Restless Leg Syndrome

Question 1

Restless Leg Syndrome:

What is it and who it impacts?

Answer 1

Chronic sensorimotor disorder causing urge to move limbs (typically legs)
-suspected to be abnormality in dopaminergic/iron metabolism system (iron required for dopamine metabolism)

• F > M 2:1
• 50% have positive family history
• typically onset after 40yo (but many report symptoms starting in 20s)

2 forms:

1) Gradual onset and progression
2) Quick onset and gradual progression

Higher prevalence in:

• rheumatoid arthritis
• fibromyalgia
• Obese
• Diabetes

Question 2

Restless Leg Syndrome:

Diagnosis criteria and features?

Answer 2

Urge to move limbs
\+/-
Sensations:
-itching
-tingling
-burning
-crawling
-fizzing
-throbbing

• typically felt below the knee
• for 30% they are considered painful

AND
History of OR current
-relief or resolution with movement
-aggravation in the evening and rest

AND
secondary causes excluded.

Commonly associated with:

• sleep disturbances
• daytime sleepiness
• anxiety/depression

Question 3

Restless Leg Syndrome:

Secondary Causes?

Answer 3

Excess caffeine, alcohol and chocolate

Iron deficiency
-25% of RLS are iron deficient also

CKD
-20% of CKD patients have RLS

Pregnancy

• RLS rate of 20%
• typically third trimester
• resolves post partum
• increases risk of developing RLS later in life

Neurological conditions:

• Parkinsons disease
• MS
• neuropathy
• sciatica

Medications:

• Dopamine antagonist
• TCAs
• SSRI/SSNRI
• antipsychotics
• lithium
• antihistamine
• beta blockers
• some antiepileptics

Question 4

Restless Leg Syndrome:

Approach and Management?

Answer 4

1) symptoms meet criteria

2) Rule out secondary causes
- serum ferritin

• medication review
• SNAP history to exclude alcohol, caffeine and chocolate

*if not clear could consider a sleep study

3) Examine affected limbs
- vascular
- neurological
- musculoskeletal

Management:

1) check International Restless Leg Syndrome Rating Scale (tool to monitor progress)
2) Educate on RLS
3) withdraw offending medications if safe and reasonable to do so

General:

• correct iron deficiency
• encourage physical activity
• reduction avoiding dietary triggers
• focus on assisting with sleep

Mild RLS:

• relaxation
• massage
• heat
• stretching
• distraction

Moderate - Severe RLS:

1) Pregabalin or Gabapentin (Off PBS)
2) Pramipexole
- risk of daytime sleepiness
- impulse control disorder (17%) NEED SAFETY NETTING

Question 5

Restless Leg Syndrome:

Prognosis?

Answer 5

After 15 years of RLS

• 8% remission
• 15% reduced
• 36% worsened
• 41% remained stable