What are the symptoms and treatment options for Restless Leg Syndrome (RLS)?

From the Guidelines

Restless Leg Syndrome (RLS) is characterized by uncomfortable sensations in the legs that create an irresistible urge to move them, typically occurring during periods of rest or inactivity, especially in the evening or at night, and treatment options should prioritize iron supplements, lifestyle changes, and medications such as gabapentin or pregabalin, as recommended by the American Academy of Sleep Medicine 1.

Symptoms of RLS

• Uncomfortable sensations in the legs, such as crawling, tingling, aching, or itching
• Irresistible urge to move the legs, typically occurring during periods of rest or inactivity
• Temporary relief with movement
• Worsening symptoms at night
• Sleep disruption

Treatment Options

• Lifestyle changes:
  • Regular exercise
  • Good sleep hygiene
  • Avoiding caffeine and alcohol
  • Maintaining a regular sleep schedule
• Iron supplements: ferrous sulfate, IV ferric carboxymaltose, or other forms of iron, especially if ferritin levels are below 50 ng/mL 1
• Medications:
  • Alpha-2-delta calcium channel ligands: gabapentin (300-1200 mg daily) or pregabalin (Lyrica, 150-300 mg daily) 1
  • Low-dose opioids: oxycodone or tramadol for refractory cases, with caution due to potential side effects and risk of augmentation 1

Important Considerations

• Treatment should be individualized, starting with the lowest effective dose to minimize side effects
• Patients should be aware of the potential for augmentation (worsening of symptoms) with long-term use of certain medications, particularly dopamine agonists 1
• Regular screening of iron indices is essential for RLS patient care, and IV iron infusion may be necessary for some patients 1

From the FDA Drug Label

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. The range of scores is 0 to 40, with 0 being absence of RLS symptoms and 40 the most severe symptoms

The symptoms of Restless Leg Syndrome (RLS) include:

• Sensory symptoms
• Motor symptoms
• Sleep disturbance
• Daytime somnolence
• Impact on activities of daily living and mood

Treatment options for RLS include:

• Ropinirole (PO)
• The dosage of ropinirole is titrated based on clinical response and tolerability over 7 weeks to a maximum of 4 mg once daily 2
• Patients continued on ropinirole demonstrated a significantly lower relapse rate compared with patients randomized to placebo (32.6% versus 57.8%, P = 0.0156) 2

Common adverse reactions associated with ropinirole in RLS patients include:

• Nausea
• Vomiting
• Somnolence
• Dizziness
• Asthenic condition (i.e., asthenia, fatigue, and/or malaise) 2

From the Research

Symptoms of Restless Leg Syndrome

• An irresistible urge to move the legs, usually accompanied by uncomfortable and unpleasant sensations 3, 4, 5
• Symptoms begin or worsen during periods of rest or inactivity, and are partially or totally relieved by movements 3, 4, 6
• Symptoms are exacerbated or occur at night and in the evening 3, 4, 6
• May cause severe sleep disturbances, poor quality of life, depressive and anxious symptoms, and may be a risk factor for cardiovascular disease 3

Treatment Options for Restless Leg Syndrome

• Elimination of triggering factors and iron supplementation when deficient 3, 6, 5
• Mild or intermittent RLS is usually treated with low doses of l-DOPA or codeine 3
• First-line treatment for moderate to severe RLS is dopaminergic agonists (pramipexole, ropinirole, rotigotine) 3, 4, 7, 6
• In severe, refractory or neuropathy-associated RLS, antiepileptic (gabapentin, pregabalin) or opioid (oxycodone, tramadol) drugs can be used 3, 4, 6
• Non-pharmacological interventions, such as good sleep hygiene, massaging the affected legs, taking hot baths, and performing mentally demanding tasks, may also be beneficial 4

Diagnosis and Differential Diagnosis

• Diagnosis is based on clinical features, including an urge to move the legs, rest-induced symptoms, and relief with activity 3, 4, 6, 5
• Differential diagnosis includes disorders of restlessness and leg discomfort, such as akathisia, attention deficit/hyperactivity disorder, growing pains, and sleep complaints in childhood 3, 5
• Polysomnographic studies and the suggested immobilization test can detect periodic leg movements, and an l-DOPA challenge has recently been validated to support the diagnosis of RLS 3