Is RLS A Disease Of The Contemporary Time or Was It Known In Earlier Times?

The term “restless legs syndrome” was coined by Karl Ekbom, a Swedish physician, in 1944. Ekbom later gave a masterful description of the condition in a monograph in 1945. He not only described the uncomfortable feelings in the legs and motor restlessness associated with movements during sleep, but also mentioned the positive family history of RLS, association with pregnancy, iron deficiency, anemia, gastric surgery, and malabsorption of vitamin B12 as well as patients’ positive responses to treatment with opium. Thus, RLS is not a new dis-ease of contemporary medicine, though it has been recently rediscovered and we are now more enlightened about this condition.

Most sleep scientists believe that the first description of the illness now called RLS was probably given by the great English physician Thomas Willis, who first described this condition in Latin in 1672; his work was translated into English in 1683. Willis described the condition as follows:

Wherefore to some, when being a bed, betake themselves to sleep presently in the arms and legs, leapings and contrac-tions of the tendons, and so great a restlessness and tossing of their members ensue, that the diseased are no more able to sleep, than if they were in a place of greatest torture.

This description seems similar to the descriptions of RLS patients found in the contemporary literature. A search through the literature, including philosophical and religious writings, however, indicates that RLS was known to the Greeks and even centuries earlier in the Vedic literature of the Hindu religion. Nevertheless, the description by Ekbom in the middle of the last century was the catalyst that brought this condition to the forefront of the medical community.

Unfortunately, the scientific community had to wait nearly two centuries after the description by Willis before Wittmack described RLS-like symptoms under the heading of “anxietias tibiarum” (anxiety state) in 1861. Both Beard in 1918 and Oppenheim in 1923 used the term “neurasthenia” (weakness of nerves) to describe what appeared to be RLS-like symptoms. The descriptions of leg movements caused by paresthesia (a skin sensation such as burning or tingling) during rest by Mussio-Fournier and Rawak in 1940 and of “leg jitters” by Allison in 1943 preceded the introduction of the notion of “irritable legs” by Ekbom in 1944 and finally the term “restless legs” in 1945.

The next milestone in the history of RLS came from a group led by Lugaresi in Bologna, Italy, in 1965. These researchers made physiological recordings of periodic leg movements in sleep (see Question 34) found in at least 80% of patients with RLS. Nearly 20 years later, a major advance in treatment of RLS came from the serendipitous observation of Akpinar, a Turkish physi-cian; in 1982, he observed improvement of RLS in a patient with Parkinson’s disease (a degenerative disorder of the central nervous system that often impairs the sufferer’s motor skills, speech, and posture) after treatment with levodopa.

The establishment of the RLS Foundation in 1992 and the International RLS Study Group (IRLSSG) in 1995 acted as a catalyst for education and awareness of RLS in contemporary medicine. Increasing awareness of this very common condition eventually attracted the attention of the pharmaceutical companies and prompted them to begin developing drugs for RLS, including conducting clinical trials with these medications. Following these trials, in both North America and Europe, two drugs were officially approved for treatment of RLS: ropinirole in 2005 and pramipexole in 2007. Active research into RLS continues throughout the world to understand what causes RLS. Although we are making slow but continuous progress, as yet we have not found the cause of the disease.