging in relaxing activities before bed.

• Iron supplements: If your iron levels are low, your provider may prescribe oral or intravenous iron supplements to increase your iron stores and reduce RLS symptoms. However, take iron supplements only with medical supervision and after your provider has checked your blood-iron level.

• Medications: Several prescription medications are available to reduce the restlessness in the legs. These include:

• Medications that increase dopamine in the brain: These medications affect levels of the chemical messenger dopamine in the brain. Rotigotine (Neupro) and pramipexole (Mirapex) are approved by the Food and Drug Administration for the treatment of moderate to severe RLS.

– Short-term side effects of these medications are usually mild and include nausea, lightheadedness and fatigue. However, they can also cause impulse control disorders, such as compulsive gambling, and daytime sleepiness. Long-term use of these medications can also lead to augmentation, which is a worsening of RLS symptoms over time.

• Drugs affecting calcium channels: Certain medications, such as gabapentin (Neurontin), gabapentin enacarbil (Horizant), and pregabalin (Lyrica), work for some people with RLS. They may be especially helpful for people who also have pain or neuropathy. Side effects may include drowsiness, dizziness, and weight gain.

• Muscle relaxants and sleep medications: These drugs help you sleep better at night, but they don't eliminate the leg sensations, and they may cause daytime drowsiness. These medications are generally only used if no other treatment provides relief. Examples include clonazepam (Klonopin), eszopiclone (Lunesta), and temazepam (Restoril).

• Opioids: Narcotic medications are used mainly to relieve severe symptoms, but they may be addicting if used in high doses. They can also cause constipation, nausea, and sedation. Examples include oxycodone (OxyContin), hydrocodone (Vicodin), and tramadol (Ultram).

• Nonpharmacologic therapies: Some alternative or complementary therapies may help relieve RLS symptoms. These include:

• Pneumatic compression: This is a device that applies pressure to the legs through inflatable cuffs. It may improve blood flow and reduce RLS symptoms.

• Near-infrared spectroscopy: This is a device that uses infrared light to stimulate the muscles and nerves in the legs. It may increase blood oxygen levels and reduce RLS symptoms.

• Transcranial magnetic stimulation: This is a procedure that uses magnetic fields to stimulate the brain. It may modulate dopamine activity and reduce RLS symptoms.

• Vibrating pads: These are devices that vibrate under the legs or feet. They may distract from the unpleasant sensations and improve sleep quality.

• Acupuncture: This is a technique that involves inserting thin needles into specific points on the body. It may stimulate the release of endorphins and reduce RLS symptoms.

Some general health and dietary guidelines for people with RLS are:

a). Eat a balanced diet that includes a variety of fresh fruits and vegetables, especially dark leafy greens, which are rich in iron, folate, and magnesium.

b). Eat foods that contain vitamin C, such as citrus fruits, broccoli, and peppers, to enhance iron absorption.

c). Eat foods that contain vitamin E, such as nuts, seeds, and vegetable oils, to protect against oxidative stress.

d). Avoid foods that can trigger or worsen RLS symptoms, such as caffeine, alcohol, tobacco, sugar, salt, processed foods, gluten, and dairy products.

e). Drink plenty of water to stay hydrated and prevent dehydration-related muscle cramps.

f). Take vitamin and mineral supplements as recommended by your provider if you have any deficiencies or malabsorption issues.

▶️ Can children have RLS?

– Yes, children can have RLS. RLS is a condition that causes an uncontrollable urge to move the legs, usually because of an uncomfortable sensation. It typically happens in the evening or nighttime hours when you're sitting or lying down. Moving eases the unpleasant feeling temporarily.

– RLS is a neurological disorder that can affect children of any age, but it is often underdiagnosed or misdiagnosed in children. Some studies estimate that about 2% of children and adolescents have RLS, and about 35% of adults with RLS report that their symptoms started before age 20.

– RLS can interfere with children's sleep quality, mood, behavior, learning and development. Children with RLS may have difficulty falling asleep or staying asleep, which can lead to daytime sleepiness, fatigue, irritability, hyperactivity, inattention, poor concentration and memory. They may also experience pain, tingling or discomfort in their legs, which can make them restless, fidgety, anxious or depressed. They may resist bedtime or avoid activities that require sitting still, such as school or car ride.

