Restless Legs Syndrome: A Review of Diagnosis and Management in Primary Care

Abstract

Restless legs syndrome (RLS) is a common neurological disorder that is characterized by an urge to move the legs (or arms), usually accompanied by uncomfortable and bothersome sensations in the affected limbs. The prevalence of RLS ranges from 7.2% to 11.5% in the general population, and its symptoms are frequent or severe enough to require medical treatment by approximately 3% of the population. However, RLS remains largely undiagnosed, perhaps due to a lack of understanding of RLS as a medically significant disorder. Restless legs syndrome can have serious clinical consequences and a significant impact on patients' quality of life, and therefore correct diagnosis and appropriate management are important. The symptoms of RLS can be managed effectively by treatment. In this review article, we provide a description of RLS and the 4 diagnostic criteria, including a discussion of differentiating symptoms and other medical conditions that mimic RLS. We review the evidence regarding the clinical impact of RLS on sleep disturbance, patients' overall health and quality of life, and the disorder's association with cardiovascular risk. The current focus of RLS therapy is to provide symptom relief; we discuss the available pharmacologic treatment options for RLS, with a focus on the clinical evidence surrounding non-ergot-derived dopamine receptor agonists, which are the current agents of choice for moderate-to-severe RLS. Finally, we consider when it may be most appropriate for the primary care physician to refer a patient with RLS to a specialist.

Keywords:

• diagnosis
• management
• sleep disturbance
• periodic leg movements
• dopamine receptor agonists
• augmentation