Q: What is restless legs syndrome (RLS)? A: RLS is a disorder characterized by a strong urge to move the legs. This urge is often accompanied by unpleasant sensations, such as creeping, crawling, tugging, tingling, burning, achy, or itchy feelings. Moving the legs relieves the symptoms. Q: Which parts of the body are affected by RLS? A: RLS affects mainly the legs. Typically, the unpleasant sensations are strongest in the calves, but they’re sometimes also felt in the feet or thighs. Occasionally, the feelings occur in the arms as well. Rarely, the trunk or genital area is affected. Q: What causes RLS? A: There may be many causes of RLS. One seems to be lack of iron or faulty use of iron in the brain. Iron is needed to make dopamine, a chemical that works in areas of the brain that control movement. Nerve damage in the limbs can also contribute to RLS, as can genetics and other disorders that affect dopamine in the brain, such as Parkinson’s disease. Q: Which diseases and drugs can trigger RLS? A: Several conditions that affect iron metabolism within the brain also increase the risk of developing RLS. These conditions include kidney failure, Parkinson’s disease, rheumatoid arthritis, and pregnancy. RLS can also be set off by iron deficiency, folate deficiency, diabetes or anemia. In addition, several medications can trigger RLS symptoms. These include certain antidepressants, antipsychotics, nausea medicines, antihistamines, and calcium channel blockers (for treating high blood pressure and heart problems). Q: Who is most likely to develop RLS? A: RLS affects about 5 to 15% of Americans. Many have a family member with the disorder. RLS occurs in both sexes, although women are more likely to develop it than men. In fact, up to one-fourth of women experience RLS during pregnancy, although it often goes away after they give birth. RLS affects all ethnic groups, but it’s particularly common in people of Northern European descent. Q: What are the primary symptoms of RLS? A: For RLS to be diagnosed, four criteria must be met: You have an overpowering urge to move your legs, often accompanied by strange or unpleasant sensations. The symptoms start or get worse when you’re inactive. The symptoms get better when you walk or otherwise move your legs. The symptoms are worse in the evening, especially when you’re lying down. Q: What complications does RLS cause? A: The symptoms of RLS often make it hard to fall or stay asleep. Lack of sleep, in turn, can lead to fatigue, drowsiness, and mood swings. Your ability to function at home, work, or school may suffer as a result. Chronic sleep deprivation also increases the risk of accidental trauma, as well as developing cardiovascular disease, diabetes, obesity, and depression. Q: How is RLS diagnosed? A: RLS is diagnosed based on your symptoms, your medical and family history, and a physical exam. Although there’s no lab test for RLS itself, your physician may do a blood test to check your iron level. In some cases, your doctor might recommend that you stay overnight in a sleep lab to determine whether there are other causes for your sleep problems. Q: What lifestyle changes help manage RLS? A: Alcohol and tobacco may trigger RLS symptoms, so cutting out these substances is often helpful. Regular, moderate physical activity during the day may also reduce RLS symptoms at night. In addition, good sleep habits can help you get a better night’s sleep. Such habits include going to bed and getting up at the same time every day and keeping your bedroom cool, quiet, and dark. Q: What activities help relieve RLS symptoms? A: Once the urge to move and unpleasant sensations strike, self-help measures may offer some relief. Try walking, stretching, massaging the affected limb, applying heat or cold packs, and taking a hot or cold bath. Doing a mentally absorbing task before bed, such as solving a crossword or Sudoku puzzle, helps distract your mind from the symptoms, which may make it easier to fall asleep. Q: What treatments are available for RLS? A: If lifestyle changes and self-help measures don’t provide enough relief, RLS can be treated with medications. Options approved by the U.S. Food and Drug Administration (FDA) include the dopamine-increasing drugs pramipexole (Mirapex) and ropinirole (Requip), and the newest option, Horizant (gabapentin enacarbil). The FDA has also approved Horizant for treating moderate to severe RLS. In the body, Horizant is converted into gabapentin, a drug used to treat epilepsy. Other preparations of gabapentin (such as Neurontin) have been used off-label to treat RLS for years. Additional off-label (non–FDA approved) treatment options include sedatives, opioids, and other anticonvulsants. Q: Can RLS be cured? A: If RLS is caused by another condition or a medication, it may go away once the condition is treated or the drug is stopped. Otherwise, RLS is a lifelong disorder. The symptoms may come and go often, or they may disappear for a long time, only to crop up again later. With treatment, however, the symptoms can usually be prevented or relieved.