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Restless Legs Syndrome Treatment

Restless Legs Syndrome (RLS), also known as Willis-Ekbom Disease, is a neurological disorder that causes an uncontrollable urge to move the legs, typically accompanied by uncomfortable sensations. These symptoms mainly occur at rest, in the evening or night, leading to significant sleep disturbances.

Symptoms of RLS:

The primary symptoms include:

  • Unpleasant sensations in the legs – Described as crawling, tingling, itching, aching, pulling, or throbbing.
  • Irresistible urge to move the legs – Provides temporary relief from discomfort.
  • Symptoms worsen at night – Making it difficult to fall or stay asleep.
  • Symptoms triggered by rest/inactivity – Such as sitting for long periods or lying in bed.
  • Periodic Limb Movements in Sleep (PLMS) – Involuntary jerking movements that can further disrupt sleep.

    • Causes & Risk Factors:

    RLS can be primary (idiopathic) or secondary to underlying conditions.

      Primary RLS:
    • Often genetic (family history common).
    • No identifiable cause.
      • Secondary RLS:
    • Iron deficiency (low serum ferritin).
    • Pregnancy (especially in the third trimester).
    • Chronic kidney disease.
    • Neurological disorders (e.g., Parkinson’s, multiple sclerosis).
    • Diabetes & Peripheral neuropathy.
    • Excess caffeine, alcohol, nicotine.
    Diagnosis of RLS:

    RLS is primarily a clinical diagnosis based on the following:

    Diagnostic Criteria (International RLS Study Group - IRLSSG):
    • Urge to move the legs, usually with unpleasant sensations.
    • Symptoms worsen at night or in the evening.
    • Symptoms triggered by rest/inactivity.
    • Movement provides temporary relief.
    • No other medical conditions explain the symptoms.

    Supporting Tests:

  • Iron studies: Serum ferritin <50 ng/mL may indicate iron deficiency.
  • Neuropathy tests: If associated peripheral neuropathy is suspected.
  • Sleep Study (Polysomnography, PSG): If periodic limb movements in sleep (PLMS) are suspected.

    • Role of Sleep Study (Polysomnography) in RLS:

    • Not required for RLS diagnosis but helps assess sleep disruption due to PLMS.
    • Identifies Periodic Limb Movements in Sleep (PLMS) – Repetitive leg jerks occurring every 20-40 seconds during sleep.
    • Confirms RLS-related sleep fragmentation, which may lead to excessive daytime sleepiness (EDS).
    • Differentiates RLS from other sleep disorders like sleep apnea.
    Treatment & Management:

    A. Lifestyle & Non-Pharmacological Approaches
    • Regular Exercise – Moderate activity (not too intense).
    • Sleep Hygiene – Maintaining a consistent sleep schedule.
    • Avoid Triggers – Reduce caffeine, alcohol, nicotine.
    • Leg Massage & Warm Baths – May help alleviate symptoms.
    • Iron Supplementation – If ferritin levels are low (<50 ng/mL).
    B. Medications (for Moderate to Severe RLS)
    • Dopamine Agonists -Pramipexole, Ropinirole (first-line treatment).
    • Alpha-2-Delta Ligands -Gabapentin, Pregabalin (especially if pain or neuropathy is present).
    • Low-dose Opioids -(for severe cases unresponsive to other treatments).
    • Benzodiazepines –(Clonazepam) – May help improve sleep but not first-line.
    Conclusion:-

    RLS significantly impacts sleep quality and daily functioning. Early diagnosis and proper management—especially identifying iron deficiency and periodic limb movements in sleep (PLMS) through a sleep study—can greatly improve symptoms.