Restless Legs Syndrome

Epidemiology:

• 10 % prevalence in general population and the prevalence increased with age
• Female predominance

Aetiology:

• Half of the patient reported family history
• Environmental Causes: Iron Deficiency, renal failure, peripheral neuropathy, diabetes mellitus, thyroid disorder, pregnancy, rheumatoid arthritis and fibromyalgia.

Diagnosis:
Current diagnostic criteria refer to four essential features and other supportive features of restless leg syndrome.

Required diagnostic criteria:

• An urge to move the legs, usually accompanied or caused by uncomfortable and unpleasant sensation in the legs.
• which begin or worsen during the periods of rest or inactivity such as lying or sitting.
• which are partially or totally relieved by movement, such as walking or stretching, at least as long as the activity continues, and
• which are worse in the evening or night than during the day or only occur in the evening or night.

Supportive or associated features:

• Family history
• Response to dopaminergic therapy
• Periodic limb movements
• Disturbed sleep

Management:

Non-pharmacological method

• Assess iron deficiency. Ferritin level less than 50 umol/L is significant
• Reduce caffeine, alcohol or nicotine intake
• Compression stocking may improve the symptoms

Pharmacological method

• Dopamine Precursor: Levodopa ( plus carbidopa / benserazide ) intially 50 mg upto 100-200 mg. An important side effect is Augmentation ( increase in severity of symptoms with regular long term therapy ), which required stopping levodopa. Other side effect is rebound with recurrence of symptoms in the early morning, reflecting the end of drug action.
• Dopamine agonists: such as pergolide, cabergoline, bromocriptine and ropinirole. Augmentation is less common ( 30% ) compared to levodopa ( 70% ) Unlike levodopa, augmentation can be treated by giving divided doses and/or increasing the dosage.
• Low potency opioids such as tramadol are useful for intermittent or daily RLS symptoms.
• Benzodiazepines or benzodiazepines agonist
• Gabapentin is especially useful for painful variants of RLS.