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Restless Legs Syndrome

 

RLS is a common sensorimotor disorder.

Symptoms: unpleasant sensations experienced in the legs and rarely in the arms. Only occurs at rest and more in the evening or at night.

There is a strong urge to move the limbs, with only temporary relief of symptoms. The disorder is characterised by periodic leg movements during sleep + interference with sleep.

Need to exclude:

  • nocturnal leg cramps
  • peripheral neuropathy –refer neuro for opinion, may co-exist
  • peripheral vascular diseases –for Vascular team
  • akathisia 
  • intermittent claudication-For Vascular team
  • anxiety/generalised anxiety disorder 

Diagnosis of the disease is supported by three clinical features

  • improvement of symptoms with the use of dopaminergic agents
  • Periodic limb movements during sleep (PLMS)
  • family history

Investigations

  • serum ferritin – RLS assoc with iron deficiency
  • thyroid, fasting glucose, B12, folate

Treatment:

Non Pharmacological treatment: Good sleep hygiene and habits

  • regular moderate exercise (excessive exercise may exacerbate symptoms)
  • abstinence from caffeine, nicotine, and alcohol
  • during an attack: walking and stretching
  • bathing in hot or cold water
  • relaxation exercises
  • massaging affected limbs

Replacement therapy if low iron, B12 etc may resolve symptoms

Drugs for use in the management of restless legs syndrome:

  • dopamine agonists

non-ergotamine dopamine agonists e.g. pramipexole, ropiniprole

ergotamine dopamine agonists e.g. cabergoline, pergolide

  • levodopa

used in patients who are intolerant to dopamine agonist

  • anti-epileptic agents
  • gabapentin is useful in patients with coexisting neuropathic pain /dialysis
  • opioids
  • weak opioids (codeine or tramadol) can be used intermittently or daily
  • benzodiazepines
  • e.g. clonazepam 0.5-2 mg 30 minutes before retiring
  • imipramine ,Clonidine, Carbemazepine

Referral :  Neurology if diagnosis unclear or failed medical treatment trial