Restless legs syndrome.
OBJECTIVE
The signs and symptoms, epidemiology, etiology, pathophysiology, diagnosis, pharmacologic and nonpharmacologic treatments, and options and guidelines for the treatment of restless legs syndrome (RLS) are reviewed.


CONCLUSIONS
RLS was first described in the 17th century and further characterized in 1945. RLS is a common disorder, occurring in about 10% of the population. Patients with RLS often describe the urge to move, uncomfortable sensations, and pain, which begin or worsen during rest or inactivity such as lying or sitting. Symptoms of RLS make sleeping difficult for many patients, and significant daytime difficulties result from the condition. RLS can either be primary or arise from secondary causes that lead to iron deficiency. There is a familial component in primary RLS, but its underlying mechanisms remain unknown. Of individuals with conditions associated with iron-deficiency states, including pregnancy, renal failure, and anemia, 25-30% may develop RLS. The goals of RLS treatment include improving its symptoms and the patient's quality of life. There are limited data on the treatment of RLS. Pharmacologic therapies include iron replacement, dopaminergic agents (e.g., levodopa), dopamine agonists, anticonvulsants, opioids, and benzodiazepines. There have been no systematic trials of nonpharmacologic therapies for RLS, but good sleep hygiene and avoidance of alcohol, caffeine, and nicotine may improve symptoms.


CONCLUSIONS
RLS is a common disorder thought to involve abnormal iron metabolism and dopaminergic systems. Nonpharmacologic therapy should be suggested for all patients with RLS, but pharmacologic therapy may be required, and evidence is strongest for levodopa and dopamine agonists.
Ryan
Melody
M
Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY 40536, USA. maryan1@email.uky.edu
Slevin
John T
JT
D000701:Analgesics, Opioid / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D015259:Dopamine Agents / Q000627:therapeutic use; D006801:Humans; D000090463:Iron Deficiencies; D012148:Restless Legs Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy
D000701:Analgesics, Opioid; D000927:Anticonvulsants; D015259:Dopamine Agents; D001569:Benzodiazepines