Restless Leg Syndrome

This is also known as Ekbom’s syndrome, affecting up to 2% of the population, greater in the elderly. Usually idiopathic or familial.

Unpleasant subjective sensations in the legs that are relieved by moving the legs occur when the patient is tired in the evenings and at the onset of sleep. It appears as a cause of sleep initiation insomnia, because the patient may find it difficult to lie still in bed, needing to get up to relieve the discomfort. Sometimes described as a “creepy crawly” feeling or as the sensation of ants walking on the skin.

Ropinirole, a dopamine agonist already available for treatment of Parkinson’s disease, is now the first drug approved by the FDA for treatment of moderate to severe RLS.

Exacerbated by caffeine, fatigue, or stress and can present with daytime somnolence due to disturbed night-time sleep.

Restless legs can be symptomatic of an underlying peripheral neuropathy or iron deficiency, pregnancy, vitamin B12 deficiency anemia, rheumatoid arthritis, hypothyroidism, poliomyelitis, chronic myelopathy, Parkinson’s disease  and renal disease.

Treatment is with clonazepam (0.5-2.0 mg), small doses of levodopa (100-200 mg) or dopamine agonists (Bromocriptine,  Pergolide) at night.

D/d: Antipsychotic-induced akathisia, ADHD.

It needs to be distinguished from the daytime sense of restlessness of the limbs known as akathisia that is a side-effect of major tranquillisers, and the related condition of periodic limb movements during sleep.