Restless leg syndrome: is it a real problem? Paul E Cotter Shaun T O’Keeffe Department of Geriatric Medicine, Galway University Hospitals, Galway, Ireland Correspondence: S O’Keeffe Unit 4, Merlin Park Regional Hospital, Galway, Ireland Tel + 353 91 775 561 Fax + 353 91 770 515 Email s.okeeffe@mailn.hse.ie R E V I E W Abstract: Restless legs syndrome (RLS) is a common condition that is frequently unrecognized, misdiagnosed and poorly managed. It is characterized by uncomfortable sensations deep in the legs developing at rest that compel the person to move; symptoms are worst at night and sleep disturbance is common. RLS occurs in 7%–11% of the population in Western countries, and many such people experience troublesome symptoms. Primary RLS is familial in up to two thirds of patients. RLS may also be secondary to a number of conditions including iron deficiency, pregnancy and end-stage renal failure and, perhaps, neuropathy. Secondary RLS is most common in those presenting for the first time in later life. The pathogenesis of RLS probably involves the interplay of systemic or brain iron deficiency and impaired dopaminergic neurotransmission in the subcortex of the brain. RLS is very responsive to dopaminergic therapies. Rebound of RLS symptoms during the early morning and development of severe symptoms earlier in the day (augmentation) are problematic in those treated for a prolonged period with levodopa. Consequently, dopamine agonists have become first line treatment. Anti-convulsant medications and opioids are helpful in some patients. Correction of underlying problem wherever possible is important in the management of secondary RLS. Keywords: Restless legs syndrome; sleep; iron deficiency; neuropathy Introduction Restless Legs Syndrome (RLS) was first described in the medical literature by the anatomist and physician Thomas Willis in 1685 and has been recognized as a well- defined, common and frequently distressing entity since Ekbom’s classic description in 1945. Nevertheless, RLS has attracted little attention in medical textbooks until recently, and, even now, it is often unrecognized, misdiagnosed and poorly managed. In this paper, we explore the reasons for the relative neglect of RLS, explain current thinking regarding the pathogenesis and management of the condition and show why patients with RLS will benefit from careful investigation and treatment. What is RLS? RLS is both a sensorimotor and a sleep disorder. It is characterized by unusual, uncomfortable sensations deep in the legs (and sometimes arms) that compel the person to move to relieve the sensation and that are brought on and exacerbated by rest; symptoms are particularly troublesome in the evening and at night, and sleep disturbance is common. The original report by Willis (1685) described the motor features and the sleep disruption but did not mention the sensory features that are often the main complaint of patients. In contrast, Karl-Axel Ekbom (1945) emphasized the importance of the sensory component of the condition. The current diagnostic criteria were developed at an National Institutes of Health (NIH)-supported workgroup on RLS and represent a slight modification of the original diagnostic criteria published by the International RLS Study Group in 1995 (Walters 1995; Allen et al 2003). There are four essential criteria and three supportive clinical features (Table 1). Therapeutics and Clinical Risk Management 2006:2(4) 465–475 © 2006 Dove Medical Press Limited. All rights reserved 465