11th August 2024

Restless legs syndrome

Restless legs syndrome is a condition that results in a strong and often overwhelming urge to move one’s legs, often accompanied by an unpleasant sensation if the legs are kept still. Its mechanism is unknown. Although similar to akathisia (generalised restlessness), restless legs syndrome is considered a distinct clinical syndrome. It usually occurs during inactivity or at rest in the late afternoon, evening and prior to sleep.

It is more commonly seen in those with PD and often predates the onset of parkinsonism. It can also be related to iron deficiency, and thus all patients should have iron studies performed (in particular ferritin – although remember this is an acute phase reactant so may be raised in infection and inflammation). If ferritin is low, then iron supplements should be prescribed as this may reduce or eliminate the condition. The cause of the iron deficiency, if unknown, may also require investigation using quantitative faecal immunochemical testing (FIT) in line with the two-week-wait colorectal cancer NICE guidelines. Less commonly, restless leg syndrome can be related to renal disease, neuropathy, pregnancy and other sleep disorders.

Management involves walking or stretching exercises and avoiding alcohol, nicotine and caffeine. Medications can also be used, the first line being dopamine agonists and alternatives/additional treatments including gabapentin and benzodiazepines.