What are the symptoms of Restless Legs Syndrome (RLS)?

From the Guidelines

Restless leg syndrome (RLS) symptoms should be managed by first checking ferritin levels to address potential iron deficiency, and then considering medications such as dopamine agonists, gabapentin, or low-dose opioids if symptoms significantly impact quality of life. The symptoms of RLS are characterized by an uncontrollable urge to move the legs, typically accompanied by uncomfortable sensations, which can be described as crawling, creeping, pulling, throbbing, aching, or itching sensations 1. These symptoms typically worsen during periods of rest or inactivity, especially in the evening or at night, and are temporarily relieved by movement. According to the American Academy of Sleep Medicine clinical practice guideline, RLS is a sleep-related movement disorder that can range from isolated occurrences to daily, near around-the-clock discomfort and movement 1.

Some key points to consider when evaluating RLS symptoms include:

• The importance of a careful clinical history, as there is no objective test to aid in making an RLS diagnosis 1
• The potential for other conditions, such as neuropathy, akathisia, spasticity, positional discomfort, joint discomfort, and nocturnal leg cramps, to present with symptoms resembling RLS in adults 1
• The impact of stress, caffeine, alcohol, and certain medications on triggering or worsening symptoms
• The variation in severity and frequency of symptoms, with some people experiencing them occasionally while others have them daily 1

In terms of management, the American Academy of Sleep Medicine clinical practice guideline provides recommendations for the treatment of RLS and periodic limb movement disorder in adult and pediatric patients 1. Medications such as dopamine agonists (pramipexole, ropinirole), gabapentin, or low-dose opioids may be prescribed by a healthcare provider after proper evaluation, and iron supplementation may be considered if ferritin levels are low 1.

From the FDA Drug Label

The effectiveness of ropinirole in the treatment of RLS was demonstrated in randomized, double-blind, placebo-controlled trials in adults diagnosed with RLS using the International Restless Legs Syndrome Study Group diagnostic criteria Patients were required to have a history of a minimum of 15 RLS episodes/month during the previous month and a total score of ≥15 on the International RLS Rating Scale (IRLS scale) at baseline. The IRLS scale contains 10 items designed to assess the severity of sensory and motor symptoms, sleep disturbance, daytime somnolence, and impact on activities of daily living and mood associated with RLS. In all 3 trials, a statistically significant difference between the treatment group receiving ropinirole and the treatment group receiving placebo was observed at Week 12 for both the mean change from baseline in the IRLS scale total score and the percentage of patients rated as responders (much improved or very much improved) on the CGI-I

Restless Leg Syndrome Symptoms:

• The symptoms of RLS include sensory and motor symptoms, sleep disturbance, daytime somnolence, and impact on activities of daily living and mood.
• Ropinirole has been shown to be effective in reducing the severity of these symptoms, with a statistically significant difference in the mean change from baseline in the IRLS scale total score and the percentage of patients rated as responders compared to placebo 2.
• The key benefits of ropinirole in the treatment of RLS include:
  • Reduction in sensory and motor symptoms
  • Improvement in sleep disturbance
  • Reduction in daytime somnolence
  • Improvement in activities of daily living and mood

From the Research

Restless Leg Syndrome Symptoms

Restless leg syndrome (RLS) is characterized by an uncomfortable urge to move the legs while at rest, relief upon movement or getting up to walk, and worsened symptom severity at night 3. The symptoms of RLS may be primary (idiopathic) or secondary to pregnancy or a variety of systemic disorders, especially iron deficiency, and chronic renal insufficiency 3.

Common Symptoms

• Uncomfortable urge to move the legs while at rest
• Relief upon movement or getting up to walk
• Worsened symptom severity at night
• Augmentation, characterized by more intense symptom severity, earlier symptom occurrence, and often, symptom spread from the legs to the arms or other body regions 3

Management and Treatment

Non-pharmacological approaches, including mental alerting activities, avoidance of substances or medications that may exacerbate RLS, and oral and intravenous iron supplementation, are outlined 4. The choice of an alpha2-delta ligand as first-line therapy for chronic persistent RLS with dopamine agonists as a second-line option is explained 4.

Treatment Options

• Dopaminergic agents, considered first-line treatment of RLS 5
• Alpha2-delta ligands, as first-line therapy for chronic persistent RLS 4
• Dopamine agonists, as a second-line option 4
• Iron supplementation, for people with RLS who have low ferritin levels 6, 3
• Non-pharmacological interventions, such as exercise, compression devices, counterstrain manipulation, infrared therapy, and standard acupuncture, may be beneficial for reducing RLS severity and enhancing sleep 7