Identifying Restless Leg Syndrome

Posted on 10 August 2017

Restless Leg Syndrome (RLS) is most commonly associated with the urge to move during periods of inactivity. Neuropsychiatrist at Mediclinic Constantiaberg, Dr Irshaad Ebrahim, explains RLS and the toll it can have on sufferers.

What Is RLS?

Restless legs syndrome (RLS) is both a movement and sleep disorder characterised by unpleasant limb sensations, sometimes accompanied by the irresistible urge to move that occurs when the body is at rest.

Dr Irshaad Ebrahim, a neuropsychiatrist specialising in sleep disorders, describes RLS as a series of symptoms people experience in the legs, in the muscles of the leg, and sometimes in the upper arm as well, that are worse at night. Sometimes these symptoms are caused by an underlying condition and sometimes they are caused by an imbalance in the sufferer’s brain chemistry.

Symptoms of RLS

Although not definitive, sensations of RLS can be described as:

  • aching
  • throbbing
  • pulling
  • itching
  • crawling / creeping

RLS can sometimes be confused with periodic limb movements (PLM) – or twitchy legs, at night. While this may be a symptom of RLS in some cases, they are not synonymous. 

What causes RLS?

The disorder, which affects both men and women of various ages, is often caused by an abnormality in the dopamine receptor in the brain. ‘There is something about the dopamine receptor itself that is abnormal,’ explains Dr Ebrahim, adding: ‘There’s also an abnormality in the way dopamine is metabolised.’

Despite no genetic test being available, Dr Ebrahim confirms that there is usually a strong genetic history of RLS in the families of those who present with it. Certain medical conditions and medications have also been associated with RLS.

‘Antidepressants can make RLS worse, so if you’re being treated for depression, for example with SSRI medicines, your RLS might become worse, and you may be become more agitated,’ he says.

Other factors that may cause or aggravate RLS:

  • end-stage renal disease and haemodialysis
  • iron deficiency
  • certain medications such as anti-nausea drugs, antipsychotic drugs, antidepressants that increase serotonin, and cold and allergy medications that contain older antihistamines
  • use of alcohol, nicotine, and caffeine
  • pregnancy
  • neuropathy (nerve damage).

Dr Ebrahim says pregnant women could experience RLS due to their iron levels being lower than normal: ‘The active form of iron is something called ferritin which is needed for the metabolism of dopamine.’

Diagnosing RLS

There are four features used to diagnose RLS:

  1. An urge to move the legs, usually accompanied or caused by uncomfortable and unpleasant sensations in the legs.
  2. The urge to move or unpleasant sensations in the legs that begin or worsen during periods of rest or inactivity.
  3. An urge to move or unpleasant sensations in the legs that are partially or totally relieved by movement, such as walking or stretching, for at least as long as the activity continues.
  4. An urge to move or unpleasant sensations in the legs that are worse during the evening or night or that only occur during the evening or night.

‘If you agree with one or two out of four of these statements, it is highly likely you have RLS. If you agree with three or four, then you definitely have it,’ says Dr Ebrahim.


RLS can disturb the sleep, which in turn affects mood and quality of life. According to Dr Ebrahim, many people with RLS will develop (and present) with symptoms of depression before being diagnosed with RLS.

Generally a lifelong condition, treatment can minimise symptoms, and increase periods of restful sleep, but is not necessary where sleep or life in general is undisturbed.

‘Some of the medications used in Parkinson’s Disease (which is also caused by problems with dopamine) will be used to treat RLS, but in much lower doses,’ concludes Dr Ebrahim.



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In the interest of our patients, in accordance with SA law and our commitment to expertise, Mediclinic cannot subscribe to the practice of online diagnosis. Please consult a medical professional for specific medical advice. If you have any major concerns, please see your doctor for an assessment. If you have any cause for concern, your GP will be able to direct you to the appropriate specialists.

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