Restless Legs Syndrome: When Leg Twitching and Numbness Signal a Real Medical Condition

Restless Legs Syndrome (RLS) is often misunderstood as mere discomfort or fatigue, but for many, it's a legitimate neurological disorder that disrupts sleep and diminishes quality of life. This case study follows a 42-year-old woman whose persistent leg discomfort was eventually diagnosed as RLS linked to iron deficiency anemia. With proper diagnosis and treatment, her symptoms resolved completely within a month—offering hope and insight for others experiencing similar issues.

Understanding Restless Legs Syndrome

Restless Legs Syndrome, also known as Willis-Ekbom Disease, is a sensorimotor disorder characterized by an irresistible urge to move the legs, usually due to uncomfortable sensations like tingling, crawling, or aching. These symptoms typically worsen during periods of rest, especially in the evening or at night, significantly interfering with sleep patterns.

In this patient's case, she had been experiencing unexplained leg discomfort for over a year, describing feelings of numbness and heaviness in her lower limbs. Initially dismissing it as stress or muscle strain, she delayed seeking medical help until the symptoms intensified and began disrupting her sleep cycle.

Patient Profile & Initial Diagnosis

Age: 42 | Gender: Female | Hospital: Henan Provincial People's Hospital | Date of Visit: February 2022

Upon consultation, the patient reported that her symptoms were most severe when sitting or lying down, particularly at bedtime. She found temporary relief by walking around or tapping her legs, but the recurring nature of these episodes left her fatigued and frustrated.

Physical examination revealed normal vital signs: temperature 97.9°F (36.6°C), heart rate 76 bpm, respiratory rate 19 breaths/min, and blood pressure 128/76 mmHg. No skin abnormalities or circulation issues were detected in the legs, and muscle strength remained intact.

To rule out neurological causes, a brain CT scan was performed, showing no structural abnormalities. However, a routine blood test uncovered a critical clue—low hemoglobin levels indicating iron-deficiency anemia, a well-documented contributor to secondary RLS.

Treatment Plan and Therapeutic Approach

With both clinical presentation and lab results pointing toward RLS triggered by iron deficiency, a comprehensive treatment strategy was initiated:

• Iron supplementation: Ferrous sulfate tablets were prescribed to correct the underlying anemia.
• Vitamin C co-administration: To enhance iron absorption in the gastrointestinal tract.
• Dopamine agonist therapy: Ropinirole hydrochloride to regulate dopamine activity in the brain, which plays a key role in motor control and RLS symptom management.
• Sleep support: Diazepam was introduced short-term to improve sleep onset and reduce nighttime awakenings caused by limb movements.

The patient was thoroughly educated on medication timing, dietary considerations, and potential side effects. She was advised to avoid caffeine, alcohol, and tannin-rich beverages like strong tea, all of which can inhibit iron absorption.

Progress and Clinical Outcomes

Follow-up after four weeks revealed remarkable improvement:

By the end of the first week, the patient noticed reduced leg pain and fewer involuntary movements. While some restlessness persisted during quiet moments, the intensity of the sensations had clearly diminished.

At two weeks, the numbness and aching had nearly disappeared, and her ability to fall asleep improved significantly. Her partner also observed fewer nighttime leg jerks.

By the third week, there were no more spontaneous leg movements, even during prolonged inactivity. Sleep continuity increased, and daytime energy levels returned to normal.

At her one-month follow-up visit, the patient reported complete resolution of all RLS symptoms. A repeat blood test confirmed that hemoglobin levels had normalized, confirming successful correction of anemia. All medications were discontinued under medical supervision, with instructions to return if symptoms recurred.

Key Lifestyle Recommendations for Long-Term Relief

To prevent relapse and maintain overall health, the following lifestyle adjustments were emphasized:

1. Promote Circulation Through Daily Habits

Engaging in light stretching or massage after long periods of sitting helps stimulate blood flow. The patient was encouraged to practice gentle calf massages and use a handheld percussive device for soothing relief.

2. Establish a Soothing Evening Routine

Soaking feet in warm water before bed not only relaxes muscles but also signals the body to prepare for rest. Adding Epsom salts may further ease muscular tension and promote relaxation.

3. Optimize Diet for Iron Repletion

Foods rich in heme iron—such as lean red meat, liver, egg yolks, spinach, lentils, and fortified cereals—were recommended. Pairing these with vitamin C–rich foods (like oranges, bell peppers, or strawberries) boosts non-heme iron absorption from plant sources.

4. Adhere Strictly to Medication Guidelines

Patients must never adjust dosages or discontinue prescribed drugs without consulting their physician. Sudden withdrawal of dopamine agonists, for example, can trigger rebound symptoms or augmentation—a worsening of RLS earlier in the day.

Clinical Insights and Final Thoughts

This case highlights how seemingly minor symptoms—like leg twitching or mild numbness—can be manifestations of a treatable condition. Although the exact pathophysiology of RLS remains incompletely understood, research consistently links it to dopaminergic dysfunction, central nervous system irregularities, and iron insufficiency in the brain.

Identifying and addressing underlying contributors—such as anemia, renal disease, pregnancy, or certain medications—is essential for effective management. In this instance, correcting iron deficiency not only resolved the hematological issue but also eliminated the neurological symptoms entirely.

Early recognition, accurate diagnosis, and personalized treatment are crucial. For anyone struggling with unexplained leg discomfort at night, this story serves as a reminder: you're not imagining it—and help is available.