Definition and Diagnosis
Restless legs syndrome (Willis-Ekbom disease) is a sensorimotor disorder characterized by an urge to move the legs, usually accompanied by uncomfortable sensations, that begins or worsens during periods of rest or inactivity, is partially or totally relieved by movement, and is worse in the evening or at night.
Epidemiology
Restless legs syndrome affects an estimated 5-10% of adults in Western populations, is more common in women, and prevalence increases with age; it is also relatively common during pregnancy.
Risk Factors
Risk factors include iron deficiency, chronic kidney disease, pregnancy, family history (a significant genetic component is recognized), and certain medications such as some antidepressants and antihistamines.
Symptoms and Subtypes
Symptoms include an uncomfortable urge to move the legs, often described as crawling, tingling, or aching sensations, occurring predominantly in the evening or night and disrupting sleep onset, sometimes accompanied by periodic limb movements during sleep.
Diagnosis
Diagnosis is primarily clinical, based on the presence of the core urge-to-move symptom with its characteristic circadian and rest-related pattern, with laboratory evaluation (particularly iron studies, including ferritin) to identify contributing or reversible causes.
Treatment
Treatment includes correction of iron deficiency when present, lifestyle measures (regular exercise, sleep hygiene, reducing caffeine/alcohol), and medications such as dopamine agonists, alpha-2-delta calcium channel ligands (e.g., gabapentin), in more persistent or severe cases.
Prognosis
Course is often chronic and can worsen with age, though symptoms are usually manageable with appropriate treatment of iron status and, where needed, pharmacotherapy; secondary forms may improve if the underlying cause is treated.
Reference
Sadock, B. J., Sadock, V. A., & Ruiz, P. Kaplan & Sadock's Synopsis of Psychiatry (11th ed.).