Highlights & Basics
- Restless legs syndrome (RLS) is characterized by a compulsive urge to move the legs.
- Sometimes associated with dysesthesias described as creeping, crawling, tingling, cramping, or aching of the extremities.
- Symptoms are usually worse during rest and in the evening, and are temporarily improved with movement.
- Lower extremities are affected more than upper extremities.
- Treatment includes nonpharmacologic interventions, dopamine agonists, opioids, benzodiazepines, or neuroleptic agents.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
Winkelman JW, Armstrong MJ, Allen RP, et al. Practice guideline summary: treatment of restless legs syndrome in adults - report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2016 Dec 13;87(24):2585-93.[Abstract][Full Text]
Silber MH, Buchfuhrer MJ, Earley CJ, et al. The management of restless legs syndrome: an updated algorithm. Mayo Clin Proc. 2021 Jul;96(7):1921-37.[Abstract][Full Text]
Allen RP, Picchietti DL, Auerbach M, et al. Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis-Ekbom disease in adults and children: an IRLSSG task force report. Sleep Med. 2018 Jan;41:27-44.[Abstract][Full Text]
Aurora RN, Kristo DA, Bista SR, et al. The treatment of restless legs syndrome and periodic limb movement disorder in adults - an update for 2012: practice parameters with an evidence-based systematic review and meta-analyses: an American Academy of Sleep Medicine Clinical Practice Guideline. Sleep. 2012 Aug 1;35(8):1039-62.[Abstract][Full Text]
1. Allen RP, Picchietti DL, Garcia-Borreguero D, et al; International Restless Legs Syndrome Study Group. Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria - history, rationale, description, and significance. Sleep Med. 2014 Aug;15(8):860-73.[Abstract]
2. Winkelman JW, Armstrong MJ, Allen RP, et al. Practice guideline summary: treatment of restless legs syndrome in adults - report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2016 Dec 13;87(24):2585-93.[Abstract][Full Text]
3. Ondo W, Jankovic J. Restless legs syndrome: clinicoetiologic correlates. Neurology. 1996 Dec;47(6):1435-41.[Abstract]
4. Bonati MT, Ferini-Strambi L, Aridon P, et al. Autosomal dominant restless legs syndrome maps on chromosome 14q. Brain. 2003 Jun;126(pt 6):1485-92.[Abstract][Full Text]
5. Picchietti DL, Van Den Eeden SK, Inoue Y, et al. Achievements, challenges, and future perspectives of epidemiologic research in restless legs syndrome (RLS). Sleep Med. 2017 Mar;31:3-9.[Abstract]
6. Ohayon MM, O'Hara R, Vitiello MV. Epidemiology of restless legs syndrome: a synthesis of the literature. Sleep Med Rev. 2012 Aug;16(4):283-95.[Abstract][Full Text]
7. American Academy of Sleep Medicine. The AASM international classification of sleep disorders - third edition, text revision (ICSD-3-TR). Jun 2023 [internet publication].[Full Text]
8. Yeh P, Walters AS, Tsuang JW. Restless legs syndrome: a comprehensive overview on its epidemiology, risk factors, and treatment. Sleep Breath. 2012 Dec;16(4):987-1007.[Abstract]
9. Ohayon MM, Bagai K, Roberts LW, et al. Refining duration and frequency thresholds of restless legs syndrome diagnosis criteria. Neurology. 2016 Dec 13;87(24):2546-53.[Abstract]
10. Allen RP, Bharmal M, Calloway M. Prevalence and disease burden of primary restless legs syndrome: results of a general population survey in the United States. Mov Disord. 2011 Jan;26(1):114-20.[Abstract]
11. Allen RP, Stillman P, Myers AJ. Physician-diagnosed restless legs syndrome in a large sample of primary medical care patients in western Europe: Prevalence and characteristics. Sleep Med. 2010 Jan;11(1):31-7.[Abstract]
12. Pantaleo NP, Hening WA, Allen RP, et al. Pregnancy accounts for most of the gender difference in prevalence of familial RLS. Sleep Med. 2010 Mar;11(3):310-3.[Abstract][Full Text]
