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

From the Guidelines

Restless leg syndrome symptoms should be managed with ferrous sulfate in patients with appropriate iron status, as it is suggested by the American Academy of Sleep Medicine (AASM) over no ferrous sulfate in adults with RLS 1. The AASM suggests this based on moderate certainty of evidence, emphasizing the importance of iron status in the treatment of RLS. Key considerations for managing RLS symptoms include:

• Identifying and addressing underlying causes or contributing factors, such as iron deficiency
• Implementing lifestyle modifications, such as regular exercise and avoiding triggers like caffeine, alcohol, and nicotine
• Using pharmacological treatments, like ferrous sulfate, as recommended by the AASM Common symptoms of RLS include:
• Uncomfortable sensations in the legs, such as crawling, creeping, pulling, throbbing, aching, or itching feelings
• Temporary relief from these sensations with movement, like walking or stretching
• Worsening of symptoms in the evening or at night, potentially disrupting sleep and leading to daytime fatigue The AASM also suggests against the standard use of certain medications, including levodopa, pramipexole, transdermal rotigotine, ropinirole, bupropion, carbamazepine, clonazepam, valproic acid, and cabergoline, due to varying levels of certainty of evidence 1. In adults with RLS and end-stage renal disease (ESRD), the AASM suggests the use of gabapentin, IV iron sucrose, and vitamin C, with specific recommendations based on ferritin and transferrin saturation levels 1. Overall, managing RLS symptoms requires a comprehensive approach that incorporates lifestyle modifications, pharmacological treatments, and addressing underlying causes, with ferrous sulfate being a recommended treatment option for patients with appropriate iron status 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
• Dysesthesia and an urge to move, predominantly occurring at rest in the evening or at night, and alleviated by moving the affected extremity or by walking 4

Factors that Exacerbate Symptoms

• Iron deficiency 3, 5, 6
• Chronic renal insufficiency 3
• Pregnancy 3, 5
• Certain substances or medications 5

Treatment Options

• Non-pharmacological approaches, including mental alerting activities, avoidance of substances or medications that may exacerbate RLS, and oral and intravenous iron supplementation 5
• Dopaminergic agents, such as pramipexole, ropinirole, and rotigotine 3, 4, 6
• Alpha2-delta ligands, such as gabapentin and pregabalin 3
• Opioids, including tramadol, oxycodone, and methadone 3