Restless Legs Syndrome

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

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 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