Restless Leg Syndrome Symptoms

Last Updated: May 17, 2022

Restless leg syndrome (RLS) is characterized by uncomfortable sensations in the legs that are momentarily relieved upon movement. The sensations typically worsen at night when the legs are at rest, which is incredibly disruptive to sleep quality.


Restless leg syndrome (RLS)[1] is a neurological disorder characterized by uncomfortable sensations in the legs and momentary relief upon movement. The sensations, which are commonly reported[2] as electrical, prickling, burning, tingling, and itching, typically worsen at night, when individuals are more likely to rest. This can be incredibly disruptive to sleep quality, which is why RLS is also classified as a sleep disorder[3].

The condition is estimated to affect 10% of the U.S. population and, as you can see in Figure 1, is more prevalent in women[4] than in men. It’s also more prevalent in individuals of western European descent[5] than those of Asian descent. Researchers believe that there is a strong genetic[6] basis to RLS, since individuals with a family history of RLS are also very likely to have the disorder. Genome-wide association studies[7] have identified variants in six different genes linked to RLS. While much remains unknown, some of these genes have been linked to the development of neurons[8].

Despite this, much evidence[9][10] suggests that dysfunctions in the basal ganglia and in dopamine-producing neurons play roles in the pathology of RLS. These areas are responsible for controlling smooth muscle, which is involved in controlling involuntary movements like those in the digestive tract. Dysfunctions in the brain regions that control these muscles can lead to disruptive involuntary movements. More evidence to support the role of dopamine dysfunction in RLS comes from individuals with Parkinson’s disease, a degenerative condition in which dopamine-producing cells in the brain die at a rapid rate. These individuals are also more likely[11] to develop RLS.

In the past, the American Academy of Sleep Medicine has recommended[12] dopamine agonists (drugs that activate specific dopamine receptors) as evidence-based treatments for RLS in its clinical practice guidelines. A 2011 Cochrane systematic review[13] and meta-analysis of 38 randomized controlled trials found that dopamine-agonists were effective in reducing symptoms of restlessness in individuals with RLS, when compared to placebo. However, participants taking dopamine agonists also had an 82% higher chance of experiencing adverse events, which may make such treatments undesirable for some. Adverse effects such as worsening symptoms over the long term (called “augmentation”) and an increase in impulse control problems led the Restless Leg Syndrome Foundation to downgrade dopamine agonists to a second-line choice for therapy in 2021.[14]

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  1. ^Venkateshiah SB, Ioachimescu OCRestless legs syndromeCrit Care Clin.(2015 Jul)
  2. ^Winkelman JW, Gagnon A, Clair AGSensory symptoms in restless legs syndrome: the enigma of painSleep Med.(2013 Oct)
  3. ^Ramar K, Olson EJManagement of common sleep disordersAm Fam Physician.(2013 Aug 15)
  4. ^Berger K, Luedemann J, Trenkwalder C, John U, Kessler CSex and the risk of restless legs syndrome in the general populationArch Intern Med.(2004 Jan 26)
  5. ^Stefansson H, Rye DB, Hicks A, Petursson H, Ingason A, Thorgeirsson TE, Palsson S, Sigmundsson T, Sigurdsson AP, Eiriksdottir I, Soebech E, Bliwise D, Beck JM, Rosen A, Waddy S, Trotti LM, Iranzo A, Thambisetty M, Hardarson GA, Kristjansson K, Gudmundsson LJ, Thorsteinsdottir U, Kong A, Gulcher JR, Gudbjartsson D, Stefansson KA genetic risk factor for periodic limb movements in sleepN Engl J Med.(2007 Aug 16)
  6. ^Trotti LM, Bhadriraju S, Rye DBAn update on the pathophysiology and genetics of restless legs syndromeCurr Neurol Neurosci Rep.(2008 Jul)
  7. ^Rye DBThe Molecular Genetics of Restless Legs SyndromeSleep Med Clin.(2015 Sep)
  8. ^Schormair B, Zhao C, Bell S, Tilch E, Salminen AV, Pütz B, Dauvilliers Y, Stefani A, Högl B, Poewe W, Kemlink D, Sonka K, Bachmann CG, Paulus W, Trenkwalder C, Oertel WH, Hornyak M, Teder-Laving M, Metspalu A, Hadjigeorgiou GM, Polo O, Fietze I, Ross OA, Wszolek Z, Butterworth AS, Soranzo N, Ouwehand WH, Roberts DJ, Danesh J, Allen RP, Earley CJ, Ondo WG, Xiong L, Montplaisir J, Gan-Or Z, Perola M, Vodicka P, Dina C, Franke A, Tittmann L, Stewart AFR, Shah SH, Gieger C, Peters A, Rouleau GA, Berger K, Oexle K, Di Angelantonio E, Hinds DA, Müller-Myhsok B, Winkelmann J, 23andMe Research Team, DESIR study groupIdentification of novel risk loci for restless legs syndrome in genome-wide association studies in individuals of European ancestry: a meta-analysisLancet Neurol.(2017 Nov)
  9. ^Hening WThe clinical neurophysiology of the restless legs syndrome and periodic limb movements. Part I: diagnosis, assessment, and characterizationClin Neurophysiol.(2004 Sep)
  10. ^Trenkwalder C, Paulus WWhy do restless legs occur at rest?--pathophysiology of neuronal structures in RLS. Neurophysiology of RLS (part 2)Clin Neurophysiol.(2004 Sep)
  11. ^Peeraully T, Tan EKLinking restless legs syndrome with Parkinson's disease: clinical, imaging and genetic evidenceTransl Neurodegener.(2012 Feb 27)
  12. ^Aurora RN, Kristo DA, Bista SR, Rowley JA, Zak RS, Casey KR, Lamm CI, Tracy SL, Rosenberg RS, American Academy of Sleep MedicineThe 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 GuidelineSleep.(2012 Aug 1)
  13. ^Scholz H, Trenkwalder C, Kohnen R, Riemann D, Kriston L, Hornyak MDopamine agonists for restless legs syndromeCochrane Database Syst Rev.(2011 Mar 16)
  14. ^Michael H Silber, Mark J Buchfuhrer, Christopher J Earley, Brian B Koo, Mauro Manconi, John W Winkelman, Scientific and Medical Advisory Board of the Restless Legs Syndrome FoundationThe Management of Restless Legs Syndrome: An Updated AlgorithmMayo Clin Proc.(2021 Jul)
Examine Database References
  1. Valerian - Cuellar NG, Ratcliffe SJDoes valerian improve sleepiness and symptom severity in people with restless legs syndromeAltern Ther Health Med.(2009 Mar-Apr)
  2. Magnesium - Hornyak M, Voderholzer U, Hohagen F, Berger M, Riemann DMagnesium therapy for periodic leg movements-related insomnia and restless legs syndrome: an open pilot study.Sleep.(1998-Aug-01)
  3. Iron - Tomer Avni, Shelley Reich, Nirit Lev, Anat Gafter-GviliIron supplementation for restless legs syndrome - A systematic review and meta-analysisEur J Intern Med.(2019 May)