Diagnosis and Treatment of Restless Legs Syndrome

Yu-Sun Min

doi:10.12786/bn.2016.9.1.25

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Min: Diagnosis and Treatment of Restless Legs Syndrome

Review Article

Brain & Neurorehabilitation 2016; 9(1): 25-30.

Published online: 31 March 2016

DOI: https://doi.org/10.12786/bn.2016.9.1.25

Diagnosis and Treatment of Restless Legs Syndrome

Yu-Sun Min, M.D.

Department of Physical Medicine and Rehabilitation, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Korea.

Correspondence to: Yu-Sun Min, Department of Physical Medicine and Rehabilitation, Kyungpook National University Hospital, Kyungpook National University School of Medicine, 807, Hoguk-ro, Buk-gu, Daegu 41404, Korea. Tel: 053-200-2167, Fax: 053-200-2028, ssuni119@naver.com

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Restless legs syndrome (RLS) is a neurological disorder characterized by an irresistible urge to move one's body to stop uncomfortable or odd sensations. It most commonly affects the legs. Moving the affected body part, such as walking or stretching provide relief the urge to move the legs and any accompanying unpleasant sensation partially or totally. RLS is relatively common, affecting 5 to 15 % of the general population, with prevalence rates increasing alongside age. Restless legs syndrome can lead to sleep-onset or sleep-maintenance insomnia, and occasionally excessive daytime sleepiness, all leading to significant morbidity. Dopaminergic systems are known to be strongly related with RLS that are closely linked to CNS iron homeostasis. Besides defective dopaminergic system that is closely related with iron metabolism, genetic factors play a role in early-onset individual with a positive family history. The diagnosis can be made based on the symptom characteristics, differential diagnosis is important because many conditions could mimic RLS symptoms. Dopamine agonists (DAs) have been considered the first-line therapy, but with the growing appreciation of problems associated with long-term treatment, particularly augmentation and impulse control disorder, alpha-2-delta drugs, such as gabapentin, are now considered the first line of treatment in patients with troublesome RLS. In more severe cases, a combination therapy may be required.

Keywords: Restless Legs Syndrome, Dopamine agonist, Augmentation, Sleep disturbance

Figures and Tables

Table 1

International Restless Legs Syndrome Study Group (IRLSSG) Consensus Diagnostic Criteria for Restless Legs Syndrome (RLS)

Essential diagnostic criteria (all must be met):

1. An urge to move the legs usually but not always accompanied by, or felt to be caused by, uncomfortable and unpleasant sensations in the legs.

2. The urge to move the legs and any accompanying unpleasant sensations begin or worsen during periods of rest or inactivity such as lying down or sitting.

3. The urge to move the legs and any accompanying unpleasant sensations are partially or totally relieved by movement, such as walking or stretching, at least as long as the activity continues.

4. The urge to move the legs and any accompanying unpleasant sensations during rest or inactivity only occur or are worse in the evening or night than during the day.

5. The occurrence of the above features is not solely accounted for as symptoms primary to another medical or a behavioral condition (e.g. myalgia, venous stasis, leg edema, arthritis, leg cramps, positional discomfort, habitual foot tapping).

Specifiers for clinical course of RLS:

A. Chronic-persistent RLS: symptoms when not treated would occur on average at least twice weekly for the past year.

B. Intermittent RLS: symptoms when not treated would occur on average

Specifier for clinical significance of RLS:

The symptoms of RLS cause significant distress or impairment in social, occupational, educational or other important areas of functioning by their impact on sleep, energy/vitality, daily activities, behavior, cognition or mood.

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