Restless Legs Syndrome in People with Multiple Sclerosis

Is RLS Contributing to Your Fatigue?

Distressed looking man sitting on hospital bed, head in hand, night
Restless Legs Syndrome in MS. Tim Brown / Getty Images

Research shows that people with multiple sclerosis (MS) are about five times more likely to have restless legs syndrome than people in the general population. 

Curious to learn more about restless legs syndrome and its association with multiple sclerosis, I looked it up on UpToDate -- an electronic reference used by many physicians who encounter patients with MS and patients looking for in-depth medical information.

See what UpToDate has to say, then read on for answers to questions you may have about what all of this means for you.

Restless legs syndrome and multiple sclerosis: Information from UpToDate


”Restless legs syndrome (RLS) refers to symptoms of spontaneous, continuous leg movements associated with unpleasant paresthesias. These sensations occur only at rest and are relieved by movement. Sleep disturbance and a frequent association with involuntary, jerking movements of the legs during sleep, known as periodic leg movements of sleep (PLMS), are common.

Mounting evidence suggests that RLS is associated with multiple sclerosis (MS), but data are conflicting. In the largest study, a prospective multicenter epidemiologic survey of 861 patients with MS and 649 control subjects, the prevalence of RLS was significantly higher in patients with MS than in controls (19 versus 4 percent, relative risk 5.4, 95% CI 3.56-8.26).”

Your Questions: Answered

Fully understanding all of this will not only give you a better grasp of what is going on, but it will help you be better able to discuss your situation with your doctor.

I Sometimes Experience Pretty Violent Jerks of My Legs at Night. Is This Restless Legs Syndrome or MS-Related Spasticity?

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 can also occur when sitting
  • Moving around relieves (at least partially) the urge to move or unpleasant sensation, while the movement continues
  • The urge is much worse at night than during the day

People with MS may be experiencing extensor spasms, which 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. It usually affects the quadriceps (the large muscles on the front of the thigh), causing the lower leg to straighten. Some extensor spasms can be so sudden and strong that the person can fall out of a chair or bed. These are very different from the experience of RLS. 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.

“Unpleasant sensations,” known as paresthesias, are a very common symptom of MS, and primarily occur in the lower legs and feet. They feel like numbness or tingling, or a pins-and-needles combination of both.

These feelings are also very distinct from the unpleasant sensations of RLS, as there is no relief from them when the person is moving (movement can actually cause these sensations to intensify). They are also usually present in the day, and not only at night.

Could Restless Legs Syndrome Be the Reason for My MS-Related Fatigue?

If you have RLS, it is probably contributing to your MS-related fatigue by causing you to lose sleep. This is called secondary fatigue and is the result of tiredness as a result of symptoms or insomnia.

The primary cause of fatigue for people with MS, however, is the demyelination of the disease process of MS itself.

Much of what those of us living with MS are feeling is called “lassitude,” which is an overwhelming tiredness that is not directly related to increased activity. This is the terrible, impossible-to-explain, crushing exhaustion that is one of the most common symptoms of MS.

In addition to RLS, other secondary causes of fatigue in people with MS include: sleep disturbances due to other causes, like spasms; depression or anxiety; pain; the frequent need to urinate at night (nocturia); medication side effects; physical exertion to make up for loss of function caused by symptoms; infections, such as colds, flu or urinary tract infections; or lack of physical fitness.

What Can I Do to Treat Restless Legs Syndrome and Get Some Sleep?

Depending on the frequency of your troubles with restless legs syndrome, the following treatments are used:

  • Avoidance of caffeine, alcohol and nicotine
  • Gabapentin (Neurontin) might be the next choice for people with MS, as it is fairly well-tolerated and used for spasticity and neuropathic pain symptoms of multiple sclerosis.
  • Low potency opioid-based drugs or opioid agonists, such as propoxyphene napsylate, ropoxyphene hydrochloride, codeine or tramadol, may be tried but may contribute to daytime fatigue.
  • Benzodiazepines or benzodiazepine agonists, such as diazepam (Valium) and clonazepam, have also been used with success, but could also cause fatigue to worsen. However, triazolam, zolpidem or zaleplon are shorter-acting and might be more suited to people with MS experiencing fatigue. The “benzos” (especially the last three) will probably only be used if you need some help for a week or two at a time, as they can be habit-forming.

My Bottom Line: If there is ANYTHING interfering with a person with MS getting a good night’s sleep, it is very important to figure out the cause and eliminate it to the extent possible. When asked, most people with MS say that fatigue is our most disabling symptom. While good sleep might not eliminate fatigue, a sleepless night due to restless leg syndrome (or anything else) may mean the difference between “getting by” and complete inability to function.

Also, those of us with MS live with plenty of “unpleasant sensations” that are very difficult or impossible to treat.

Unlike some of the MS-related paresthesias, RLS is very treatable. If you think you have RLS, go talk to your neurologist and start working on getting some rest.

Want to learn more? See UpToDate’s topic, "Restless legs syndrome," for additional in-depth, current and unbiased medical information on this syndrome, including expert physician recommendations.


Tarsy, Daniel and Sheon, Robert P. “Restless legs syndrome.” UpToDate. Accessed: March 2009.

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