Restless legs syndrome

Pinky Agarwal MD (Dr. Agarwal of the University of Washington received research support from Adams, Astellas, and Auspex; honorariums from UCB and Xenoport for speaking engagements and consulting work; honorariums from Teva for speaking engagements; honorariums from Merz for consulting work; and honorariums from US World Meds for speaking engagements and research support.)
Narendra Vaish PhD (Dr. Vaish owns stock in Antares Pharma, Ariz Biopharma, Atossa Genetics, Curis Inc, Exelixis, Isoray Inc, Lightpath Technologies, Marina Biotech, MEI Pharma, Pharmathens, RXI Pharmaceuticals, and Pain Therapeutics.)
Sindhu R Srivatsal MD MPH (Dr. Srivatsal of the University of Washington Medical Center has no relevant financial relationships to disclose.)
Joseph Jankovic MD, editor. (Dr. Jankovic, Director of the Parkinson's Disease Center and Movement Disorders Clinic at Baylor College of Medicine, received research funding from Allergan, Allon, Ceregene, Chelsea, EMD Serono, Impax, Ipsen, Lundbeck, Medtronic, Merz, and Teva, and compensation for his services as a consultant or an advisory committee member by Allergan, Auspex, EMD Serono, Lundbeck, Merz, Neurocrine Biosciences, and Teva.)
Originally released April 5, 1995; last updated April 4, 2016; expires April 4, 2019

This article includes discussion of restless legs syndrome, anxietas tibiarum, leg jitters, Willis-Ekbom disease. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

The sensory symptoms of restless legs syndrome are paresthesias and dysesthesias in the calves and legs. Descriptions of these phenomena include words such as aching, pulling, drawing, numbness, tingling, prickling, creeping, or crawling. The unpleasant sensations occur during rest and inactivity and are worse in the late evening and when attempting to sleep. In this article, the authors discuss the genetics, clinical features, diagnosis and differential diagnosis, etiology, pathophysiology, management, and prognosis of this common disorder. Management of special conditions, such as restless legs syndrome in pregnancy, are addressed as well. The current update includes recent literature on insights into the etiopathogenesis of restless legs syndrome as well as its impact on cardiovascular health.

Key points

 

• Restless legs syndrome is an underdiagnosed and a very common disorder, often with a positive family history.

 

• Several genetic linkages have been identified.

 

• Restless legs syndrome may be primary or secondary to other conditions.

 

• Treatment is generally quite effective, though sometimes drugs are associated with side effects.

 

• Several potential drugs are currently under investigation for treatment of restless legs syndrome.

Historical note and terminology

The first clinical description of restless legs is attributed to Thomas Willis. He described the syndrome in 1672, and in the 1685 edition of his textbook wrote, "Wherefore to some, when being a Bed they betake themselves to sleep, presently in the Arms and Legs, Leapings and Contractions of the Tendons, and so great a Restlessness and Tossings of their Members ensue that the diseased are no more able to sleep than if they were in a Place of the greatest Torture" (Willis 1685). In 1861 Wittmaack called the disorder "anxiety tibiarum," and wrote that it was a frequent symptom of hysteria (Wittmaack 1861). Oppenheim was the first to define the disease as a neurologic illness and the first to recognize the genetic component of the disease (Oppenheim 1923). The first significant clinical review of restless legs syndrome was written by Ekbom in 1945. His monograph described 2 forms of the disorder: one form presents with prominent paresthesia, "asthenia crurum paresthetica," and the other form presents with prominent pain, "asthenia crurum dolorosa" (Ekbom 1945).

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