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February 21, 2017

Restless Legs Syndrome

JAMA. 2017;317(7):780. doi:10.1001/jama.2016.21375

Common symptoms of restless legs syndrome include uncomfortable feelings in the legs and an urge to move the legs.

Restless legs syndrome—also called Willis-Ekbom disease—causes significant symptoms in about 2% to 3% of people in the United States. Women are more likely than men to be affected. Most people are at least middle aged or older when they develop symptoms, but children can have restless legs syndrome as well.


Restless legs syndrome causes an uncomfortable urge to move the legs. Usually, this urge is associated with unpleasant sensations in the legs. The sensations can be difficult to describe but include burning, aching, tingling, or crawling. Symptoms are worst while at rest; moving the legs usually provides relief. Symptoms occur mostly in the evening or at night. The leg sensations often cause difficulty falling or staying asleep.


The cause of restless legs syndrome is not fully understood, but evidence suggests that low iron levels in the brain and abnormal regulation of a chemical in the body called dopamine may play a role in the disease process. In some cases, restless legs syndrome runs in families. Restless legs syndrome can also be associated with other medical conditions, including low levels of iron in the blood and kidney failure. Certain medications—mainly antidepressants and medications that block dopamine—can also worsen symptoms.


Diagnosis of restless legs syndrome is primarily based on a medical history and physical examination performed by a health care clinician. However, additional testing may be ordered to look for conditions that can cause or worsen the symptoms of restless legs syndrome. A blood test should be ordered to check ferritin levels and transferrin saturation, which are measures of the body’s iron stores, since iron stores are low in some people with restless legs syndrome. Because the symptoms of restless legs syndrome often occur at night and affect sleep, a sleep study may also be ordered to rule out other conditions that could be contributing to poor sleep.


If symptoms of restless legs syndrome are mild and infrequent, lifestyle changes such as exercising regularly may be helpful. Massaging the legs or soaking the legs in water may also provide relief.

Medications may be used if symptoms occur on a regular basis and are bothersome. Medications approved by the US Food and Drug Administration for restless legs syndrome include pramipexole, ropinirole, rotigotine patch, and gabapentin enacarbil. Common side effects of many of the medications used to treat restless legs syndrome include sleepiness and dizziness. Some medications may become less effective over time, and switching to another therapy may be necessary in these instances.

In situations in which restless legs syndrome is related to another medical condition, treatment of that condition may improve symptoms. For example, in people with restless legs syndrome and low iron levels, taking iron supplements may reduce symptoms.

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Article Information

Sources: National Institute of Neurological Disorders and Stroke, American Academy of Sleep Medicine, American Academy of Neurology

Topic: Neurology