Restless Legs syndrome (RLS) is a syndrome of spontaneous, continuous lower limb movements that may be associated with paraesthesia. Restless Legs syndrome is extremely common, affecting between 2-10% of the general population. Males and females are equally affected and a family history may be present
Clinical Features:
- Uncontrollable urge to move legs (akathisia). Symptoms initially occur at night but as condition progresses may occur during the day. Symptoms are worse at rest
- Antsy legs and horrible creeping sensations in legs
- Paraesthesias such as ‘crawling’ or ‘throbbing’ sensations
- Movements during sleep may be noted by the partner -periodic limb movements of sleeps (PLMS)
Clinical Features
Causes and Associations:
- There is a positive family history in 50% of patients with idiopathic RLS. Idiopathic RLS is when no cause can be attributed to it
- Iron deficiency anaemia
- Uraemia as in chronic kidney disease
- Diabetes mellitus
- Pregnancy
- Brain chemistry: imbalances in certain neurotransmitters as dopamine can also play role
- Parkinson’s disease and peripheral neuropathy
The diagnosis is clinical although bloods such as ferritin to exclude iron deficiency anaemia may be appropriate. Serum ferritin is single most important blood test for RLS
Management:
- Simple measures: walking, stretching, massaging affected limbs
- Treat any iron deficiency
- Dopamine agonists are first-line treatment (e.g. Pramipexole, ropinirole)
- Benzodiazepines
- Gabapentin
Lifestyle Factors:
Certain lifestyle factors, such as caffeine consumption, tobacco use, and lack of physical activity, may worsen RLS symptoms. Stress and sleep disturbances may also exacerbate RLS symptoms.
Written By: Dr. Maisam Raza