13. Phillips B, Young T, Finn L, et al. Epidemiology of restless legs symptoms in adults. Arch Intern Med. 2000 Jul 24;160(14):2137-41.[Abstract][Full Text]
14. Murtagh FE, Addington-Hall J, Higginson IJ. The prevalence of symptoms in end-stage renal disease: a systematic review. Adv Chronic Kidney Dis. 2007 Jan;14(1):82-99.[Abstract]
15. Allen RP, Auerbach S, Bahrain H, et al. The prevalence and impact of restless legs syndrome on patients with iron deficiency anemia. Am J Hematol. 2013 Apr;88(4):261-4.[Abstract][Full Text]
16. Giannaki CD, Hadjigeorgiou GM, Karatzaferi C, et al. Epidemiology, impact, and treatment options of restless legs syndrome in end-stage renal disease patients: an evidence-based review. Kidney Int. 2014 Jun;85(6):1275-82.[Abstract][Full Text]
17. Manconi M, Govoni V, De Vito A, et al. Restless legs syndrome and pregnancy. Neurology. 2004 Sep 28;63(6):1065-9.[Abstract]
18. Schürks M, Bussfeld P. Multiple sclerosis and restless legs syndrome: a systematic review and meta-analysis. Eur J Neurol. 2013 Apr;20(4):605-15.[Abstract]
19. Yang X, Liu B, Shen H, et al. Prevalence of restless legs syndrome in Parkinson's disease: a systematic review and meta-analysis of observational studies. Sleep Med. 2018 Mar;43:40-6.[Abstract]
20. Garg A, Chilakamarri P, Koo BB. Diagnostic and treatment considerations in restless legs syndrome complicated by diabetic neuropathy. Curr Diab Rep. 2021 Dec 24;21(12):66.[Abstract]
21. Phillips B, Hening W, Britz P, et al. Prevalence and correlates of restless legs syndrome: results from the 2005 National Sleep Foundation Poll. Chest. 2006 Jan;129(1):76-80.[Abstract]
22. Allen RP, Earley CJ. Restless legs syndrome: a review of clinical and pathophysiologic features. J Clin Neurophysiol. 2001 Mar;18(2):128-47.[Abstract]
23. Silber MH, Buchfuhrer MJ, Earley CJ, et al. The management of restless legs syndrome: an updated algorithm. Mayo Clin Proc. 2021 Jul;96(7):1921-37.[Abstract][Full Text]
24. Ondo WG, Vuong KD, Jankovic J. Exploring the relationship between Parkinson disease and restless legs syndrome. Arch Neurol. 2002 Mar;59(3):421-4.[Abstract][Full Text]
25. Li K, Liu B, Wang F, et al. Decreased serum ferritin may be associated with increased restless legs syndrome in Parkinson's disease (PD): a meta-analysis for the diagnosis of RLS in PD patients. Int J Neurosci. 2019 Oct;129(10):995-1003.[Abstract]
26. Garcia-Borreguero D, Silber MH, Winkelman JW, et al. Guidelines for the first-line treatment of restless legs syndrome/Willis-Ekbom disease, prevention and treatment of dopaminergic augmentation: a combined task force of the IRLSSG, EURLSSG, and the RLS-foundation. Sleep Med. 2016 May;21:1-11.[Abstract][Full Text]
27. Allen RP, Picchietti DL, Auerbach M, et al. Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis-Ekbom disease in adults and children: an IRLSSG task force report. Sleep Med. 2018 Jan;41:27-44.[Abstract][Full Text]
28. Trenkwalder C, Allen R, Högl B, et al. Comorbidities, treatment, and pathophysiology in restless legs syndrome. Lancet Neurol. 2018 Nov;17(11):994-1005.[Abstract]
29. American Academy of Sleep Medicine. The AASM manual for the scoring of sleep and associated events. Feb 2023 [internet publication].[Full Text]
30. Ferri R, Fulda S, Allen RP, et al. World Association of Sleep Medicine (WASM) 2016 standards for recording and scoring leg movements in polysomnograms developed by a joint task force from the International and the European Restless Legs Syndrome Study Groups (IRLSSG and EURLSSG). Sleep Med. 2016 Oct;26:86-95.[Abstract]
31. Walters AS, LeBrocq C, Dhar A, et al. Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome. Sleep Med. 2003 Mar;4(2):121-32.[Abstract]
