LAS VEGAS—Restless legs syndrome (RLS) is a common condition that is easy to identify and treat, says Victor Rosenfeld, MD, Medical Director of the SouthCoast Sleep Center in Savannah, Georgia.
“It is entirely a symptomatic diagnosis,” Dr. Rosenfeld told attendees of a session on RLS. “There is no physical finding or test that is technically required to make a diagnosis of restless legs.”
According to 2003 National Institutes of Health criteria, all four of the following must be present to diagnose RLS
- Urge to move legs associated with unpleasant sensation
- Worsening of symptoms with rest
- Improvement of symptoms with movement or getting up
- Symptoms tend to increase in evening and night.
Symptoms can include a creepy-crawly feeling, burning or tingling, pain, and aching. Arms also can be affected. RLS usually occurs at night and it has been shown to affect daytime functioning, work, relationships, and quality of life. RLS symptoms are more common in smokers, patients suffering from obesity, and in people who exercise less than 3 hours per month.
He emphasized that periodic limb movement of sleep (PLMS) is different from RLS and that PLMS is not necessary for a diagnosis of RLS. PLMS may or may not be clinically relevant.
Dr. Rosenfeld told attendees that they should consider a referral to a neurologist for electromyography (EMG) and nerve conduction testing to rule out peripheral nephropathy and consider a formal overnight polysomnography. RLS is associated with iron deficiency, so he recommended testing for iron levels and initiating iron replacement if levels are low.
Secondary causes of RLS are pregnancy, gastric surgery, iron deficiency anemia, end-stage renal disease, and thyroid disease, he said.
Medications that are effective in treating RLS include benzodiazepines, antiepileptic drugs, opioids, muscle relaxants, and dopamine agonists. Relatively new FDA-approved drugs for RLS include gabapentin encacabril extended release (Horizant) and rotigitine transdermal system (Neupro), and Dr. Rosenfeld said he has had good results using these medications to treat RLS.
He cautioned that drugs that increase norepinephrine, including serotonin-norepinephrine reuptake inhibitors such as venlafaxine, can activate RLS.