Restless legs syndrome

by BTM

Tue, 18 August 2020

Bahrain Specialist Hospital Neurology Specialist Dr. Mahmoud Hesham

This month, Bahrain Specialist Hospital Neurology Specialist, Dr. Mahmoud Hesham, tells our readers about Restless Legs Syndrome (RLS) - a condition that causes an uncontrollable urge to move legs, usually because of an uncomfortable sensation. Dr. Hesham explains that it typically happens in the evening or nighttime hours when the patient is sitting or lying down. Moving eases the unpleasant feeling temporarily.


The main manifestation is an impulse to move the lower limbs. Common accompanying symptoms of RLS include:

  • Sensations that begin after rest. The sensation begins after the patient lays down to  sleep or is sitting for an extended time, such as in a car, or airplane
  • Relief with movement. The sensation of RLS decreases with movement, such as stretching, legs or walking.
  • Worsening of symptoms in the evening. Symptoms occur mainly at night.
  • RLS may be associated with another condition called (periodic limb movement) of sleep, which forces lower limbs to twitch and kick, during night while sleeping.

Patients usually express RLS symptoms as abnormal, bothersome sensations in their lower limbs or feet. Those senses commonly take place bilaterally. The sensations are described as crawling, creeping, pulling, throbbing, aching, itching, or electric, which are sometimes difficult to explain. It's common for symptoms to fluctuate in severity. Sometimes, symptoms disappear for periods of time, and then return.

While there's no known cause for RLS, researchers suspect the condition may be caused by an imbalance of the brain’s Dopamine, which sends messages to control muscle movement.

RLS might start at any age stage, including childhood. The disorder is more common with increasing age and more common in women than in men. Restless legs syndrome generally isn't associated with a significant hidden disease. However, it sometimes accompanies other conditions, such as: Peripheral neuropathy as in diabetes and alcoholism, Iron deficiency, Kidney failure, Spinal cord disorders, or pregnancy especially during the last 3 months, but symptoms commonly cease after giving birth.

Many patients state that their ability to fall asleep or stay asleep is difficult.  Severe cases can cause impairment in life quality and can result in depression. Insomnia may lead to excessive daytime drowsiness.

Doctor will take the medical history and ask the patient to describe their symptoms and their duration. The doctor may conduct a physical, neurological exam and blood tests, to rule out other possible causes for the symptoms.

Lifestyle and home remedies

 Modest lifestyle modifications can help ease symptoms of RLS. This includes

  1. Baths and massages. Soaking in a warm bath and massaging legs can relax muscles.
  2. Application of warm or cool packs. Utilization of heat, cold, or both alternatively
  3. Good sleep hygiene:  a cool, quiet, comfortable sleeping environment, going to bed and rising at the same time daily, and getting at least seven hours of sleep nightly.
  4. Exercise:  Getting moderate, regular exercise. Begin and end your day with stretching exercises.
  5. Avoid caffeine: avoid caffeine-containing products, including chocolate, coffee, and tea.
  6. Stop smoking.
  7. Using a foot wrap. A foot wrap specially designed for people with RLS , puts pressure under foot and may help


Sometimes, treating an underlying condition, such as iron deficiency, greatly relieves symptoms. If there is RLS without an associated condition, and if the lifestyle changes above aren't effective, the doctor might prescribe medications, which include:

  1. Medications that increase dopamine in the brain: like Pramipexole.
  2. Anti-epileptic drugs: like   Gabapentin, Pregabalin.
  3. Opioids:  like Codeine, Oxycodone.
  4. Sleep medications: like benzodiazepines.

It may take several trials for both patient and doctor to find the right medication or combination of medications that work best.