Restless Legs Syndrome Twice as Common in Multiple Sclerosis Patients: Study Finds
Spain: Patients living with multiple sclerosis (MS) appear to face a substantially higher risk of developing restless legs syndrome (RLS), a study published in the Journal of Neurology has shown. Importantly, all RLS diagnoses in the study were confirmed by sleep disorders specialists, strengthening the reliability of the findings.
The research, led by Yolanda Aladro from the Department of Neurology at Hospital Universitario de Getafe, Madrid, Spain, highlights that RLS occurs nearly twice as often in patients with MS compared to individuals without the disease. The findings also identify family history of RLS and pyramidal tract involvement as the strongest factors associated with the condition in this population.
RLS is a neurological sleep-related movement disorder characterized by an uncontrollable urge to move the legs, often accompanied by uncomfortable sensations that worsen during rest and at night. While previous studies have reported widely varying prevalence rates of RLS among people with MS—ranging from 13% to as high as 65—methodological limitations have raised concerns about overestimation.
To address this, the investigators conducted a case–control study between 2023 and 2024 at a Spanish hospital. The study included 440 patients diagnosed with MS according to the 2017 McDonald criteria and 241 age- and sex-matched control participants without MS. RLS screening was performed in two stages. Initially, participants underwent telephone or in-person interviews using a structured questionnaire based on the International Restless Legs Syndrome Study Group criteria. Those who screened positive were then evaluated by a sleep disorders specialist to confirm the diagnosis.
The following were the key findings:
- Questionnaire-based screening identified restless legs syndrome in 19.6% of patients with multiple sclerosis compared with 9.6% of control participants.
- After confirmation by a sleep disorders specialist, the prevalence of restless legs syndrome decreased to 15.2% in the multiple sclerosis group and 7.9% in the control group, indicating a false-positive rate of 22.1% with questionnaire screening alone.
- Following specialist confirmation, patients with multiple sclerosis were found to have more than twice the risk of developing restless legs syndrome compared with controls, with the difference reaching statistical significance.
- Among patients with multiple sclerosis, a positive family history of restless legs syndrome was associated with an almost fivefold increase in the likelihood of developing the condition.
- Pyramidal tract involvement in multiple sclerosis was linked to over a fourfold higher risk of restless legs syndrome.
- The presence of spinal cord lesions was associated with a 60% reduction in the odds of developing restless legs syndrome, a finding that requires further investigation.
The authors emphasized the clinical relevance of these observations, noting that sleep disturbances and motor impairment are common in MS and may be compounded by unrecognized RLS. They recommend routine screening for RLS in patients with MS, particularly in those reporting sleep-related symptoms or signs of pyramidal tract involvement.
Overall, the study provides robust evidence that RLS is significantly more prevalent in MS than in the general population, highlighting the importance of specialist-confirmed diagnosis to avoid overestimation and guide appropriate management.
Reference:
Aladro, Y., Álvarez-Sáenz de Tejada, C., Díaz-Díaz, J. et al. Prevalence of restless legs syndrome in patients with multiple sclerosis, as confirmed by sleep disorders specialists. J Neurol 273, 96 (2026). https://doi.org/10.1007/s00415-026-13620-8
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