Restless legs syndrome is an urge to move the legs, usually with unpleasant sensations, that is worse at rest and in the evening and eases with movement. It often disrupts sleep and can be linked to low iron, kidney disease, pregnancy or some medicines.
Key symptoms
- Crawling, pulling or aching feelings in the legs
- Strong urge to move the legs when sitting or lying down
- Relief with walking or stretching
- Worse in the evening and at night
- Trouble falling asleep and daytime tiredness
What you find on exam
- Neurological exam, usually normal
- Look for neuropathy: sensation and reflexes in the feet
- Signs of anemia or kidney disease
Tests
- Ferritin and iron studies
- Blood count and kidney function
- Review of medicines such as antihistamines, antidepressants and antipsychotics
Treatment basics
- Iron replacement if ferritin is under 75 ng/mL
- Sleep habits, exercise and less caffeine and alcohol
- Gabapentin or pregabalin as first-line drug treatment
- Dopamine agonists such as pramipexole used with care because of augmentation
Red flags
- Weakness or numbness suggesting neuropathy or spine disease
- Symptoms starting earlier and spreading to the arms (augmentation)
- Severe insomnia affecting safety or mood
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.