Clinical assessment of patients with RLS should rule out or confirm any underlying, causative factors. This is particularly the case if disease onset occurred very recently or when symptoms are present for only short periods or have recently become more severe. Appropriate treatment of secondary causes may sometimes eliminate or reduce RLS symptoms. For example, recombinant erythropoietin therapy for anemia or kidney transplantation for end-stage renal disease may alleviate RLS symptoms. In many patients, iron supplementation to treat iron deficiency significantly reduces the symptoms of secondary RLS and, in some patients, may be the only treatment required.
Reports suggest that iron supplementation be considered in all cases.
Patients should be evaluated for a personal or family history of hemochromatosis. In addition, folate supplementation may be helpful in patients who experience symptomatic RLS due to folate deficiency, particularly pregnant females. Although there is no direct evidence to date, anecdotal reports suggest that appropriate supplementation with folate, B vitamins, vitamin C, or vitamin E may alleviate RLS symptoms even in cases in which a specific deficiency has not been determined.