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 four times more likely to have restless legs syndrome than people in the general population. 

Restless leg syndrome is a sleep disorder that causes spontaneous, jerking leg movements in the evening hours, and these movements are associated with unpleasant sensations.

Diagnosis of Restless Leg Syndrome

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 eases (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.

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

Mimickers of Restless Leg Syndrome

There are a couple MS-related symptoms that can mimic that of restless leg syndrome.

For instance, 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.

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. 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.

In addition, 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.

Restless Legs Syndrome and 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, as the tiredness is 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, or 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
  • Lack of physical fitness

Treating Restless Legs Syndrome

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

  • Avoidance of caffeine, alcohol, and nicotine
  • Neurontin (gabapentin) 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.
  • Benzodiazepines or benzodiazepine agonists, such as diazepam (Valium) and clonazepam, have also been used with success, but could also cause fatigue to worsen. They also are probably only used if you need some help for a week or two at a time, as they can be habit-forming.

    A Word From Verywell

    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 their 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 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.

    Sources:

    Manconi M et al. Restless legs syndrome is a common finding in multiple sclerosis and correlates with cervical cord damage. Mult Scler. 2008 Jan;14(1):86-93.

    Multiple sclerosis and restless legs syndrome: a systematic review and meta-analysis. Schürks M, Bussfeld P. Eur J Neurol. 2012 Apr;20(4):605-15.

     

    Ondo WG. (2017). Clinical features and diagnosis of restless legs syndrome/Willis-Ekborn disease and periodic limb movement disorder in adults. Hurtig HI, Avidan AY ed. UpToDate. Waltham, MA: UpTiDate Inc.

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