20th July 2023

Restless Legs Syndrome (RLS)

RLS causes spontaneous, continuous, lower limb movements, which may be associated with paraesthesia. It generally comes on with rest and at night. Initially, patients tend to be symptomatic during the night, which can progress into daytime symptoms. 2-10% of the general population are affected, and 50% of cases have a positive family history.

Causes

Two distinct types; familial – early onset occurring before the age of 45, which worsens with age. Late onset begins after 45, tends to be sudden onset but does not progress.

Found to be common in those with iron deficiency states, including iron deficiency anaemia (IDA), CKD, diabetes, rheumatoid arthritis, pregnancy, coeliac, Parkinson’s disease, electrolyte deficiency, peripheral neuropathy and some autoimmune diseases. Medications have also been noted to precipitate the disorder, including antipsychotics, calcium channel blockers, and antidepressants.

Signs and Symptoms

Sensation of compulsion to move legs, paraesthesia, daytime somnolence, lethargy and low mood.

Mobilising eases the symptoms and brings temporary relief.

Diagnosis

Diagnosis of exclusion – must rule out all other potential causes of other pathology for symptoms.

Diagnostic criteria have 5 main symptoms – worsens with rest, improves with activity, worse in the evening/night, a strong urge to move limbs, not caused by a medical condition.

Management

Treat the underlying cause where possible, e.g. iron supplementation. Sleep hygiene, alcohol and smoking cessation. Some use of dopamine agonists or gabapentin. If treatment resistant, opioids may be used.