An Overview of Restless Legs Syndrome in Multiple Sclerosis

Is RLS Contributing to Your Fatigue?

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Research shows that people with multiple sclerosis (MS) are about four times more likely to have restless legs syndrome (RLS) than people in the general population. Restless legs syndrome is a sleep disorder that if often associated with spontaneous, jerking leg movements called periodic leg movements.

The syndrome can be disruptive to sleep and contribute to the overall fatigue common in people with MS.

Restless Leg Syndrome Common Symptoms
Verywell / Gary Ferster

Symptoms

RLS is a movement disorder that is characterized by unpleasant feelings in the legs that is associated with a need to move. The sensations may include:

  • Aches
  • Pulling
  • Itching
  • A sensation of bugs crawling under the skin
  • Tingling
  • Tightness
  • Electrical or jolting sensations

These symptoms typically come on during periods of rest, especially at night, and are relieved by movement. They may make it hard to fall or stay asleep, resulting in sleep-onset insomnia.

If you have RLS, it is probably contributing to your MS-related fatigue by causing you to lose sleep. This is called secondary fatigue, as the tiredness is a result of symptoms or insomnia. (The primary cause of fatigue for people with MS is the demyelination of nerves and the disease process of MS itself.)

Causes

RLS may be related to abnormalities in neurotransmitters that help regulate muscle movements or in the part of the central nervous system that controls automatic movements.

According to research, people with MS who have a more severe disease course— primary progressive MS (PPMS)—and lesions in their cervical spinal cord are at a higher risk for having restless legs syndrome.

Diagnosis

Restless legs syndrome is diagnosed when the following criteria are met:

  • There is an urge to move the legs (usually caused by or accompanied by uncomfortable or unpleasant sensations in the legs).
  • This urge to move gets worse when you are still (usually lying down, but it can also occur when sitting).
  • Moving around eases (at least partially) the urge to move or the unpleasant sensation.
  • The urge is much worse at night than during the day.

While these symptoms can be due to restless legs syndrome that co-occurs with multiple sclerosis, know that MS itself can cause symptoms that mimic (and can be mistaken for) RLS, too.

  • Extensor spasms: These happen when a limb stiffens and the person is unable to bend the joint. These cause the limb, usually a leg, to jerk away from the body. Muscle spasms usually affect the quadriceps (the large muscles on the front of the thigh), causing the lower leg to straighten. In fact, some extensor spasms can be so sudden and strong that the person can fall out of a chair or bed. Extensor spasms are involuntary movements, rather than an “urge.” They are not relieved by movement, but can actually be the result of trying to move, such as turning over in bed or trying to move to a wheelchair.
  • Parasthesias: These include unpleasant sensations that occur primarily in the lower legs and feet. They feel like numbness or tingling, or like pins-and-needles. These feelings are also very distinct from the unpleasant sensations of RLS, as there is no relief from them when the person is moving. They are also usually present in the day as well as the night.

Your doctor will be able to discern the nuances, and it's helpful to provide a detailed account of when you experience symptoms.

Leg Symptoms Due to MS

  • Spasms are involuntary

  • Unpleasant sensations and muscle stiffening not improved with movement

  • Sensations present day and night

Leg Symptoms Due to RLS

  • Movement brought on by an urge

  • Typically worse at night

  • Unpleasant sensations eased with movement

Treatment

Depending on how often your restless legs syndrome acts up, the following treatments may be used:

  • Avoidance of caffeine, alcohol, and nicotine
  • Neurontin (gabapentin), which is used to treat neuropathic pain, a common symptom in patients with multiple sclerosis
  • Benzodiazepines or benzodiazepine agonists, such as Valium (diazepam) and Klonopin (clonazepam): These have been used with success, but could also cause fatigue to worsen. They likely to only be used if you need some help for a week or two at a time, as they can be habit-forming.
  • Medications that increase dopamine in the brain, such as Requip (ropinirole) and Mirapex (pramipexole)

A Word From ​Verywell

If you have MS, you likely experience assorted unpleasant sensations, as well as fatigue and difficulty sleeping. Many people with MS say that fatigue is their most disabling symptom. Add sleepless nights due to RLS, and it may mean the difference between “getting by” and complete inability to function. Fortunately, restless legs syndrome is very treatable. If you have RLS symptoms, a visit to your neurologist is in order.

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