Skip to main content

Advertisement

SpringerLink
Log in

Restless legs syndrome

  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Opinion statement

In the past 10 years, restless legs syndrome (RLS) has gained recognition as a common sleep disorder. There are several therapeutic options in treating patients with RLS. RLS causes significant sleep disturbance and negatively impacts on patient quality of life. Pharmacologic treatment can result in improved sleep and quality of life issues. RLS patients should be evaluated for iron deficiency anemia; iron replacement in deficient patients may lead to a resolution of symptoms or may reduce the severity of their symptoms. For patients with daily symptoms, the initial therapy is dopamine agonists. Low doses given in the evening or 2 hours before bed provide adequate relief of symptoms for many RLS patients. Augmentation can be seen with all dopamine agents, but is most prevalent with levodopa. Levodopa therapy is best used for milder intermittent symptoms or in aggravating situations, such as long car rides. Opiates and antiepileptics remain a beneficial therapy for RLS and are useful in patients who experience pain as part of their RLS. Newer anticonvulsants may provide additional treatment options, but they have yet to undergo clinical trials. Intravenous iron also may provide relief of RLS symptoms; however, dosing and safety issues have not been fully evaluated in a RLS population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Ekbom KA: Restless legs syndrome. Neurology 1960, 10:868873.

    Google Scholar 

  2. Allen R, Hening W, Montplaisir J, et al.: Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institute of Health. Sleep Med 2003, 4:101119. This paper provides an up-to-date review regarding diagnostic criteria, including criteria for children.

    Google Scholar 

  3. Saletu M, Anderer P, Saletu B, et al.: EEG mapping in patients with restless legs syndrome as compared with normal controls. Psychiatry Res 2002, 115:4961. One of many studies demonstrating that RLS significantly impacts quality of life.

    Google Scholar 

  4. Earley CJ: Clinical practice: restless legs syndrome. N Engl J Med 2003, 348:21032109. This paper is an excellent review of the disorder and treatment.

    Article  Google Scholar 

  5. Thorpe M: Periodic limb movement disorder and restless leg syndrome. In The International Classification of Sleep Disorders Diagnostic and Coding Manual. Edited by Thorpe M. Lawrence: Allen Press; 1990:6571.

    Google Scholar 

  6. Bonati MT, Ferini-Strambi L, Aridon P, et al.: Autosomal dominant restless legs syndrome maps on chromosome 14q. Brain 2003, 126:14851492.

    Article  Google Scholar 

  7. Desautels A, Turecki G, Montplaisir J, et al.: Identification of a major susceptibility locus for restless legs syndrome on chromosome 12q. Am J Hum Genet 2001, 69:12661270.

    Article  Google Scholar 

  8. Tan EK, Seah A, See SJ, et al.: Restless legs syndrome in an Asian population: a study in Singapore. Mov Disord 2001, 16:577579.

    Google Scholar 

  9. Lavigne GJ, Montplaisir JY: Restless legs syndrome and sleep bruxism: prevalence and association among Canadians. Sleep 1994, 17:739743.

    Google Scholar 

  10. Winkelman JW, Chertow GM, Lazarus JM: Restless legs syndrome in end-stage renal disease. Am J Kidney Dis 1996, 28:372378.

    Google Scholar 

  11. Hui D, Wong T, Li T, et al.: Prevalence of sleep disturbances in Chinese patients with end stage renal failure on maintenance hemodialysis. Med Sci Monit 2002, 8:331336.

    Google Scholar 

  12. Winkelmann J, Stautner A, Samtleben W, Trenkwalder C: Long-term course of restless legs syndrome in dialysis patients after kidney transplantation. Mov Disord 2002, 17:10721076.

    Article  Google Scholar 

  13. Manconi M, Govoni V, Cesnik E, et al.: Epidemiology of restless legs syndrome in a population of 606 pregnant women. Sleep 2003, 26:A330331.

