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Restless legs syndrome (RLS) refers to a distressing need or urge to move the legs accompanied by an uncomfortable paresthetic sensation in the legs, worst in the evening, brought on by rest, and relieved with moving or walking. It affects 2~10% of the population, mostly women. Besides a positive family history among first-degree relatives, earlieronset RLS patients (<40 years) tend to have milder symptoms, slower progression, and less relation between body iron stores and severity of disease. Those with an onset after 50 years are more likely to be idiopathic and have symptoms or signs of neuropathy. Established secondary causes of RLS include pregnancy, end-stage renal disease, and iron deficiency (with or without anemia) but diabetes mellitus, small-fiber neuropahty, and radiculopathy also increase the risk. Worsening of symptoms has been associated with low magnesium and folate levels. Symptoms resolve with resolution of the condition. Most cases of secondary RLS have a late onset and tend to advance more rapidly. RLS may be associated (and confused) with brief (1-5s) and repetitive (every 20-40s) periodic leg movements during sleep or while awake. The movements of RLS may be of spinal, possibly propriospinal, origin. The best evidence for treatment efficacy in relieving RLS symptoms is for newer dopamine agonists, ropinirole (0.5~6 mg/d) and pramipexole (0.25~1.5 mg/d).
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