Clinical Review

Restless legs syndrome

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e3056 (Published 23 May 2012) Cite this as: BMJ 2012;344:e3056
  1. Guy Leschziner, consultant neurologist1,
  2. Paul Gringras, professor of sleep medicine and neurodisability2
  1. 1Department of Neurology and Sleep Disorders Centre, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
  2. 2Department of Paediatric Neurosciences, Evelina Children’s Hospital, London, UK
  1. Correspondence to: G Leschziner guy.leschziner{at}gstt.nhs.uk

Summary points

  • Restless legs syndrome is common in primary and hospital care; it causes great distress and disturbance of sleep

  • The syndrome may be idiopathic or secondary to other disease

  • Because of its varied presentations, it is often missed or misdiagnosed; diagnostic criteria have now been defined

  • Screen all affected patients for iron store status; consider iron supplementation if serum ferritin is below 112 pmol/L (50 µg/L)

  • Dopamine agonists are a licensed and proved treatment but are associated with augmentation and impulse control disorders; other unlicensed agents may be efficacious

Restless legs syndrome is common; it is characterised by an urge to move and usually, but not exclusively, affects the legs. This urge to move is typically accompanied by abnormal sensations, variably described as burning, tingling, aching, or “insects crawling under the skin.” These sensations are transiently or partially relieved by movement, and there is a strong circadian influence—symptoms are worse in the evening. It may be idiopathic or secondary to iron deficiency, pregnancy, uraemia, or neurological problems.

Estimates of prevalence of the syndrome range from 1.9% to 15%, depending on case ascertainment,1 and it affects all age groups, although prevalence increases with age. Prevalence is about twice as high in women as in men.

Restless legs syndrome is a common cause of insomnia related to problems with sleep initiation and sleep maintenance, unrefreshing sleep, and excessive daytime sleepiness, and it may signify an underlying medical condition. Recognition of the condition and appropriate treatment therefore has a large impact on morbidity and quality of life.2

Sources and selection criteria

We searched Medline, the Cochrane Library, and the National Institute for Health and Clinical Excellence website with the search term “restless legs syndrome”. We used evidence from published articles and guidelines on the management and treatment of restless legs syndrome by the International Restless Legs …

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