Restless legs syndrome increases the risk of depression, anxiety, and suicide among affected patients, the Spanish Sleep Society warned in Madrid ahead of World Restless Legs Syndrome Day on Wednesday.
Neurologist Laura Lillo, a member of the Movement and Sleep Conduct Disorders Group at the organization, explained that the neurological condition exerts a direct impact on emotional health that extends well beyond nocturnal physical discomfort.
Lillo highlighted that patients in Spain face diagnostic delays exceeding ten years from the initial onset of symptoms, while the most effective emerging device treatment remains unavailable in the country.
The Spanish Sleep Society is a multidisciplinary scientific association based in Spain that advances research, clinical training, and public awareness regarding sleep disorders. World Restless Legs Syndrome Day is commemorated annually on September 23 to highlight Willis-Ekbom disease, a sensorimotor disorder that disrupts sleep and overall health.
Symptoms and Daily Life Impact
The disorder is characterized by an imperious need to move the legs during evening or night rest, accompanied by unpleasant sensations that ease only when the limbs are moved.
Because this urge manifests primarily at the start of the night, it prevents individuals from falling asleep and severely deteriorates the quality of their rest.
Lillo noted that the effects of the syndrome also spill over into daily life, interfering with any activity that requires remaining seated for a prolonged period, such as having dinner, going to the cinema, or traveling.
Restless legs syndrome, medically classified as a sensorimotor neurological disorder, causes paresthesias or dysesthesias often described as crawling, pulling, or aching sensations deep within the legs. These sensations compel patients to pace, move, or stretch, disrupting normal rest cycles and leading to severe chronic daytime fatigue.
Prevalence and Diagnostic Challenges in Spain
An estimated 11.6 percent of the population in Spain may suffer from restless legs syndrome, with its most severe form affecting between 2 percent and 3 percent of people.
Despite its high frequency, the condition remains a very little known disease among both patients and healthcare professionals across the medical community.
This widespread lack of awareness causes physical symptoms to be misinterpreted as general anxiety, primary insomnia, or emotional nervousness.
Such misattributions delay medical consultations and complicate accurate identification, leading to diagnostic delays that can exceed ten years from the onset of symptoms.
In a country of nearly 48 million residents, an 11.6 percent prevalence indicates that over five million individuals in Spain live with the condition, making restless legs syndrome one of the most common yet frequently overlooked neurological disorders in primary care settings.
Genetics and Neurological Mechanisms
Although the exact causes of restless legs syndrome are not completely defined, research confirms a clear genetic predisposition linked to common genetic variants rather than specific single mutations.
The other major risk factor is ferropenia, or iron deficiency, which alters the functioning of several brain systems. These metabolic and genetic variables modify the tone of neurotransmitters, specifically dopamine and glutamate, which are involved in the development of symptoms.
Lillo and the society noted that numerous scientific questions persist regarding how these genetic and metabolic mechanisms interact and the precise order in which neurological changes occur.
Dopamine is a key neurotransmitter responsible for regulating motor control and movement pathways in the central nervous system, while glutamate serves as the primary excitatory neurotransmitter. Iron acts as an essential cofactor for tyrosine hydroxylase, an enzyme required for dopamine synthesis in the basal ganglia. When central iron levels drop, dopaminergic signaling becomes impaired, triggering involuntary motor urges and unpleasant sensations.
Evolving Treatments and Augmentation Risks
Early detection remains essential because effective treatments exist that can relieve symptoms. For decades, dopaminergic agonists such as pramipexole, ropinirole, and rotigotine served as the primary therapeutic foundation.
However, clinical evidence in recent years has demonstrated that prolonged use of dopaminergic agonists can actually worsen the disease, triggering what is known as the augmentation phenomenon, an intensification of symptoms that forces a complete review of patient management.
Because of this risk, the routine use of dopaminergic agonists is currently discouraged in clinical practice.
Dopamine agonists directly stimulate dopamine receptors in the brain to relieve leg discomfort initially. However, long term stimulation can downregulate receptors and hypersensitize spinal cord pathways, causing symptoms to start earlier in the day, spread to other limbs such as the arms, or become more severe than before treatment began.
Current Clinical Strategies and Emerging Technology
Modern clinical management focuses on two main therapeutic lines. The first line is iron replacement in patients suffering from ferropenia, administered through oral iron supplements or intravenous iron infusions.
The second line relies on alpha-2-delta agonists, such as gabapentin and pregabalin, which have demonstrated efficacy in reducing physical discomfort and controlling symptoms.
In severe cases, or when the augmentation phenomenon has already appeared following dopamine therapy, physicians may prescribe opioids under strict medical supervision.
A recent technological innovation in treatment is Tomac, an external peroneal nerve stimulation device that has shown positive clinical results with few side effects.
However, the Tomac stimulation device is not yet available in Spain.
Alpha-2-delta ligands work by binding to calcium channels in the central nervous system, reducing the presynaptic release of excitatory neurotransmitters like glutamate. The Tomac device non-invasively stimulates the peroneal nerve below the knee, delivering electrical impulses that disrupt abnormal sensory signals traveling to the brain without systemic pharmacological side effects.
Call for Awareness and Faster Diagnosis
The Spanish Sleep Society emphasized that improving knowledge about restless legs syndrome is vital to reducing patient suffering and preventing the disorder from remaining unnoticed.
Because the condition exerts a heavy toll on sleep quality, social life, and mental health, specialists demand broader medical attention and faster diagnostic pathways.
Enhanced awareness is particularly urgent in Spain, where thousands of individuals continue to live with the debilitating effects of restless legs syndrome without ever receiving an accurate diagnosis.
