Diagnosis & Treatment of Restless legs syndrome (RLS)
What is restless legs
syndrome?
Restless legs syndrome (RLS),
also called Willis-Ekbom Disease is a common neurological condition, causes
unpleasant or uncomfortable sensations in the legs and an irresistible urge to
move them.
RLS is classified as a sleep
disorder since the symptoms are triggered by resting and attempting to sleep,
and as a movement disorder, since people are forced to move their legs in order
to relieve symptoms.
How is restless legs syndrome
diagnosed?
Since there is no specific test
for RLS, the condition is diagnosed by a doctor’s evaluation. The five
basic criteria for clinically diagnosing the disorder are:
- A strong and often overwhelming need or urge to move
the legs that is often associated with abnormal, unpleasant, or
uncomfortable sensations.
- The urge to move the legs starts or get worse during
rest or inactivity.
- The urge to move the legs is at least temporarily and
partially or totally relieved by movements.
- The urge to move the legs starts or is aggravated in
the evening or night.
- The above four features are not due to any other medical or behavioral condition.
A neurological and physical exam,
plus information from the person’s medical and family history and list of
current medications, may be helpful.
A laboratory analysis is not necessary for the diagnosis, but it can help exclude secondary causes of RLS. Initial laboratory tests include a basic metabolic panel and ferritin level.
How is restless legs syndrome
treated?
Treatment options for RLS
include:
Lifestyle changes. Certain lifestyle changes and
activities may provide some relief in persons with mild to moderate symptoms of
RLS.
These steps include avoiding or
decreasing the use of alcohol and tobacco, changing or maintaining a regular
sleep pattern, a program of moderate exercise, and massaging the legs, taking a
warm bath, or using a heating pad or ice pack.
There are new medical devices that have been cleared by the U.S. Food & Drug Administration (FDA), including a foot wrap that puts pressure underneath the foot and another that is a pad that delivers vibration to the back of the legs.
Medications:
Iron. For individuals with low or low-normal ferritin
and transferrin saturation, a trial of iron supplements is recommended as the
first treatment.
Anti-seizure drugs. Anti-seizure drugs are becoming
the first-line prescription drugs for those with RLS. The FDA has
approved gabapentin for the treatment of moderate to severe RLS.
Other anti-seizure drugs such as
the pregabalin can decrease such sensory disturbances as creeping and crawling
as well as nerve pain.
Dopaminergic agents. They have been shown to
reduce symptoms of RLS when they are taken at nighttime. The FDA has
approved ropinirole, pramipexole, and rotigotine to treat moderate to severe
RLS. Levodopa plus carbidopa may be effective when used intermittently,
but not daily.
Although dopamine-related
medications are effective in managing RLS symptoms, long-term use can lead to
worsening of the symptoms in many individuals.
Opioids. Drugs such as methadone, codeine,
hydrocodone, or oxycodone are sometimes prescribed to treat individuals with
more severe symptoms of RLS who did not respond well to other
medications.
Benzodiazepines. Can be useful in intermittent RLS, particularly when insomnia is significant; these drugs such as clonazepam can help individuals obtain a more restful sleep. And may be used with dopamine agonist in patients with refractory RLS.
Source:
https://www.sleepfoundation.org/restless-legs-syndrome
https://www.aafp.org/afp/2008/0715/p235.html
Note: For informational purposes only. Consult your
textbook for advising your patients.
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