Restless legs syndrome is a very common disorder and manifests as an imperative need to move the legs, with or without an unpleasant sensation. It often manifests itself with hyperactivity in the afternoon and evening hours and during sleep. It is not initially a dangerous but rather annoying condition and if symptoms are mild, no treatment is needed, apart from iron and vitamin supplementation.
However, if it causes an unpleasant feeling (chilling, restlessness, cramp, pulling, itching) deep in the muscle or bone, from the knees to the ankles, then a neurological examination is needed. There are young patients, mainly women who, due to this syndrome, have disturbed sleep and resort to sedative medications. In such cases a referral to a neurologist is appropriate.
Symptoms that warrant attention and workup for restless legs syndrome include:
- Disturbed sleep due to unpleasant sensations while in bed.
- Severe leg cramps, associated with pain.
- Improvement of symptoms after leg rubbing, walking or any type of leg movement.
- Worsening of symptoms in the evening, at bedtime or in the early morning hours.
The cause of RLS is not known but is likely associated with the dopaminergic system and is more common in patients with Parkinson’s Disease than in the general population. It is associated also with low iron levels and may coexist with polyneuropathy, diabetes, kidney failure, autoimmune disease and worsened by venous insufficiency in the lower extremities.
Diagnosis is a clinical one and supported by appropriate blood tests if necessary.
Drugs of first choice are dopamine agonists, like ropinirole, gabapentin and pregabalin.
