Restless Legs

Restless Legs Syndrome (RLS / Willis-Ekbom Disease) is an irresistible urge to move the legs, often with unpleasant sensations (crawling, tingling, aching). Symptoms are worse at rest, especially at night — disturbing sleep. RLS is common, under-diagnosed, and often very treatable — particularly once iron status is corrected.

Features (the 4-U's)

• Urge to move the legs.
• Under-rest — symptoms start with inactivity.
• Under-night — worse evening/night.
• Upon-movement — relief with walking or stretching.

Common causes / drivers

• Iron deficiency (even without anaemia — check ferritin).
• Pregnancy — often in third trimester; usually resolves post-delivery.
• Kidney disease (especially on dialysis).
• Medicines — antihistamines, some antidepressants, antipsychotics, anti-nausea drugs.
• Caffeine, alcohol, nicotine — can worsen.
• Peripheral neuropathy — overlapping symptoms.
• Family history — common.

Evaluation

• Clinical diagnosis.
• Ferritin — aim > 75 μg/L for RLS (higher than general population).
• Kidney function, thyroid, vitamin B12.
• Medicine review.

Treatment

• Iron supplementation if ferritin low — oral iron (preferably alternate-day) or IV iron in resistant cases. Dramatic relief for many.
• Lifestyle — regular sleep, reduce caffeine/alcohol, stretch before bed, moderate exercise, warm bath.
• Avoid RLS-triggering medicines where possible.
• Dopamine-agonist medicines or nerve-pain-modulator classes — for persistent moderate-to-severe RLS, under neurology guidance. Long-term use has risks (augmentation) — needs monitoring.
• Pregnancy-related RLS — iron is usually the answer; most medicines are avoided.