Epidemiology


Etiology


Pathophysiology


  • The pathophysiology of RLS is incompletely understood but likely involves CNS iron deficiency (even in patients with normal serum iron levels) and abnormalities in dopaminergic transmission.
  • See akathisia, an Antipsychotics > Extrapyramidal symptoms (EPS)

Clinical features


  • A recurrent urge to move the legs that is:
    • Typically relieved by movement
    • Triggered and/or worsened with rest
    • Worse in the evening and at night (may occur exclusively at night)
  • The urge to move the legs is often accompanied by uncomfortable sensations (e.g., pain, pins and needles, itching, tickling, or crawling sensations).

Diagnostics


Treatment


  • Provide oral iron supplementation
  • Alpha-2-delta ligands (e.g., gabapentin enacarbil, pregabalin, or gabapentin): first-line for most patients, unless contraindicated
  • Low-dose nonergot dopamine agonists (e.g., pramipexole, ropinirole, rotigotine)