Restless Legs Syndrome
What is restless legs syndrome?
Restless legs syndrome (RLS) is a neurological condition characterized by an unpleasant urge to move the legs that occurs mainly at rest and in the evening/at night. RLS is one of the most common neurological conditions and affects about 5–10% of the population.
Symptoms
- Unpleasant urge to move the legs, less often also the arms
- Abnormal sensations: tingling, pulling, tearing, burning deep in the legs
- Symptoms occur at rest (sitting, lying down) and improve with movement
- Worsening in the evening and at night
- Difficulty falling asleep and staying asleep
- Periodic limb movements during sleep (PLMS)
- Daytime tiredness and exhaustion as a result of disturbed sleep
Causes
Primary (idiopathic) RLS
- Most common form, often familial clustering
- Genetic predisposition (several risk genes identified)
- Disturbance of dopamine metabolism in the brain
Secondary RLS
- Iron deficiency – most common treatable cause (the ferritin value can be too low even with normal hemoglobin)
- Kidney insufficiency – especially in dialysis patients
- Pregnancy – temporary, usually resolving after birth
- Polyneuropathy – can trigger or worsen RLS symptoms
- Medications – antidepressants (SSRIs), neuroleptics, antihistamines can worsen RLS
Diagnostics
- Detailed medical history – the diagnosis is made clinically based on the typical symptoms
- Neurological examination – to rule out polyneuropathy
- Laboratory tests – ferritin (iron stores), transferrin saturation, kidney values, thyroid values, vitamin B12
- Nerve conduction velocity (NCV) – when accompanying polyneuropathy is suspected
- Polysomnography if needed – sleep laboratory examination in unclear cases (referral)
Treatment
Treatment of the cause
- Iron supplementation when ferritin is below 75 µg/l (oral or intravenous)
- Discontinuing or switching medications that worsen RLS
- Treatment of an underlying condition (kidney insufficiency, polyneuropathy)
Drug therapy
- Iron supplementation (oral or intravenous) – a first-line option according to current guidelines (incl. AASM 2024): the ferritin value is checked first; symptoms often improve simply by replenishing the iron stores
- Gabapentinoids / alpha-2-delta ligands (Gabapentin, Pregabalin) – also first-line, especially for painful RLS and accompanying sleep disturbances
- Dopamine agonists (e.g. Pramipexole, Rotigotine patch) – now only second-line, because long-term use frequently leads to augmentation (paradoxical worsening: symptoms start earlier in the day and become more intense)
- L-Dopa – only for intermittent symptoms in low doses (risk of augmentation)
- Opioids (e.g. Oxycodone/Naloxone) – for treatment-refractory RLS
Non-drug measures
- Regular moderate exercise (no intense sport in the evening)
- Sleep hygiene (regular sleep times, cool bedroom)
- Avoiding caffeine and alcohol in the evening
- Leg massages, alternating hot and cold showers
Last updated: 2026-07-22