1. Introduction

Restless Legs Syndrome (RLS), also called Willis–Ekbom disease, is a neurological sensory-motor disorder.
It is characterized by an uncontrollable urge to move the legs, usually accompanied by unpleasant sensations.
Symptoms typically worsen at rest and in the evening or night, leading to sleep disturbance and impaired quality of life.

2. Symptoms

Main clinical features include:

• Urge to move legs: Often due to tingling, creeping, pulling, or burning sensations.
• Worsening at rest: Symptoms start or intensify during sitting or lying down.
• Relief with movement: Walking, stretching, or shaking legs temporarily improves symptoms.
• Evening/night predominance: Symptoms are worse in the evening or at night, often causing insomnia.
• Additional features:
  • Involuntary leg twitching during sleep (Periodic Limb Movements of Sleep, PLMS).
  • Fatigue, daytime sleepiness, irritability, anxiety due to poor sleep.

3. Diagnosis

RLS is diagnosed clinically (no specific test) based on the following essential criteria (International RLS Study Group):

1. Urge to move legs, usually with unpleasant sensations.
2. Symptoms begin or worsen during rest/inactivity.
3. Symptoms improve with movement.
4. Symptoms are worse in the evening or night.
5. Symptoms are not solely explained by another condition (e.g., leg cramps, arthritis).

• Supporting features: Family history, response to dopaminergic therapy, periodic limb movements on sleep study.
• Investigations:
  • Iron studies (serum ferritin) – iron deficiency is a common cause.
  • Rule out secondary causes: renal failure, diabetes, pregnancy, neuropathy.

4. Treatment

Treatment depends on severity and cause:

• General / Lifestyle measures:
  • Regular sleep schedule.
  • Moderate exercise, stretching, massage.
  • Avoid caffeine, alcohol, nicotine.
  • Warm baths, relaxation techniques before bed.
• Address underlying cause:
  • Iron supplementation if ferritin < 50–75 ng/mL.
  • Treat kidney disease, neuropathy, or vitamin deficiencies.
• Pharmacological treatment (for moderate–severe cases):
  • First line: Dopamine agonists (pramipexole, ropinirole, rotigotine).
  • Alternatives: Gabapentin, pregabalin (esp. if pain is prominent).
  • Others (selected cases): Low-dose opioids, benzodiazepines (e.g., clonazepam).
  • Avoid long-term levodopa (may worsen symptoms with “augmentation”).

5. Prevention

While not all cases are preventable, symptoms may be reduced by:

• Maintaining healthy lifestyle habits: regular sleep, daily activity.
• Avoiding triggers: caffeine, alcohol, nicotine, certain medications (antihistamines, some antidepressants, antipsychotics).
• Early management of risk factors: treating iron deficiency, diabetes, kidney disease.
• Stress management: relaxation, mindfulness, yoga.

✅ In short:
RLS is a neurological disorder causing an irresistible urge to move the legs at rest, worse at night, relieved by movement. Diagnosis is clinical, and treatment involves lifestyle changes, correcting iron deficiency, and medications like dopamine agonists or gabapentinoids.