Restless Legs Syndrome (RLS) is an uncontrollable urge to move the legs while at rest.

The symptoms consist of unpleasant sensations in the legs. These are usually described as burning, tingling, crawling, creeping, tugging, electrical shocks and crazy limbs. When a person is sitting, the only choice remaining to relieve these symptoms is to move the legs and therefore the uncontrollable urge. Either walking or moving the legs gives the sufferer relief from the symptoms of RLS. Symptoms are also worse at night when lying down and often a cause of insomnia for the affected and many a times a cause for the disturbed sleep for the partner.

It was first identified over 300 years ago. The National Institute of Health (NIH) identifies it as a primary disorder with no apparent cause however it is believed to be associated with a number of factors, including iron deficiency, peripheral neuropathy, Parkinson's disease and other neurological disorders. There is a great overlap in the symptoms of vein disease and restless legs syndrome. As the two conditions have similar presentations, it is important to consider both the vascular and neurological concerns. The epidemiological risk factors for RLS are female sex, multiple pregnancies, old age and a family history. These risk factors are also common for Chronic Venous Disease (CVD). The prevalence of RLS in the adult population is as high as 15%. Recent medical research reported in the Journal of Dermatologic Surgery showed that 22% of patients with restless legs syndrome also have venous insufficiency as revealed through Doppler examination.

Studies show that the treatment of venous insufficiency can relieve symptoms of restless legs syndrome. According to a study published in the Journal of Phlebology, in patients with restless legs syndrome and venous insufficiency, 98% of patients experienced relief from restless legs syndrome symptoms by treating their venous insufficiency and 80% had long-term relief.

RLS is poorly understood, often under or misdiagnosed and inadequately treated. Before committing a patient of restless legs syndrome to possible life-long medication with potential side effects, venous insufficiency should be checked as a possible cause, as correction of the vein reflux provides long-term and likely permanent relief.

Clinically there are four basic criteria with an acronym as URGE

1. Urge to move legs because of unpleasant sensation

2. Rest induced symptoms

3. Gets better with activity

4. Evening and night accentuations.

It appears to increase in prevalence as age increases. It also affects women two-fold over men.

You need to rate your symptoms for the following ten questions.

1. Overall, how would you rate the RLS discomfort in your legs or arms?

(4) Very severe

(3) Severe

(2) Moderate

(1) Mild

(0) None

2. Overall, how would you rate the need to move around because of your RLS symptoms?

(4) Very severe

(3) Severe

(2) Moderate

(1) Mild

(0) None

3. Overall, how much relief of your RLS arm or leg discomfort do you get from moving around?

(4) No relief

(3) Slight relief

(2) Moderate relief

(1) Either complete or almost complete relief

(0) No RLS symptoms and therefore question does not apply

4. Overall, how severe is your sleep disturbance from your RLS symptoms?

(4) Very severe

(3) Severe

(2) Moderate

(1) Mild

(0) None

5. How severe is your tiredness or sleepiness from your RLS symptoms?

(4) Very severe

(3) Severe

(2) Moderate

(1) Mild

(0) None

6. Overall, how severe is your RLS as a whole?

(4) Very severe

(3) Severe

(2) Moderate

(1) Mild

(0) None

7. How often do you get RLS symptoms?

(4) Very severe (This means 6 to 7 days a week.)

(3) Severe (This means 4 to 5 days a week.)

(2) Moderate (This means 2 to 3 days a week.)

(1) Mild (This means 1 day a week or less.)

(0) None

8. When you have RLS symptoms, how severe are they on an average day?

(4) Very severe (This means 8 hours per 24 hour day or more.)

(3) Severe (This means 3 to 8 hours per 24 hour day.)

(2) Moderate (This means 1 to 3 hours per 24 hour day.)

(1) Mild (This means less than 1 hour per 24 hour day.)

(0) None

9. Overall, how severe is the impact of your RLS symptoms on your ability to carry out your daily affairs, for example carrying out a satisfactory family, home, social, school, or work life?

(4) Very severe

(3) Severe

(2) Moderate

(1) Mild

(0) None

10. How severe is your mood disturbance from your RLS symptoms–for example angry, depressed, sad, anxious, or irritable?

(4) Very severe

(3) Severe

(2) Moderate

(1) Mild

(0) None

Diagnosis is made using the International RLS study group (IRLSSG) criteria (above). Symptoms are rated on a scale from 1 to 40 points.

Very severe: 31-40 points

Severe:          21-30 points

Moderate:      11-20 points

Mild:                01-10 points

None:             0 points

Many theories as to its cause include genetic, familial, anemia, pregnancy, Parkinson's disease, thyroid disease, kidney failure, varicose veins and idiopathic.

McDonagh, King, Guptan in Phlebology 2007 studied 174 consecutive patients and 174 matched healthy controls. They found that 36% of patients presenting to Phlebology practice had RLS symptoms compared to control of 19%. Of the 36% that had RLS symptoms 98% had chronic venous disease. Of the 19% matched healthy control that had RLS symptoms 91% had chronic venous disease. Only 9% of control group that had RLS symptoms had no CVD. It appears that higher RLS scores were associated with higher CEAP score.

Kanter Dermatological Surgery 1995 had 113 patients with the dual diagnosis of RLS and varicose veins. They were treated with sclerotherapy only. Fifty seven percent had CEAP Class I CVD (telangiectasia). Of those treated 98% reported rapid relief.

Hayes et al Phlebology 2008 studied 35 patients with moderate to severe RLS with CVD. They were divided into operative (EVLT/UGS) and non-operative (no treatment). 80% of those with treatment had improvement in their symptoms. 53% had a follow up score less than 5 indicating their symptoms had been largely alleviated. 31% had a score of 0 indicating complete relief of their symptoms.

McDonagh et al COMPASS study Phlebology 2002 studies 186 with GSV reflux, 17% with RLS. They were treated with sclerotherapy. 100% reported RLS relief.

Venous congestion hypothesis: Venous congestion causes pooling of blood in the extremities which then stimulates movement of the extremities to increase venous return.