Neurotherapeutics for restless legs syndrome

Abstract

Restless legs syndrome (RLS) is a sensory–motor disorder that causes insomnia due to abnormal sensations in the lower limbs and is frequently associated with periodic leg movements during sleep or resting wakefulness. RLS is associated with neurological disorders such as migraine and Parkinson's disease as well as peripheral neuropathy, which can also mimic RLS. RLS is diagnosed by interviewing patients to confirm the 4 essential features (URGE) : U＝urge to move the legs ; R＝rest induces symptoms ; G＝getting active brings relief ; and E＝evening and night make symptoms worse. In addition, it is necessary to exclude RLS mimics such as leg cramps, arthritis and peripheral neuropathy. For treatment, iron is administered in patients with low serum ferritin (＜50µg/L), and the main pharmacotherapies used are dopamine agonists and alpha–2 delta ligands. Intermittent administration of levodopa may be an option for daytime symptoms triggered at rest. In this article, I will review the pathophysiology, diagnosis and treatment of RLS.