    Google Scholar 

  14. Lee KA, Zaffke ME, Baratte-Beebe K: Restless legs syndrome and sleep disturbance during pregnancy: the role of folate and iron. J Womens Health Gend Based Med 2001, 10:335341.

    Article  Google Scholar 

  15. O’Keeffe ST, Gavin K, Lavan JN: Iron status and restless legs syndrome in the elderly. Age Ageing 1994, 23:200203.

    Article  Google Scholar 

  16. Sun ER, Chen CA, Ho G, et al.: Iron and the restless legs syndrome. Sleep 1998, 21:371377.

    Google Scholar 

  17. Comella CL: Restless legs syndrome: treatment with dopaminergic agents. Neurology 2002, 58:S87S92.

    Google Scholar 

  18. Silber MH, Shepard JW, Jr., Wisbey JA: Pergolide in the management of restless legs syndrome: an extended study. Sleep 1997, 20:878882.

    Google Scholar 

  19. Silber M, Girish M, Izurieta R: Pramipexole in the management of restless legs syndrome: an extended study. Sleep 2003, 26:819821. This study is just one of a few to provide long-term follow-up on treatment with evidence for augmentation; long-term studies will be essential.

    Google Scholar 

  20. Allen RP, Earley CJ: Augmentation of the restless legs syndrome with carbidopa/levodopa. Sleep 1996, 19:205213.

    Google Scholar 

  21. Hening W, Allen R, Earley C, et al.: The treatment of restless legs syndrome and periodic limb movement disorder: an American Academy of Sleep Medicine review. Sleep 1999, 22:970999. This review article provides an excellent overview of the clinical treatment studies done in RLS.

    Google Scholar 

  22. Garcia-Borreguero D, Larrosa O, de la Llave Y, et al.: Treatment of restless legs syndrome with gabapentin: a double-blind, crossover study. Neurology 2002, 59:15731579. Although gabapentin had been used for RLS, this provides clinical evidence for its efficacy.

    Google Scholar 

  23. Chervin RD, Archbold KH, Dillon JE, et al.: Associations between symptoms of inattention, hyperactivity, restless legs, and periodic leg movements. Sleep 2002, 25:213218.

    Google Scholar 

  24. Kryger MH, Otake K, Foerster J: Low body stores of iron and restless legs syndrome: a correctable cause of insomnia in adolescents and teenagers. Sleep Med 2002, 3:127132.

    Article  Google Scholar 

  25. Walters AS, Mandelbaum DE, Lewin DS, et al.: Dopaminergic therapy in children with restless legs/ periodic limb movements in sleep and ADHD. Dopaminergic Therapy Study Group. Pediatr Neurol 2000, 22:182186.

    Article  Google Scholar 

  26. Phillips B, Young T, Finn L, et al.: Epidemiology of restless legs symptoms in adults. Arch Intern Med 2000, 160:21372141.

    Article  Google Scholar 

  27. Ohayon MM, Roth T: Prevalence of restless legs syndrome and periodic limb movement disorder in the general population. J Psychosom Res 2002, 53:547554.

    Google Scholar 

  28. Earley CJ, Yaffee JB, Allen RP: Randomized, doubleblind, placebo-controlled trial of pergolide in restless legs syndrome. Neurology 1998, 51:15991602.

    Google Scholar 

  29. Telstad W, Sorensen O, Larsen S, et al.: Treatment of the restless legs syndrome with carbamazepine: a double blind study. BMJ 1984, 288:444446.

    Article  Google Scholar 

  30. von Scheele C, Kempi V: Long-term effect of dopaminergic drugs in restless legs: a 2-year follow-up. Arch Neurol 1990, 47:12231224.

    Google Scholar 

  31. Benes H, Kurella B, Kummer J, et al.: Rapid onset of action of levodopa in restless legs syndrome: a double-blind, randomized, multicenter, crossover trial. Sleep 1999, 22:10731081.

