Symptom Management for Restless Leg Syndrome

Restless leg syndrome (RLS) continues to be one of the most difficult sleep disorders to manage. Although sleep medicine, neurology, and primary care providers usually manage patients with RLS, it is important for all clinicians to understand the symptoms associated with the condition.

Patients are often misdiagnosed with RLS when criteria for the disease have not been met. Patients may describe their urges as “Jimmy jumpy legs,” “twitchy,” “legs want to move on their own,” “numbness,” or “painful.” In my experience, patients with neuropathy or radiating pain secondary to back issues are those who are often misdiagnosed with RLS.

Also known as Willis-Ekbom disease, RLS is characterized by an irresistible urge to move the limbs.  According to the International Classification of Sleep Disorders,¹ the following criteria must be met for a diagnosis of RLS.

• An urge to move the legs, usually accompanied by or thought to be caused by uncomfortable and unpleasant sensation in the legs. The symptoms must:
  
  • Begin or worsen during periods of rest or in activities such as lying down or sitting;
  • Be partially or totally relieved by movement, such as walking or stretching, at least as long as the activity continues; and
  • Occur exclusively or predominantly in the evening or night rather than during the day.
• The above features are not solely accounted for as symptoms of another medical or behavioral condition such as leg cramps, venous stasis, arthritis, or habitual foot tapping.
• The symptoms of RLS cause concern, distress, sleep disturbance, or impairment in mental, physical, social, occupational, educational, behavioral, or other areas of functioning.

Brain iron deficiency, with serum ferritin level <50 ng/mL, is often the cause of RLS. If the anemia is treated, with ferritin levels brought to >50 to75 ng/mL, symptoms usually improve.¹

New evidence points to possible improvement of symptoms with certain exercises. According to a randomized control trial, tension and trauma release exercises were associated with improvement in RLS symptoms.² In addition, as medications for RLS can result in augmentation, or worsening, of RSL symptoms, nonpharmacologic interventions may be a beneficial treatment option.² Tension and trauma release exercises activate natural reflex mechanisms that release muscular tension. These shaking and vibrating exercises encourage the body to relieve tension and return the body to homeostasis.²^,³ During the same study, the control group comprised patients who participated in group discussion with other patients with RLS.² Reduction in RLS symptom severity and improvement in sleep quality were noted in patients participating in both the exercise and discussion groups.

Finding novel ways to control RLS should continue to be investigated as patients report significant suffering from symptoms. Managing symptoms with control of anemia, exercise, and RLS patient groups may help to reduce symptoms.

1. International Classification of Sleep Disorders. 3rd ed.  Darien, IL: American Academy of Sleep Medicine; 2014.
2. Harrison EG, Keating JL, Morgan P. http://www.jabfm.org/content/31/5/783.full#ref-2 2018;31(5):783-794.
3. Tension & trauma releasing exercises. TRE for All, Inc. website. Accessible at: https://traumaprevention.com/. Accessed November 26, 2018.