Restless Legs Syndrome: Contemporary Diagnosis and Treatment

Abstract

Restless legs syndrome (RLS) is characterized by an uncomfortable urge to move the legs while at rest, relief upon movement or getting up to walk, and worsened symptom severity at night. RLS may be primary (idiopathic) or secondary to pregnancy or a variety of systemic disorders, especially iron deficiency, and chronic renal insufficiency. Genetic predisposition with a family history is common. The pathogenesis of RLS remains unclear but is likely to involve central nervous system dopaminergic dysfunction, as well as other, undefined contributing mechanisms. Evaluation begins with a thorough history and examination, and iron measures, including ferritin and transferrin saturation, should be checked at presentation and with worsened symptoms, especially when augmentation develops. Augmentation is characterized by more intense symptom severity, earlier symptom occurrence, and often, symptom spread from the legs to the arms or other body regions. Some people with RLS have adequate symptom control with non-pharmacological measures such as massage or temperate baths. First-line management options include iron-replacement therapy in those with evidence for reduced body-iron stores or, alternatively, with prescribed gabapentin or pregabalin, and dopamine agonists such as pramipexole, ropinirole, and rotigotine. Second-line therapies include intravenous iron infusion in those who are intolerant of oral iron and/or those having augmentation with intense, severe RLS symptoms, and opioids including tramadol, oxycodone, and methadone. RLS significantly impacts patients' quality of life and remains a therapeutic area sorely in need of innovation and a further pipeline of new, biologically informed therapies. KeywordsRestless legs syndrome • Periodic limb movement disorder • Periodic leg movements • Cardiovascular risk • Treatment • Dopamine agonist • Alpha-2-delta ligand • Opiate • Iron deficiency.

Prevalence of restless legs syndrome in pregnant women in Oman and its effect on pregnancy and neonatal outcomes

“…An earlier study showed that weight gain and higher BMI in early adulthood (age 18–21 years) were related to the development of RLS in the general population. [ 28 ] The possible explanation of the link between weight gain and RLS is that both may be affected by the dopaminergic system in the CNS. [ 29 ]…”

Dopamine receptor agonists: standard and non-standard applications in medicine

“…Однако улучшение сна на фоне приема АДР отмечается не только у пациентов с БП. Впервые о таком непротивопаркинсоническом назначение АДР заговорили очень рано: практически сразу же после одобрения АДР для использования у пациентов с БП они были разрешены для лечения СБН [15]. СБН (болезнь Уиллиса -Экбома) является двигательным расстройством, преимущественно с вовлечением ног, характеризующимся неприятными ощущениями с непреодолимой потребностью двигать конечностями, которое обычно начинается или усиливается во время бездействия и может уменьшаться при движении, а в тяжелых случаях возникать в дневное время и вовлекать руки.…”

Restless Legs Syndrome: Known Knowns and Known Unknowns

“…The former often shows an autosomal dominant transmission and has specific genetic risk factors, whereas medical conditions more frequently associated with RLS include iron deficiency, end-stage renal disease, pregnancy, peripheral neuropathy, diabetes mellitus, and Parkinson’s disease [ 3 , 9 ]. Effective medications include dopamine agonists (pramipexole, ropinirole, rotigotine), levodopa, α2δ agonists (gabapentin, pregabalin), iron supplementation and opioids [ 10 , 11 , 12 ].…”