    Google Scholar 

  32. Kaplan PW, Allen RP, Buchholz DW, Walters JK: A double-blind, placebo-controlled study of the treatment of periodic limb movements in sleep using carbidopa/ levodopa and propoxyphene. Sleep 1993, 16:717723.

    Google Scholar 

  33. Trenkwalder C, Collado Seidel V, Kazenwadel J, et al.: One-year treatment with standard and sustained-release levodopa: appropriate long-term treatment of restless legs syndrome? Mov Disord 2003, 18:11841189.

    Article  Google Scholar 

  34. Wetter TC, Trenkwalder C, Stiasny K, et al.: [Treatment of idiopathic and uremic restless legs syndrome with L-dopa—a double-blind cross-over study]. Wien Med Wochenschr 1995, 145:525527.

    Google Scholar 

  35. Saletu M, Anderer P, Hogl B, et al.: Acute double-blind, placebo-controlled sleep laboratory and clinical follow-up studies with a combination treatment of rr-L-dopa and sr-L-dopa in restless legs syndrome. J Neural Transm 2003, 110:611626.

    Article  CAS  Google Scholar 

  36. Wetter TC, Stiasny K, Winkelmann J, et al.: A randomized controlled study of pergolide in patients with restless legs syndrome. Neurology 1999, 52:944950.

    Google Scholar 

  37. Pieta J, Millar T, Zacharias J, et al.: Effect of pergolide on restless legs and leg movements in sleep in uremic patients. Sleep 1998, 21:617622.

    Google Scholar 

  38. Stiasny K, Wetter TC, Winkelmann J, et al.: Long-term effects of pergolide in the treatment of restless legs syndrome. Neurology 2001, 56:13991402.

    Google Scholar 

  39. Montplaisir J, Nicolas A, Denesle R, Gomez-Mancilla B: Restless legs syndrome improved by pramipexole: a double-blind randomized trial. Neurology 1999, 52:938943.

    Google Scholar 

  40. Happe S, Sauter C, Klosch G, et al.: Gabapentin versus ropinirole in the treatment of idiopathic restless legs syndrome. Neuropsychobiology 2003, 48:8286.

    Article  CAS  Google Scholar 

  41. Ondo W: Ropinirole for restless legs syndrome. Mov Disord 1999, 14:138140.

    Google Scholar 

  42. Thorp ML, Morris CD, Bagby SP: A crossover study of gabapentin in treatment of restless legs syndrome among hemodialysis patients. Am J Kidney Dis 2001, 38:104108.

    Google Scholar 

  43. Schenck CH, Mahowald MW: Long-term, nightly benzodiazepine treatment of injurious parasomnias and other disorders of disrupted nocturnal sleep in 170 adults. Am J Med 1996, 100:333337.

    Article  Google Scholar 

  44. Bezerra ML, Martinez JV: Zolpidem in restless legs syndrome. Eur Neurol 2002, 48:180181.

    Article  Google Scholar 

  45. Walters AS, Wagner ML, Hening WA, et al.: Successful treatment of the idiopathic restless legs syndrome in a randomized double-blind trial of oxycodone versus placebo. Sleep 1993, 16:327332.

    Google Scholar 

  46. Walters AS, Winkelmann J, Trenkwalder C, et al.: Longterm follow-up on restless legs syndrome patients treated with opioids. Mov Disord 2001, 16:11051109.

    Article  Google Scholar 

  47. Earley CJ, Heckler D, Allen RP: IV iron treatment for the restless legs syndrome (RLS). Sleep 2001, 24:A359.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Johns Hopkins Bayview Medical Center and the Johns Hopkins Center for Restless Legs Syndrome, 5501 Hopkins Bayview Circle, AAC-1B-82, 21224, Baltimore, MD, USA

    Suzanne Lesage MD

Authors
  1. Suzanne Lesage MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher J. Earley MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lesage, S., Earley, C.J. Restless legs syndrome. Curr Treat Options Neurol 6, 209–219 (2004). https://doi.org/10.1007/s11940-004-0013-8

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11940-004-0013-8

Keywords

Search

Navigation