Restless legs syndrome

Pinky Agarwal MD (

Dr. Agarwal of the University of Washington received research support from Adamas, Astellas, Merck, and US World Meds; honorariums from Acadia and Adamas for consulting work; and honorariums from Adamas, Acadia, and US World Meds for speaking engagements.

Sindhu R Srivatsal MD MPH (

Dr. Srivatsal of Virginia Mason Medical Center has no relevant financial relationships to disclose.

Robert Fekete MD, editor. (

Dr. Fekete of New York Medical College received consultation fees from Acadia, Acorda, Adamas, Amneal/Impax, Kyowa Kirin, Lundbeck, Neurocrine, and Teva.

Originally released April 5, 1995; last updated April 25, 2020; expires April 25, 2023

This article includes discussion of restless legs syndrome, anxietas tibiarum, leg jitters, Willis-Ekbom disease. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.


The sensory symptoms of restless legs syndrome are paresthesias and dysesthesias in the calves and legs. Descriptions of these phenomena include words such as aching, pulling, drawing, numbness, tingling, prickling, creeping, or crawling. The unpleasant sensations occur during rest and inactivity and are worse in the late evening and when attempting to sleep. In this article, the authors discuss the genetics, clinical features, diagnosis and differential diagnosis, etiology, pathophysiology, management, and prognosis of this common disorder. Management of special conditions, such as restless legs syndrome in pregnancy, are addressed as well. The current update includes recent literature on insights into the etiopathogenesis of restless legs syndrome as well as its impact on cardiovascular health.

Key points


• Restless legs syndrome is an underdiagnosed and a very common disorder, often with a positive family history.


• Several genetic linkages have been identified.


• Restless legs syndrome may be primary or secondary to other conditions.


• Treatment is generally quite effective, though sometimes drugs are associated with side effects.


• Several potential drugs are currently under investigation for treatment of restless legs syndrome.

Historical note and terminology

The first clinical description of restless legs is attributed to Thomas Willis. He described the syndrome in 1672, and in the 1685 edition of his textbook wrote, "Wherefore to some, when being a Bed they betake themselves to sleep, presently in the Arms and Legs, Leapings and Contractions of the Tendons, and so great a Restlessness and Tossings of their Members ensue that the diseased are no more able to sleep than if they were in a Place of the greatest Torture" (Willis 1685). In 1861 Wittmaack called the disorder "anxiety tibiarum," and wrote that it was a frequent symptom of hysteria (Wittmaack 1861). Oppenheim was the first to define the disease as a neurologic illness and the first to recognize the genetic component of the disease (Oppenheim 1923). The first significant clinical review of restless legs syndrome was written by Ekbom in 1945. His monograph described 2 forms of the disorder: one form presents with prominent paresthesia, "asthenia crurum paresthetica," and the other form presents with prominent pain, "asthenia crurum dolorosa" (Ekbom 1945).

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