Restless legs syndrome

Pathophysiology and modern management

Kavitha Nagandla, Somsubhra De

Research output: Contribution to journalReview article

35 Citations (Scopus)

Abstract

Restless legs syndrome (RLS) is a common sensory motor neurological disorder that is characterised by an irresistible urge to move the legs that significantly affects the quality of life of the patient. Prevalence in the general population is 5-25% and it is twice as prevalent in women as in men. RLS is the most common movement disorder in pregnancy with a fourfold increased risk of developing this disorder later in life. The pathophysiology of RLS is centred on dopaminergic dysfunction, reduced central nervous system iron, genetic linkages, or alteration in neurotransmitters such as hypocretins, endorphins levels and immune dysfunction and inflammatory mechanisms. With the emergence of new evidence, there are changes to the previous treatment recommendations for RLS. There is sufficient evidence to conclude that dopamine agonists such as rotigotine transdermal patch, pramipexole, ropinirole, gabapentin enacarbil, pregabalin and gabapentin are effective in the short-term treatment of RLS and rotigotine, followed by gabapentin enacarbil, ropinirole, pramipexole and gabapentin for long-term treatment. Based on expert consensus, the recommendation for daily RLS is dopamine agonists or gabapentin or low-potency opioids. Levodopa is less preferred for treating daily RLS due to its high risk of augmentation. For intermittent RLS, it is levodopa or dopamine agonists or low-potency opioids or benzodiazepines. For refractory RLS, the choice is to change to gabapentin or a different dopamine agonist, addition of a second agent like gabapentin or benzodiazepine to the existing drug or changing to a high-potency opioid or tramadol. Medications with safety record in pregnancy include opioids and antiepileptics such as carbamazepine and gabapentin. There are concerns that patients with RLS are at risk for metabolic deregulation, autonomic dysfunction and cardiovascular morbidity. However, a recent study concluded that RLS is not associated with increased risk of cardiovascular complications.

Original languageEnglish
Pages (from-to)402-410
Number of pages9
JournalPostgraduate Medical Journal
Volume89
Issue number1053
DOIs
Publication statusPublished - 01-07-2013
Externally publishedYes

Fingerprint

Restless Legs Syndrome
Dopamine Agonists
Opioid Analgesics
Levodopa
Benzodiazepines
Transdermal Patch
Endorphins
Tramadol
Pregnancy
Genetic Linkage
Carbamazepine
Movement Disorders
Nervous System Diseases
Anticonvulsants
Neurotransmitter Agents
gabapentin
Leg
Consensus
Therapeutics
Iron

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Nagandla, Kavitha ; De, Somsubhra. / Restless legs syndrome : Pathophysiology and modern management. In: Postgraduate Medical Journal. 2013 ; Vol. 89, No. 1053. pp. 402-410.
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Restless legs syndrome : Pathophysiology and modern management. / Nagandla, Kavitha; De, Somsubhra.

In: Postgraduate Medical Journal, Vol. 89, No. 1053, 01.07.2013, p. 402-410.

Research output: Contribution to journalReview article

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