Restless Legs Syndrome

Introduction 

-Restless legs syndrome is a chronic, neurological movement disorder characterized by a feeling of needing to move the legs (dysesthesia), associated with abnormal sensations like unpleasant creeping, crawling, tingling, and itching. 

-Cause is unknown in most cases. 

-Known causes of RLS: iron-deficiency anemia, renal failure, alcohol before sleep, thyroid disease, pregnancy, and certain medications 

-Druginduced RLS 

Anti-nausea drugs: Metoclopramide, Prochlorperazine 

Anticonvulsants: Phenytoin, Droperidol 

Antipsychotic drugs: Haloperidol 

Antidepressants: Sertraline 

-The disorder seems especially common among pregnant women (1 in 5)

Symptoms & Signs 

-Irresistible urge to move the limbs with creeping or crawling sensations 

-Symptoms usually occur when patient is lying down or relaxing 

-Abnormal sensations are temporarily alleviated by movement, stretching, or massage 

-Symptoms are worse in the evening and first half of night 

Diagnosis 

Diagnosis is usually made on clinical grounds alone

Search for iron deficiency: Ferritin levels should always be measured

Treatment 

Non-Pharmacotherapy

– Stop aggravating medications, smoking, excessive alcohol consumption, coffee 

-Daily moderate exercise, massage

-cognitive behavioral therapy 

Pharmacotherapy

-RLS is treated by addressing the underlying cause 

-Oral iron sulfate in patients with levels ≤ 75 mcg/L (13.4 mcmol/L)

-Other medications: Pramipexole, ropinirole, rotigotine, gabapentin, Pregabalin, Levodopa, clonazepam, temazepam, opiates 

Dopaminergic therapy is the treatment of choice for severe cases but carries the risk of augmentation

Augmentation: the earlier onset or enhancement of symptoms; earlier onset of symptoms at rest; and a briefer response to medication.

RLS vs PLMS (Periodic Limb Movements of Sleep): 

-RLS tends to occur during waking and at sleep onset, whereas PLMs occur during sleep. 

-Patients with RLS sometimes also have PLMs, but patients with PLMs often do not have RLS. 

Prognosis 

Prognosis depends on the underlying cause

Q.Most common treatable cause of RLS: Iron deficiency 

Q.What is the most common complication of long-term dopaminergic therapy? Augmentation

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