PA Medical News about Restless legs syndrome

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Restless legs syndrome: Diagnostic time-savers, Tx tips
APCToday, 08/19/09

Moyer DE et al. – These 4 criteria can help speed the diagnosis. A handy algorithm can facilitate your treatment approach.

To diagnose restless legs syndrome (RLS), start with the 4 "essential criteria" – (1) a powerful urge to move the legs that is (2) rest–induced, (3) improves with activity, and (4) worsens in the evening (Strength of recommendation (SOR) C – Consensus, usual practice, opinion, disease–oriented evidence, case series).

Urge to move the legs
Rest induced
Gets better with activity
Evening and night accentuation.

Carefully screen for secondary causes of RLS, including renal failure, pregnancy, iron deficiency, and medications that can cause or exacerbate symptoms. (SOR A – Good–quality patient–oriented evidence). Any patient with a plasma ferritin concentration <50 mcg/L and RLS symptoms should be started on iron replacement therapy.

Carbidopa/levodopa is the first–line treatment for patients with intermittent symptoms of RLS; dopamine agonists are recommended for those with daily or refractory symptoms. (SOR C). If no substitute can be found for a medication associated with RLS symptoms, consider changing the dosing schedule to earlier in the day. Carbidopa/levodopa is a good choice for patients with intermittent symptoms because it can be taken on an as–needed basis.

Both physical and mental stimulation alleviate the symptoms of restless legs syndrome. The course of RLS is partly age dependent, progressing more rapidly in those who develop the condition as older adults. If you suspect sleep apnea in a patient taking opioids for RLS, provide a referral for polysomnography.