Symptoms
Restless legs syndrome manifests as an uncomfortable and difficult-to-describe feeling in the legs and a strong urge to move the legs. Less commonly, the arms are also affected. The unilateral or bilateral insensations include, for example, a burning sensation, pain, pressing, creeping and a pulling sensation. The discomfort occurs mainly at rest, for example, when sitting or lying down, and improves temporarily with physical activity and stretching. They are observed mainly in the evening and during the night. The syndrome causes sleep disturbances, fatigue, headaches and depression, and has a negative impact on the quality of life. It occurs more frequently in adults and in old age, but is also observed in children and adolescents.
Causes
The exact cause cannot always be identified. Disorders in the central iron and dopamine systems are known to trigger restless legs syndrome, and heredity plays an important role. Other possible causes and risk factors include:
- Kidney disease
- Rheumatic diseases
- Drugs, for example, antidepressants such as mirtazapine, paroxetine, neuroleptics such as quetiapine and risperidone and other dopamine antagonists, lithium, antihistamines, opioid withdrawal
- Migraine
- Pregnancy, especially in the 3rd trimester
- Neurological diseases
- Celiac disease
- Diabetes mellitus
Diagnosis
The diagnosis is made in medical treatment on the basis of clinical symptoms. To do this, four criteria must be met. Possible differential diagnoses include akathisia (sitting restlessness), nocturnal calf cramps, leg pain, ADHD, peripheral neuropathy, and vascular disease.
Nonpharmacologic treatment
Physical exercise, stretching, and massage may temporarily relieve discomfort. Exercise during the day may also have a positive effect. Causing medications should be discontinued or changed if possible. Good sleep hygiene is recommended.
Drug treatment
Causative therapy: if the syndrome is secondary to a medical condition, that condition can be treated. For example, oral or intravenous iron is given for iron deficiency. Dopamine agonists:
- Such as pramipexole (Sifrol, generics), ropinirole (Adartrel), and rotigotine (Neupro) have dopaminergic properties and are used for treatment. They are effective in up to 70-90% of patients. They are usually taken before bedtime. Levodopa (Madopar + benserazide) is also approved.
Benzodiazepines:
- Such as clonazepam (Rivotril), lorazepam (Temesta), and related substances such as zolpidem (Stilnox, generics) are sleep-inducing and muscle relaxant. A problem is the high potential for dependence and the risk for adverse effects.
Other active ingredients:
- Other agents used include opioids such as oxycodone (Oxycontin) and antiepileptic drugs such as gabapentin (Neurontin, generic) and pregabalin (Lyrica). Numerous other drugs are used off-label for treatment.
