Restless leg syndrome: is it a real problem?

Figures & data

Table 1 Features of restless legs syndrome (RLS). Modified from Allen RP, Picchietti D, Hening WA, et al. 2003. Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology.A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med Mar, 4:101–19.

A. Essential criteria:These features must be present for a diagnosis of RLS.

1. An urge to move the legs, usually accompanied or caused by uncomfortable or unpleasant sensations in the legs. (Sometimes the urge to move is present without the uncomfortable sensations and sometimes the arms or other body parts are involved in addition to the legs.)

2. The urge to move or unpleasant sensations begin or worsen during periods of rest or inactivity such as lying or sitting.

3. The urge to move or unpleasant sensations are partially or totally relieved by movement, such as walking or stretching, at least as long as the activity continues.

4. The urge to move or unpleasant sensations are worse in the evening or night than during the day or only occur in the evening or night. (When the symptoms are very severe, the worsening at night may not be noticeable, but must have been previously present.)

B. Supportive clinical features of RLS: Presence of these features may help resolve any diagnostic uncertainty.

1. Periodic limb movements (during wakefulness or sleep).

2. Family history of RLS in a first degree relative.

3. Response to dopaminergic therapy.

C.Associated clinical features:These features may provide additional information about the patient's diagnosis.

1. Clinical course following certain identifiable patterns.

2. Sleep disturbance.

3. Normal medical evaluation/physical examination.

Table 2 Epidemiological studies of the prevalence of Restless Legs Syndrome using International Restless Legs Syndrome (IRLS) Study Group criteria and either telephone or face-to-face interviews

Year	Author	n	Population	Prevalence
1994	Lavigne and Montplaisir*	2019	Canada,	10%
2000	Phillips et al**	1803	Kentucky, USA	10.0%
2000	Rothdach et al	369	Germany, 65–83 years	9.8%
2002	Ohayon and Roth	18 980	Five European countries	5.5%
2003	Sevim et al	3234	Turkey,	3.2%
2005	Allen et al	15 391	USA, 5 European countries,	7.2%
2005	Högl et al	701	Bruneck, Northern Italy, 40–79 y	10.6%
2005	Bjorvatn et al	2005	Norway and Denmark,	11.5%
2005	Mizuno et al†	3287	Japan >65 years	1.1%
2005	Tison et al	10 263	France, adults	8.5%
2005	Kim et al	9930	Korea, adults	12.1%

* Notes: 3 of 4 IRLS criteria used for diagnosis;

** 2 of 4 IRLS criteria used for diagnosis;

† Screening by questionnaire, followed by telephone interview.

Table 3 Medications shown to benefit idiopathic restless legs syndrome (RLS) in randomized double blind trials

Medication	Starting – usual dose	Evidence base
Dopamine precursors
Levodopa +/− benserazide	50–200 mg at night	3 RCTs, 58 pts
Combined slow and regular release levodopa	100–200 mg at night	2 RCT 51 pts
Dopaminergic agonists
Pergolide	0.025–0.5 mg daily	3 RCTs 146 pts
Pramipexole	0.125–1.5 mg daily	2 RCTs 355 pts
Ropinirole	0.25–3.0 mg daily	4 RCTs 595 pts
Cabergoline	0.5–2.0 mg daily	1 RCT 85 pts
Rotigotine (patch)	1.125–4.5 mg daily	1 RCT 63 pts
Sedative-hypnotic agents
Clonazepam	0.25–2 mg at night	1 RCTs 6 pts
Antiepileptic agents
Carbamezapine	100–300 mg daily	1 RCT 174 pts
Gabapentin	300–1500 mg daily	1 RCTs 24 pts
Opioids
Oxycodone	5–20 mg daily	1 RCT 11 pts

Abbreviations: RCT, randomized controlled trials; pts, patients.

AllenRPPicchiettiDHenningWARestless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of HealthSleep Med200341011914592341

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