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Restless legs syndrome (RLS) is a movement condition that causes an irresistible urge to move the legs, often accompanied by uncomfortable sensations such as pulling, searing, tingling, or crawling. While the main cause of RLS is unknown, it is believed to be linked to dopamine deficiency, low iron levels, and genetic factors. RLS can cause sleep disruptions and is often associated with Periodic Limb Movement Disorder (PLMD) or Periodic Limb Movement of Sleep (PLMS), which involves involuntary leg twitching or jerking during sleep. PLMS is a common comorbidity, affecting up to 80% of people with RLS. Therefore, it is clear that RLS can be a contributing factor to muscle twitching, specifically in the legs, during sleep or periods of rest.
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What You'll Learn
RLS and Periodic Limb Movement Disorder (PLMD)
Restless legs syndrome (RLS) is a movement condition where one has an urge to move their legs while at rest, which can interfere with sleep. RLS causes uncomfortable sensations in the legs, which can be described as "pulling, searing, drawing, tingling, bubbling, or crawling", usually in the calf area. These sensations can also affect the thighs, feet, and sometimes, even the arms. RLS can be temporary, such as during pregnancy, or chronic and long-term. It can develop from several medical conditions and genetic risk factors.
Periodic limb movement disorder (PLMD) is a condition that causes leg muscles to contract and jerk every 20 to 40 seconds during sleep. These movements can last less than a second or up to 10 seconds. Unlike RLS, contractions in PLMD do not usually wake the person experiencing them, although they may disturb their bed partner. PLMD is often associated with RLS, and four out of five people who have RLS also report having PLMD. However, only about a third of people with PLMD have RLS. The causes of PLMD are not entirely clear, but some research suggests that it may be due to abnormalities in the autonomic nervous system, which regulates involuntary actions of the smooth muscles, heart, and glands.
While RLS and PLMD have distinct clinical features, they are considered overlapping disorders that can cause nocturnal, involuntary limb movements and sleep disruption. RLS is diagnosed based on established clinical criteria, while PLMD requires the presence of periodic limb movements on polysomnography, as well as an associated sleep complaint. Treatment options for both conditions mostly overlap, with dopaminergic drugs being commonly used for RLS and levodopa compounds and sedative-hypnotics for PLMD.
Both RLS and PLMD can result in uncontrolled and unwanted movements, making it challenging to get a restful night's sleep. These conditions often co-occur and can be frustrating and tiring for those affected. Treatment for these conditions is available, and specialists in sleep disorders can help determine the underlying causes and provide appropriate management strategies.
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RLS and low dopamine levels
Restless Legs Syndrome (RLS) is a movement condition where one has an urge to move their legs when resting, which can interfere with sleep. The main cause of RLS is unknown, but several studies support the theory that an imbalance in neurotransmitters (chemical messengers in the brain), notably dopamine, may play a part in RLS. Dopamine levels naturally fall towards the end of the day, which may explain why RLS symptoms are often worse in the evening and during the night.
RLS is a dopamine-dependent disorder characterised by a strong urge to move. The most compelling theory of its pathogenesis involves the neurotransmitter dopamine (DA), more specifically, the hypofunctioning in brain DA signalling. Supporting evidence for this notion is given by the fact that RLS symptoms decrease with drugs that stimulate the DA system and are produced with drugs that block DA neurotransmission in the brain. The levels of DA in the brain are directly proportional to the number of brain DA D2 receptors (D2Rs).
RLS may often have a genetic basis, particularly in those who develop it before the age of 40. RLS in older adults is less likely to be inherited. There are at least six genetic factors that may play a part. Two of the genes are linked to spinal cord development. However, more research is needed to show a link between these genetic factors and dopamine or iron-regulating systems.
Blood plasma dopamine levels were significantly increased in medicated RLS subjects compared to unmedicated RLS subjects and controls. The percentage of lymphocytes and monocytes expressing D2Rs differed between the control, RLS medicated, and RLS unmedicated subjects. Downregulation of WBCs D2Rs occurs in RLS. This downregulation is not reversed by medication, although commonly used RLS medications increase plasma dopamine levels.
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RLS and genetics
Restless legs syndrome (RLS) is a common neurological disorder characterised by an urge to move the legs, particularly in the evening and at night. It is one of the most common sleep and movement disorders, affecting an estimated 5 to 10 percent of adults and 2 to 4 percent of children in the United States. The prevalence is greater in individuals with reduced iron reserves.
The underlying cause of RLS is unknown, but genetic factors play a strong role in the pathogenesis of the condition, particularly when it starts at a young age. The inheritance pattern of RLS is usually unclear because many genetic and environmental factors can be involved. However, RLS often runs in families, with 40 to 90 percent of affected individuals reporting having at least one affected first-degree relative. The early-onset form of the disorder is more likely to be familial than the late-onset form. In some families, RLS appears to have an autosomal dominant pattern of inheritance, meaning that one copy of an altered gene in each cell is sufficient to cause the disorder.
