Restless leg syndrome
Restless leg syndrome is a common sensorimotor disorder marked by an urge to move the legs with an uncomfortable sensation, worse at rest and in the evening, and relieved by movement. Diagnosis is clinical; management starts with correcting iron deficiency, then a dopamine agonist or an alpha-2-delta calcium channel ligand.
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What this article covers
- Overview
Definition: restless leg syndrome (RLS) is a sensorimotor disorder characterized by an urge to move the legs, usually accompanied by an uncomfortable sensation, that begins or worsens during periods…
- Epidemiology
Common in the general adult population, with a higher prevalence in women than men.
- Risk factors
Iron deficiency, the single most important modifiable risk factor; RLS symptoms are linked to low-normal ferritin even without frank anemia.
- Pathophysiology
Central dopaminergic dysfunction is the leading mechanistic model, supported by the therapeutic response to dopamine agonists and worsening of symptoms with dopamine-blocking drugs; the exact circuit…
- Clinical features
The diagnostic criteria are the clinical features: an urge to move the legs, usually with an uncomfortable sensation (described as crawling, aching, or paresthesia), that begins or worsens during…
- Differential diagnosis
Periodic limb movements of sleep (without RLS): brief, repetitive triple-flexion leg movements occurring only during sleep, painless, and without patient awareness (a bed partner typically reports…
- Diagnosis
RLS is a clinical diagnosis established when all four core criteria are met: an urge to move the legs usually with an uncomfortable sensation, onset or worsening with rest or inactivity, worsening in…
- Management
First step: identify and correct iron deficiency.
- Complications
Chronic sleep-onset and sleep-maintenance insomnia, with downstream daytime fatigue, impaired concentration, and mood disturbance.
- Prognosis
Primary (idiopathic) RLS is typically a chronic, often slowly progressive condition over years, though severity fluctuates and spontaneous remission periods occur.
- Prevention
Maintain ferritin above 50-75 mcg/L (ng/mL) in patients with a history of RLS or known iron deficiency, since correction and maintenance of iron stores in this range reduces symptom recurrence…
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