The new non-ergot dopamine agonist pramipexole has also been associated with improvements in symptoms of RLS, and preliminary data suggest that cabergoline and ropinirole may also be useful. Other potent long-acting opioids such as methadone or levorphanol tartrate can be used in patients with severe disease, and epidural morphine may be useful in extreme cases. The benzodiazepines were the first drugs to be investigated for use in RLS in the twentieth century. It is not as potent as dopaminergic or opioid drugs, and should be reserved for patients in whom other treatments have failed or are not suitable. There is some evidence that clonidine, a centrally acting inhibitory presynaptic alpha 2 -adrenergic agent, has a favourable effect on uraemic and idiopathic RLS, although reports have been contradictory.
Neurological examination reveals no abnormalities with the primary form of the disorder.
In secondary forms, clinical signs and laboratory evidence of associated abnormality may be present The disorder may begin at any age. References Collado-Seidel V, Winkelmann J, Trenkwalder C. Aetiology and treatment of restless legs syndrome. Towards a better definition of restless legs syndrome. On the mechanism of morphine action on rat striatal dopamine metabolism. Clinical symptoms and possible anticipation in a large kindred of familial restless legs syndrome.