Restless Legs Syndrome

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

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 usually made on clinical grounds alone

Ferritin levels should always be measured

Oral iron sulfate in patients with ferritin 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