32. Allen RP, Earley CJ. Validation of the Johns Hopkins restless legs severity scale. Sleep Med. 2001 May;2(3):239-42.[Abstract]
33. Trotti LM, Becker LA. Iron for the treatment of restless legs syndrome. Cochrane Database Syst Rev. 2019 Jan 4;(1):CD007834.[Abstract][Full Text]
34. Harrison EG, Keating JL, Morgan PE. Non-pharmacological interventions for restless legs syndrome: a systematic review of randomised controlled trials. Disabil Rehabil. 2019 Aug;41(17):2006-14.[Abstract]
35. Aurora RN, Kristo DA, Bista SR, et al. The treatment of restless legs syndrome and periodic limb movement disorder in adults - an update for 2012: practice parameters with an evidence-based systematic review and meta-analyses: an American Academy of Sleep Medicine Clinical Practice Guideline. Sleep. 2012 Aug 1;35(8):1039-62.[Abstract][Full Text]
36. de Oliveira CO, Carvalho LB, Carlos K, et al. Opioids for restless legs syndrome. Cochrane Database Syst Rev. 2016 Jun 29;(6):CD006941.[Abstract][Full Text]
37. Silber MH, Becker PM, Buchfuhrer MJ, et al. The appropriate use of opioids in the treatment of refractory restless legs syndrome. Mayo Clin Proc. 2018 Jan;93(1):59-67.[Abstract]
38. Lal R, Ellenbogen A, Chen D, et al. A randomized, double-blind, placebo-controlled, dose-response study to assess the pharmacokinetics, efficacy, and safety of gabapentin enacarbil in subjects with restless legs syndrome. Clin Neuropharmacol. 2012 Jul-Aug;35(4):165-73.[Abstract]
39. Hayes WJ, Lemon MD, Farver DK. Gabapentin enacarbil for treatment of restless legs syndrome in adults. Ann Pharmacother. 2012 Feb;46(2):229-39.[Abstract]
40. Bogan RK, Bornemann MA, Kushida CA, et al; XP060 Study Group. Long-term maintenance treatment of restless legs syndrome with gabapentin enacarbil: a randomized controlled study. Mayo Clin Proc. 2010 Jun;85(6):512-21.[Abstract][Full Text]
41. Walters AS, Ondo WG, Kushida CA, et al; XP045 Study Group. Gabapentin enacarbil in restless legs syndrome: a phase 2b, 2-week, randomized, double-blind, placebo-controlled trial. Clin Neuropharmacol. 2009 Nov-Dec;32(6):311-20.[Abstract]
42. Lee DO, Ziman RB, Perkins AT, et al. A randomized, double-blind, placebo-controlled study to assess the efficacy and tolerability of gabapentin enacarbil in subjects with restless legs syndrome. J Clin Sleep Med. 2011 Jun 15;7(3):282-92.[Abstract][Full Text]
43. Talati R, Phung OJ, Mather J, et al. Effect of non-ergot dopamine agonists on health-related quality of life of patients with restless legs syndrome. Ann Pharmacother. 2009 May;43(5):813-21.[Abstract]
44. Baker WL, White CM, Coleman CI. Effect of nonergot dopamine agonists on symptoms of restless legs syndrome. Ann Fam Med. 2008 May-Jun;6(3):253-62.[Abstract][Full Text]
45. Garcia-Borreguero D, Cano-Pumarega I. New concepts in the management of restless legs syndrome. BMJ. 2017 Feb 27;356:j104.[Abstract]
46. Picchietti DL, Hensley JG, Bainbridge JL, et al. Consensus clinical practice guidelines for the diagnosis and treatment of restless legs syndrome/Willis-Ekbom disease during pregnancy and lactation. Sleep Med Rev. 2015 Aug;22:64-77.[Abstract]
47. Garbazza C, Manconi M. Management strategies for restless legs syndrome/Willis-Ekbom disease during pregnancy. Sleep Med Clin. 2018 Sep;13(3):335-48.[Abstract]
48. Sagheb MM, Dormanesh B, Fallahzadeh MK, et al. Efficacy of vitamins C, E, and their combination for treatment of restless legs syndrome in hemodialysis patients: a randomized, double-blind, placebo-controlled trial. Sleep Med. 2012 May;13(5):542-5.[Abstract]
49. Sauerbier A, Sivakumar C, Klingelhoefer L, et al. Restless legs syndrome - the under-recognised non-motor burden: a questionnaire-based cohort study. Postgrad Med. 2019 Sep;131(7):473-8.[Abstract]
