Restless Legs Syndrome

About Restless Legs Syndrome

Restless Legs Syndrome RLS, also called Willis Ekbom disease, affects approximately 5 to 10 percent of the population. It is characterized by an irresistible urge to move the legs, usually accompanied by uncomfortable sensations crawling, creeping, pulling, itching, described variably by patients. Symptoms occur or worsen at rest, particularly in the evening or night, and are partially or totally relieved by movement. The circadian pattern with evening night worsening is a key diagnostic criterion. RLS causes significant sleep disturbance, with most patients reporting insomnia. The condition involves dopaminergic dysfunction and brain iron deficiency. Approximately 50 to 60 percent of cases are familial, with identified genetic variants including BTBD9, MEIS1, and MAP2K5. Secondary causes include iron deficiency, judged in RLS against a higher ferritin threshold than usual, pregnancy particularly third trimester, end stage renal disease, and certain medications antidepressants SSRIs, SNRIs, mirtazapine, antihistamines, dopamine antagonists. Diagnosis is clinical using IRLSSG criteria. Sleep study polysomnography may show periodic limb movements in sleep PLMS in approximately 80 percent of patients. Management typically starts with checking iron status and correcting deficiency with oral or intravenous iron when indicated. Reducing caffeine and alcohol and reviewing triggering medications with a clinician may help. For persistent symptoms, first line treatments are alpha 2 delta ligands gabapentin, pregabalin, which are preferred over dopamine agonists pramipexole, ropinirole, rotigotine due to the risk of augmentation symptoms worsening with treatment, which becomes common with long term dopamine agonist use. Opioids are reserved for severe refractory cases.