– The exact cause of RLS is not known, but it may be related to an imbalance of the brain chemical dopamine, which helps control muscle movement. Some factors that may increase the risk of RLS in children include family history, iron deficiency, kidney disease, medications, allergies and other sleep disorders.

– The diagnosis of RLS in children is based on the medical history, physical examination and sleep study. The sleep study is a test that monitors the breathing and other body functions while the child sleeps. It can measure how many times the child stops breathing or has reduced airflow per hour of sleep (apnea-hypopnea index) and how many times the child has involuntary leg movements during sleep (periodic limb movement index).

– These indices can indicate the severity of RLS and its impact on sleep quality.

The treatment of RLS in children depends on the severity and frequency of the symptoms, as well as the underlying cause if any. Some general strategies to manage RLS in children include:

• Lifestyle changes: These include avoiding or limiting caffeine, alcohol, tobacco and other stimulants; exercising regularly but not too close to bedtime; eating a balanced diet rich in iron, folate and magnesium; maintaining a healthy weight; practicing good sleep hygiene; avoiding activities that worsen symptoms; and engaging in relaxing activities before bed.

• Iron supplements: If the child has low iron levels or iron deficiency anemia, iron supplements may be prescribed to increase the iron stores and reduce RLS symptoms. However, iron supplements should be taken only under medical supervision and after checking the blood-iron level.

• Medications: Some prescription medications may be used to reduce the restlessness in the legs and improve sleep quality. These include medications that increase dopamine in the brain (such as pramipexole or ropinirole), medications that affect calcium channels (such as gabapentin or pregabalin), or opioids (such as oxycodone or tramadol). However, these medications should be used with caution and under close monitoring by a doctor, as they may have side effects or cause dependence.

• Nonpharmacologic Therapies: Some alternative or complementary therapies may help relieve RLS symptoms in children. These include massage therapy, acupuncture, biofeedback, cognitive behavioral therapy or hypnosis. However, these therapies should be used as adjuncts to conventional treatment and not as substitutes.

▶️ What's the prevalence of RLS

– The prevalence of RLS is the proportion of people in a population who have RLS at a given time. According to the web search results, the prevalence of RLS varies depending on the geographic region, ethnic group, age group, and diagnostic criteria. However, some estimates are:

• A comprehensive analysis of RLS epidemiological studies finds the prevalence rate of RLS to be 5–15% in the general population with 2.5% of adults having symptoms severe enough to require medical intervention.

• A large population-based door-to-door survey on 19176 adults in Tehran, Iran, finds the standardized prevalence rate of RLS to be 60.0/1000.

• A Wikipedia article states that RLS affects between 5 and 10% of the population to some extent and about 2.5% severe.

– These figures suggest that RLS is a common condition that affects millions of people worldwide, but it may be underdiagnosed or misdiagnosed in some regions or populations. Therefore, more research and awareness are needed to improve the diagnosis and treatment of RLS.

▶️ What are the risk factors for RLS?

– Some of the risk factors for RLS are:

• Family History: RLS can run in families, especially if the condition starts before age 40. Researchers have identified sites on the chromosomes where genes for RLS may be present.

• Iron Deficiency: Low levels of iron or the incorrect use of iron in the brain are the main causes of RLS. Several conditions may affect iron levels, such as kidney failure, peripheral neuropathy, diabetes, Parkinson's disease, rheumatoid arthritis, and iron deficiency anemia.

• Pregnancy: RLS is common during pregnancy, particularly from week 27 until birth. In most cases, the symptoms disappear within four weeks of giving birth.

• Kidney Disease: People with chronic kidney disease or end-stage renal disease may have low iron levels and reduced dopamine production, which can trigger RLS.

• Medications: Some drugs can worsen or cause RLS, such as antihistamines, antidepressants, antipsychotics, lithium, and some anti-nausea drugs.

• Lifestyle Factors: Smoking, drinking alcohol, consuming caffeine, and being overweight or obese can increase the risk or severity of RLS.