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ALL / Neurology
Restless legs syndrome
Restless legs syndrome
Restless legs syndrome (RLS) is a syndrome of spontaneous, continuous lower limb movements that may be associated with paraesthesia. It is extremely common, affecting between 2-10% of the general population. Males and females are equally affected and a family history may be presentClinical 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
- paraesthesias e.g. 'crawling' or 'throbbing' sensations
- movements during sleep may be noted by the partner - periodic limb movements of sleeps (PLMS)
Causes and associations
- there is a positive family history in 50% of patients with idiopathic RLS
- iron deficiency anaemia
- uraemia
- diabetes mellitus
- pregnancy
The diagnosis is clinical although bloods such as ferritin to exclude iron deficiency anaemia may be appropriate
Management
- simple measures: walking, stretching, massaging affected limbs
- treat any iron deficiency
- alpha-2-delta ligands (pregabalin or gabapentin) are first-line
- dopamine agonists (e.g. Pramipexole, ropinirole) were once first-line for RLS, but due to high rates of augmentation and impulse control disorders, gabapentinoids are now preferred.
+PassMedicine Notes
Restless legs syndrome (RLS) is a syndrome of spontaneous, continuous lower limb movements that may be associated with paraesthesia. It 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
- paraesthesias e.g. 'crawling' or 'throbbing' sensations
- movements during sleep may be noted by the partner - periodic limb movements of sleeps (PLMS)
- there is a positive family history in 50% of patients with idiopathic RLS
- iron deficiency anaemia
- uraemia
- diabetes mellitus
- pregnancy
The diagnosis is clinical although bloods such as ferritin to exclude iron deficiency anaemia may be appropriate
Management- simple measures: walking, stretching, massaging affected limbs
- treat any iron deficiency
- alpha-2-delta ligands (pregabalin or gabapentin) are first-line
- dopamine agonists (e.g. Pramipexole, ropinirole) were once first-line for RLS, but due to high rates of augmentation and impulse control disorders, gabapentinoids are now preferred.
