Restless legs syndrome G25.8

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 18.09.2022

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Anxietas tibiarum; hereditary acromelalgia; Nocturnal leg symptoms; Pes dolorus; prisoner's campfoot; Prisoner\'s camp-foot; restless legs; Restless legs; restless legs syndrome; RLS; Wittmaack-Ekbom Syndrome

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Willis, 1672; Wittmaack, 1861; Ekbom, 1945

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Seizure-like, spontaneously occurring dysesthesias and restlessness of movement of the legs, especially at night. The phenomenon plays a major practical role.

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A distinction is made:

Idiopathic restless legs syndrome

restless legs syndrome

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Common, affecting 5-10% of the population in older age. Occurrence predominantly in nervous persons.

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Heterogeneous causes are considered. Favoring factors include gravidity (especially in the 3rd trimester), cold, anemia. Psychological factors may also trigger the syndrome.

In some cases autosomal dominant inheritance.

Predominantly idiopathic genesis, including in:

No association has been demonstrated between CVI and restless legs syndrome (Fronek et al. 2017).

Clinical features
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When lying down, rarely also when sitting, usually at night when falling asleep, discomfort in the legs in the form of paresthesia, dysesthesia and pain in muscles or bones of the lower legs. As a result, the legs become restless. The discomfort can be improved by movement. Improvement can sometimes be achieved by prone position. The paroxysms occur in mild cases briefly and rarely, in severe cases with considerable impairment of night sleep and regularly. Phased exacerbation and spontaneous remissions.

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Clinical criteria of RLS

Minimum criteria:

Sensory symptoms

  • Abnormal sensations in the extremities, unilateral or bilateral, e.g., tingling, pulling, tearing, itching, burning, cramping, or pain

Urge to move

  • Restlessness, stretching, moving the leg, walking around, turning or twisting in bed, rubbing or massaging the legs

Worsening at rest, improvement with movement

Intensification of symptoms in the evening or at night

Advanced criteria:

  • Sleep disturbances
  • Difficulty falling asleep or staying asleep, daytime sleepiness, exhaustion
  • Involuntary movements
  • Unilateral or bilateral (PLM, PLMS)
  • Chronic fluctuating course
  • Onset/worsening due to iron deficiency, renal insufficiency, pregnancy, medications
  • Positive family history (autosomal dominant inheritance)

Differential diagnosis
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Polyneuropathies(burning feet), arterial occlusive disease, calf cramps, sleep myoclonies, nocturnal pruritus in renal insufficiency, acathisia (=dyskinesia syndrome: inability to sit).

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No causal therapy possible. Collaboration with neurologists. Treatment of the underlying condition may lead to a reduction in symptoms (e.g., iron substitution for iron deficiency, renal transplantation for uremic RLS). Occasionally improvement by prone position.

The drug of choice is L-DOPA. Most patients require 10o-400mg as evening dose. In severely affected patients, the combination of L-Dopa+opioid may prove beneficial.

Alternatively: opioids can be tried, e.g. oxycodone (Oxygesic).

Alternative: gabapentin (dosage 400-1600 mg, possibly more if needed).

Alternative: Benzodiazepines (e.g. clonazepam).

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Most of the time, no cause is found.

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  1. Boghen D, Peyronnard JM (1976) Myoclonus in familial restless legs syndrome. Arch Neurol 33: 368-370
  2. Ekbom KA (1945) Restless legs. Acta med scand Suppl 158: 1-123
  3. Ekbom KA (1960) Restless Legs Syndrome. Neurology 10: 868-873
  4. Fronek LF et al (2017) Nocturnal leg symptoms are not associated with specific patterns of superficialvenous
    insufficiency. Int Angiol 36:565-568.
  5. Hornyak M et al (2003) Consensus statement from the German Sleep Society: indications for performing polysomnography in the diagnosis and treatment of restless leg syndrome. Sleep Med 3: 457-458
  6. Michaud M et al (2004) Circadian rhythm of restless legs syndrome: Relationship with biological markers. Ann Neurol 55: 372-380
  7. Montplaisir J, Lapierre O, Warnes H, Pelletier G (1992) The treatment of the restless leg syndrome with or without periodic leg movements in sleep. Sleep 15: 391-395
  8. Willis T (1672) De anima brutorum quæ hominis vitalis ac sensitiva est, excertitationes duæ; prior physiologica ejusdem naturam, partes, potentias et affectiones tradit; altera pathologica morbos qui ipsam, et sedem ejus primarium, nempe ceerebrum et nervosum genus atticiunt, explicat, eorumque therapeias instituit. R. Davis, London
  9. Wittmaak T (1861) Pathology and Therapy of Sensitivity Neuroses. In: T. Wittmaak, Textbook of Nervous Diseases, Part 1: Pathology and Therapy of Sensitive Neuroses. E. Schäfer, Leipzig


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Last updated on: 18.09.2022