Restless legs syndrome G25.8

Seizure-like, spontaneously occurring dysesthesias and restlessness of movement of the legs, especially at night. The phenomenon plays a major practical role.

A distinction is made:

Idiopathic restless legs syndrome

restless legs syndrome

Common, affecting 5-10% of the population in older age. Occurrence predominantly in nervous persons.

Heterogeneous causes are considered. Favoring factors include gravidity (especially in the 3rd trimester), cold, anemia. Psychological factors may also trigger the syndrome.

In some cases autosomal dominant inheritance.

Predominantly idiopathic genesis, including in:

• Uremia (about 20% of all ESRD patients.
• Rheumatoid arthritis (about 25% of all patients with seropositive r.A.)
• fibromyalgia syndrome (about 30% of all patients)
• spinal damage
• gastric resection
• Iron deficiency
• malabsorption
• hypovitaminosis
• Medications(suramin, cimetidine, tricyclics, mianserin, lithium); thalidomide intoxication.

No association has been demonstrated between CVI and restless legs syndrome (Fronek et al. 2017).

When lying down, rarely also when sitting, usually at night when falling asleep, discomfort in the legs in the form of paresthesia, dysesthesia and pain in muscles or bones of the lower legs. As a result, the legs become restless. The discomfort can be improved by movement. Improvement can sometimes be achieved by prone position. The paroxysms occur in mild cases briefly and rarely, in severe cases with considerable impairment of night sleep and regularly. Phased exacerbation and spontaneous remissions.

Clinical criteria of RLS

Minimum criteria:

Sensory symptoms

• Abnormal sensations in the extremities, unilateral or bilateral, e.g., tingling, pulling, tearing, itching, burning, cramping, or pain

Urge to move

• Restlessness, stretching, moving the leg, walking around, turning or twisting in bed, rubbing or massaging the legs

Worsening at rest, improvement with movement

Intensification of symptoms in the evening or at night

Advanced criteria:

• Sleep disturbances
• Difficulty falling asleep or staying asleep, daytime sleepiness, exhaustion
• Involuntary movements
• Unilateral or bilateral (PLM, PLMS)
• Chronic fluctuating course
• Onset/worsening due to iron deficiency, renal insufficiency, pregnancy, medications
• Positive family history (autosomal dominant inheritance)

Polyneuropathies(burning feet), arterial occlusive disease, calf cramps, sleep myoclonies, nocturnal pruritus in renal insufficiency, acathisia (=dyskinesia syndrome: inability to sit).

No causal therapy possible. Collaboration with neurologists. Treatment of the underlying condition may lead to a reduction in symptoms (e.g., iron substitution for iron deficiency, renal transplantation for uremic RLS). Occasionally improvement by prone position.

The drug of choice is L-DOPA. Most patients require 10o-400mg as evening dose. In severely affected patients, the combination of L-Dopa+opioid may prove beneficial.

Alternatively: opioids can be tried, e.g. oxycodone (Oxygesic).

Alternative: gabapentin (dosage 400-1600 mg, possibly more if needed).

Alternative: Benzodiazepines (e.g. clonazepam).

Most of the time, no cause is found.

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