Restless legs syndrome (RLS)

Diagnosis

Diagnosing restless legs syndrome involves your healthcare provider conducting a comprehensive review of your medical history and discussing your symptoms with you.

The diagnosis of RLS is based on specific criteria established by the International Restless Legs Syndrome Study Group, which include:

• You experience a compelling, frequently irresistible urge to move your legs, often accompanied by discomfortfeelings in the legs.
• Symptoms tend to emerge or intensify during periods of rest, such as when sitting or lying down.
• Engaging in activity, such as walking or stretching, offers partial or temporary relief from symptoms.
• Symptoms typically worsen during nighttime.
• No other medical or behavioral condition adequately explains the symptoms.

Your doctor may conduct both physical and neurological examinations. Blood tests, particularly focusing on iron levels, may be ordered to rule out other possible causes of your symptoms. If needed, you might be referred to a sleep specialist. While an overnight stay at a sleep clinic may be necessary for further assessment if another sleep disorder like sleep apnea is suspected, typically diagnosing RLS does not require a sleep study.

Treatment

Symptoms of restless legs syndrome may resolve upon addressing an underlying condition, such as iron deficiency. Treating an iron deficiency may entail oral iron supplementation or intravenous administration. It’s crucial to take iron supplements under medical supervision and following assessment of your blood iron levels.

For individuals with RLS not linked to another condition, treatment primarily centers on lifestyle modifications. If these prove ineffective, medication may be prescribed by your doctor.

Medications

There are various prescription medications available to alleviate the leg restlessness. While originally designed to treat other ailments, they have shown efficacy in managing RLS. These medications comprise:

• Medications that elevate dopamine levels in the brain: These drugs influence the levels of dopamine, a neurotransmitter in the brain. Rotigotine, pramipexole, and ropinirole are FDA-approved for managing moderate to severe RLS.
  Short-term side effects of these medications are typically mild and may include nausea, dizziness, and fatigue. However, they can also result in impulse control issues, such as compulsive gambling, and daytime drowsiness. Occasionally, dopamine medications that initially alleviate RLS symptoms may become less effective over time or leading to augmentation. This may present as a return of symptoms earlier in the day or affecting other body parts like the arms. If augmentation occurs, your doctor may suggest switching to another medication.
  For those experiencing occasional RLS symptoms, carbidopa-levodopa may be prescribed as needed. However, using this medication daily or near-daily is not recommended, as it can contribute to augmentation.
• Medications targeting calcium channels: Drugs like gabapentin, gabapentin enacarbil, and pregabalin have shown effectiveness in managing RLS symptoms for certain individuals.
• Opioids: Primarily prescribed for severe symptoms, these medications carry a risk of addiction, particularly when taken in high doses. Examples include tramadol, codeine, oxycodone, and hydrocodone.
• Muscle relaxants and sleep aids: These medications can improve sleep quality but do not directly alleviate leg sensations. They may also induce daytime drowsiness. Typically, they are considered when other treatments fail to provide relief.

Finding the most effective medication or combination of medications to manage RLS may involve several trials. Many medications commonly used for RLS are not typically recommended during pregnancy. Instead, doctors may suggest self-care techniques to alleviate symptoms. However, if symptoms become troublesome during the last trimester, certain medications may be approved under medical supervision.

Additionally, some medications have the potential to worsen RLS symptoms. These may include certain antidepressants, antipsychotics, anti-nausea drugs, and cold/allergy medications. If possible, doctors may advise against their use. However, if necessary, they can discuss alternative treatments to help manage RLS symptoms.