Restless Legs Specialists & Information About the Syndrome

The official name of the condition is Restless Legs Syndrome (RLS). It is characterized by movement disorders and abnormal sensations that cause intense inner restlessness. Patients experience an increased, unpleasant urge to move. This sensation is most noticeable in the legs, though the arms can also be affected.

The syndrome is considered a neurological disorder and was little known until a few years ago. The German Restless Legs Association (Deutsche Restless Legs Vereinigung e.V.) estimates that several hundred thousand people in Germany are affected.

Those affected describe their symptoms in very different ways.

The following overview lists the most important symptoms:

• A strong urge to move, accompanied by sensations of tingling, pulling, or tearing in the legs.
• These sensations occur on one side or both sides of the body.
• The arms are rarely affected.
• Pain felt in the arms or legs

Symptoms usually appear in the evening and at night, as soon as the body settles down to rest. The consequences include sleep disturbances, daytime sleepiness, and fatigue.

Symptoms also occur during the day. Prolonged sitting, such as during air travel, theater visits, or conferences, can trigger RLS symptoms.

This situation leads to significant psychological stress. RLS patients avoid situations that require prolonged sitting. Sleepless nights trigger anxiety about going to bed. The psychological stress can exacerbate insomnia. It’s a vicious cycle.

Depending on its severity, Restless Legs Syndrome can drastically reduce quality of life. In the worst cases, the psychological strain can lead to depression.

Many patients experience involuntary leg movements during sleep, which interfere with the ability to fall asleep and with deep sleep @ Andrey Popov /AdobeStock

Primary RLS: Genes and Metabolism

About sixty percent of all patients suffer from primary (idiopathic) Restless Legs Syndrome. In primary RLS, it is a distinct underlying condition. Research into primary RLS is still in its early stages. Findings to date indicate that it is a neurological disorder.

Researchers believe the cause is a genetic predisposition, as the condition often affects multiple family members across different generations. Those affected report experiencing initial symptoms before the age of 30. Most seek medical attention for the first time between the ages of 50 and 60, as the symptoms become noticeably distressing.

However, scientists have not yet found any specific changes in brain structure in people with RLS.

Substances containing dopamine or opioids alleviate the symptoms. Doctors therefore conclude that the symptoms of RLS result from a disturbance in dopamine metabolism. Iron metabolism is also suspected of playing a role.

Secondary RLS: Pre-existing Conditions and Specific Life Circumstances

Forty percent of RLS patients develop secondary (symptomatic) restless legs syndrome. This means that RLS is associated with other diseases.

Possible causes include:

• Pre-existing conditions, such as kidney disease, thyroid disorders, or rheumatic diseases
• Iron deficiency
• Pregnancy
• Use of certain medications, such as those for depression or thyroid treatment

Secondary RLS improves or goes away as soon as the underlying cause is resolved. During the medical history interview, your doctor will determine which form of RLS you have. If you have secondary RLS, you should never stop taking medications on your own or discontinue treatment for another (underlying) condition.

Talk to your doctor. He or she can prescribe an alternative medication.

It usually takes some time before a patient receives a definitive diagnosis for their symptoms. The first point of contact is typically the primary care physician. The physician will conduct a comprehensive examination of the patient. If no other explanation for the symptoms can be found, the primary care physician will refer the patient to a neurologist.

Before diagnosing RLS, the doctor and patient usually have an in-depth discussion of the patient’s medical history. Observing and evaluating this history plays a key role in the process.

The following accompanying symptoms usually lead to a diagnosis:

• Patients complain of insomnia and daytime sleepiness.
• The urge to move becomes stronger, especially in the evening or at night, or when at rest.
• People close to the patient complain about the patient’s symptoms (sleep disturbances and fatigue).

Self-Care for Mild Symptoms

People with mild forms of restless legs syndrome can manage their symptoms on their own. 

Here are some self-help tips:

• Make sure to get sufficient, but moderate, physical activity.
• Avoid strenuous physical work.
• Try cold foot baths.
• Massage the affected arms, feet, and legs.
• Do squats.
• Avoid coffee and alcohol.
• Avoid heat, such as saunas.

There are support groups in every region. There, people can discuss their condition, offer each other encouragement, and share the latest information about RLS. A support group coordination office can tell you in which city the nearest RLS group meets.

If your symptoms are preventing you from carrying out your daily responsibilities, you should definitely see a doctor. They will discuss medication options with you.

Cold foot baths help with Restless Legs Syndrome @ SusaZoom /AdobeStock

RLS Treatment with Medication for Severe Symptoms

If the measures mentioned above are not sufficient to noticeably alleviate your symptoms, medication is necessary. A neurologist will work with you to select an appropriate medication and determine the dosage.

The following treatment options are usually the focus:

1. The first-line treatment is dopaminergic therapy. The patient takes L-dopa, which is an amino acid. The human body uses it to produce the neurotransmitters adrenaline, norepinephrine, and dopamine. These substances are important neurotransmitters that influence brain metabolism. Alternatively, dopamine agonists are used. Brain metabolism and neuronal activity play a role in RLS. 
2. The second option is treatment with opioids. Typically, the neurologist prescribes short-acting medications. Only in particularly severe cases does the neurologist resort to long-acting medications.
3. A third option is treatment with anticonvulsants. This class of medications was originally developed for the treatment of epilepsy. It also alleviates the symptoms of restless legs syndrome.

RLS is a debilitating chronic condition that tends to run in families. The first signs of the disease typically appear before the age of 30. It is not until later in life that the symptoms worsen to the point where treatment becomes necessary. In addition to self-care, medicine offers effective medications that significantly improve quality of life.

For all neurological conditions, a neurologist is the right person to consult. After completing medical school, a neurologist undergoes a 5-year residency program that covers all relevant therapeutic and diagnostic treatment methods.