Epidemiology

Etiology

Pathophysiology

• The pathophysiology of RLS is incompletely understood but likely involves CNS iron deficiency (even in patients with normal serum iron levels) and abnormalities in dopaminergic transmission.
• See akathisia, an Antipsychotics#Extrapyramidal symptoms (EPS)

Clinical features

• A recurrent urge to move the legs that is:
  • Typically relieved by movement
  • Triggered and/or worsened with rest
  • Worse in the evening and at night (may occur exclusively at night)
• The urge to move the legs is often accompanied by uncomfortable sensations (e.g., pain, pins and needles, itching, tickling, or crawling sensations).

Diagnostics

Treatment

• Provide oral iron supplementation
• Alpha-2-delta ligands (e.g., gabapentin enacarbil, pregabalin, or gabapentin): first-line for most patients, unless contraindicated
• Low-dose nonergot dopamine agonists (e.g., pramipexole, ropinirole, rotigotine)