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Key Features

  • Affects 1–5% of people

  • May occur as a primary (idiopathic) disorder or in relation to

    • Parkinson disease

    • Pregnancy

    • Iron deficiency anemia

    • Peripheral neuropathy (especially uremic or diabetic)

  • May have a hereditary basis, and several genetic loci have been associated with the disorder (12q12-q21, 14q13-q21, 9p24-p22, 2q33, 20p13, 6p21, and 2p14-p13)

Clinical Findings

  • Restlessness and curious sensory disturbances lead to an irresistible urge to move the limbs, especially during periods of relaxation

  • Disturbed nocturnal sleep and excessive daytime somnolence

Diagnosis

  • Diagnosis usually made on clinical grounds alone

  • Ferritin levels should always be measured

Treatment

  • Oral iron sulfate in patients with levels ≤ 75 mcg/L (13.4 mcmol/L) should be attempted prior to initiation of other pharmacotherapies

  • Pramipexole (0.125–0.5 mg orally once daily), ropinirole (0.25–4 mg orally once daily) 2–3 hours before bedtime, or rotigotine (1–3 mg/24h transdermal patch once daily), or with gabapentin enacarbil (300–1200 mg orally each evening)

  • Gabapentin (starting with 300 mg orally daily, increasing to approximately 1800 mg orally daily depending on response and tolerance)

  • Pregabalin (150–300 mg orally divided twice to three times daily)

  • Levodopa

    • Generally reserved for those who do not respond to other measures

    • May worsen symptoms

  • Extended release oxycodone-naloxone (5 mg-2.5 mg to 10 mg-5 mg orally twice daily) is useful in patients with severe symptoms or those who are refractory to first-line therapies

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