Restless Leg Syndrome (RLS), also known as Willis-Ekbom disease, is a common condition affecting 1 in 10 of us.  It is a neurological disorder characterized by an irresistible urge to move the limbs accompanied by uncomfortable sensation.  It can cause an unpleasant crawling or creeping sensation in the feet, calves and thighs. The sensation may be daily or come in episodes but is often worse at rest in the evening or at night and improved by movement.

The pathophysiology of RLS is not fully understood, but several factors have been implicated in its development.

One of the main theories is that RLS is caused by an imbalance in dopamine signaling in the brain. Dopamine is a neurotransmitter that plays a key role in controlling movement and motivation. In RLS, it is thought that there may be a deficiency of dopamine in certain parts of the brain, leading to abnormal movement and sensation in the limbs.

Another theory is that RLS is related to iron metabolism. Iron is essential for the production of dopamine, and low levels of iron in the brain have been linked to RLS. Some studies have also shown that RLS may be associated with abnormalities in other minerals, such as magnesium and zinc.

There may also be a genetic component to RLS, as it often runs in families. Researchers have identified several genes that may be involved in the development of the disorder, including genes related to dopamine and iron metabolism.

Finally, other factors such as pregnancy, certain medications, and medical conditions like peripheral neuropathy and kidney disease have been linked to RLS. These factors may disrupt normal dopamine signaling or cause other physiological changes that contribute to the development of the disorder. 

Unfortunately, there is no specific test currently available to confirm the diagnosis of RLS.  Blood tests to measure Iron and assess function of the kidneys can identify secondary RLS, and in these cases the symptoms of RLS will usually disappear if the underlying cause is treated.  However, in primary RLS, where the cause is unknown, the symptoms can sometimes get worse with time and severely disrupt sleep causing anxiety and depression.  

NICE recommends non-pharmacological interventions as the first-line treatment for mild to moderate RLS, including lifestyle modifications such as regular exercise and improving sleep hygiene. Pharmacological treatments, including dopamine agonists, gabapentin, and opioids, may be considered for patients with moderate to severe RLS that significantly affects their quality of life. Often these interventions are still ineffective and there are side effects attached to these drugs, including nausea, drowsiness, headaches, hallucinations, swelling of feet and ankles, and loss of balance.  In this instance other treatment options can be considered….

The National Institute of Clinical Excellence advises that massage can be helpful. Acupuncture can also be an effective treatment. and should be considered if other treatments have been tried without success.

If you suffer from RLS the charity Restless Leg Syndrome UK provides information and support for people affected by restless legs syndrome, and may be able to put you in touch with other people in your area affected by the condition.