Clinical Medicine Reviews in Therapeutics

Restless legs syndrome (RLS) is a common sleep disorder, clinically diagnosed in the presence of a unique symptom complex which adversely impacts a patient’s quality of life. There is an urge to move the legs which develops during or is worsened by rest, is alleviated with movement, and is more severe in the evenings. RLS can be idiopathic or exist in association with several conditions including pregnancy, iron deficiency, advanced renal disease, and the use of certain medications. There is likely a genetic predisposition to the development of RLS. The physiologic mechanisms behind RLS are not fully understood but likely include derangements in the dopamine and iron regulatory systems. Several pharmacotherapeutic options, within the dopaminergic, antiepileptic, opioid, and sedative-hypnotic drug classes, have proven beneficial in the treatment of RLS. There is little evidence to suggest superiority of any specific agent and treatment is individualized based on symptoms and modified according to drug efficacy and tolerance. With the correct agent, or combination of agents, patients generally respond well with favorable long term treatment success.