Overview
Restless legs syndrome (RLS) is a movement disorder characterised by a strong and irresistible urge to move the limbs (usually the legs) accompanied by uncomfortable sensations. Symptoms tend to be worse at night and can disturb sleep.
RLS is thought to be due to dysfunction of the dopaminergic system within the central nervous system.
Epidemiology
- RLS can develop at any age, but the mean age of onset is 20-40 years
- In people >35 years, the prevalence in women is around twice that of men
Causes
- Idiopathic – in most cases
- Familial – may be autosomal dominant
- Iron deficiency
- Pregnancy
- Stage 5 chronic kidney disease and uraemia
- Diabetes mellitus
- Medications (e.g. antidopaminergic medications, tricyclic antidepressants, inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), alcohol, caffeine, and lithium.
Presentation
- Akathisia in the legs – an irresistible urge to move
- Symptoms may be worse at night and interrupt sleep
- ‘Crawling’, ‘throbbing’, ‘buzzing’, or ‘tickling’ sensations may be felt
Differential Diagnoses
Nocturnal leg cramps
- Involves a specific muscle group rather than being generalised
- Stretching usually relieves symptoms rather than non-specific movement
- Muscle hardening may be seen – this is not seen in RLS
Akathisia
- Describes a feeling of inner restlessness and a need to be in continuous motion
- Example motions are rocking, walking on the spot, crossing and uncrossing the legs
- Symptoms do not worsen at night or follow a circadian pattern
Peripheral neuropathy
- Other symptoms such as numbness, paraesthesias, impaired balance or gait may be seen
- Symptoms do not worsen at night or follow a circadian pattern
Investigations and Diagnosis
Overview
Diagnosis is clinical. Blood tests may be appropriate to rule out a possible underlying cause, such as iron deficiency or renal dysfunction.
Management
Overview
- 1st-line: lifestyle changes and simple measures:
- Such as good sleep hygiene, stopping smoking, reducing alcohol
- Measures which may relieve RLS include walking and stretching, applying heat, or massaging
- 2nd-line or if symptoms have a significant impact on their life: dopamine agonists
- Examples are ropinirole or pramipexole
- Other treatment options may include benzodiazepines or gabapentin