Twin and familial aggregation studies have suggested that genetic factors contribute up to 70% of the risk of developing RLS. Several large genomic regions have been identified through linkage studies in multiplex families, but no definitive causal variant or gene has been identified. Genome-wide association studies (GWAS) have identified many predisposing loci, but these variants only explain about 20% of the heritability. A recent meta-analysis of GWAS data from 480,982 Caucasians confirmed 19 of the 20 previously reported RLS sequence variants at 19 loci and reported three novel RLS associations. At four of the 22 RLS loci, cis-eQTL analysis indicates a causal impact on gene expression.
Molecular genetic studies have suggested the presence of susceptibility genes on chromosomes 12q, 14q, and 9p. In addition, three loci showing vulnerability to RLS have been described in French-Canadian and Italian families in chromosomes 12q, 14q, and 9q, emphasising an autosomal dominant mode of inheritance. These have been labelled RLS1, RLS2, and RLS3, respectively. However, specific causative mutations remain unknown, and no linkage analysis has been identified in the candidate genes investigated in RLS.
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RLS and sleep disruption
Restless legs syndrome (RLS) is a sleep disorder that causes an irresistible urge to move the legs. It is a movement condition, as people with RLS are forced to move their legs to find relief from uncomfortable sensations. These sensations can include feelings of pulling, searing, drawing, tingling, bubbling, or crawling, usually in the calf area, and they worsen during periods of rest or inactivity. The sensations can also affect the thighs, feet, and sometimes the arms. RLS can cause sleep disruption, difficulty falling asleep or staying asleep, and fatigue or daytime sleepiness.
RLS is a clinical diagnosis that doesn't require sleep testing. To diagnose RLS, a healthcare provider will look for specific criteria, including the urge to move the legs accompanied by uncomfortable sensations, symptoms that worsen during rest, and relief from discomfort when moving the legs. Symptoms typically occur exclusively or predominantly in the evening or at night.
RLS is a common condition, with between 7% and 10% of the United States population affected. It is more prevalent in women and white people, and the risk of developing it increases with age. RLS may have a genetic basis, particularly in those who develop it before the age of 40. In older adults, RLS is less likely to be inherited.
While the primary cause of RLS is unknown, research suggests that it may be related to a dysfunction in the basal ganglia, a part of the brain that controls movement using the brain chemical dopamine. Low levels of iron in the brain may also contribute to RLS, as iron plays a role in regulating dopamine levels. Treating iron deficiency and addressing other exacerbating factors, such as alcohol, caffeine, and untreated sleep apnea, can help manage RLS symptoms and improve sleep quality.
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RLS diagnosis
Restless legs syndrome (RLS) is a movement condition where one experiences an urge to move their legs when resting, which can interfere with sleep. The sensations can also affect the thighs, feet, and sometimes, even the arms. While RLS is a clinical diagnosis that doesn't require sleep testing, there is currently no definitive test to diagnose RLS.
Diagnosis
Your healthcare provider may recommend blood tests and an overnight sleep study to rule out other conditions or determine the cause of your symptoms. They will consider your age, overall health, and other factors when advising treatment. In addition, they will treat any underlying disorders that may be affecting your RLS.
RLS may often have a genetic basis, particularly in those who develop it before the age of 40. People with RLS often have a family history of the disorder, and there are at least six genetic factors that may play a role, two of which are linked to spinal cord development. However, more research is needed to establish a clear link between these genetic factors and dopamine or iron-regulating systems.
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Frequently asked questions
Restless Legs Syndrome (RLS) is a movement condition that causes an overwhelming, irresistible urge to move the legs. It is a common condition of the nervous system that can interfere with sleep.
The most prominent symptom of RLS is the urge to move the legs, especially when sitting still or lying in bed. Other symptoms include unusual sensations in the legs such as tingling, crawling, throbbing, pulling, itching, or an aching feeling. RLS can also cause sleep disruptions, fatigue, behavioural changes, and difficulty concentrating.
Yes, RLS can cause muscle twitching or jerking movements in the legs, particularly during sleep. This is known as Periodic Limb Movement of Sleep (PLMS) and occurs every 15 to 40 seconds throughout the night. PLMS can also lead to sleep deprivation.
There is no cure for RLS, but treatments can help manage symptoms. Lifestyle changes such as improving sleep habits, stretching, yoga, meditation, and reducing caffeine intake may be beneficial. Medications can also be prescribed to help decrease leg movement and improve sleep quality.
