Dr Andrew G Veale FRACP NZ Respiratory & Sleep Institute Restless Leg Syndrome Dr Andrew G Veale FRACP NZ Respiratory & Sleep Institute

What is it? A common disorder affecting 2% to 5% of the populaton More common in women Common in pregnancy Can begin at any age Positive family history in those with early onset Usually intermittent Cause uncertain

Diagnosis History!!! A strong and often overwhelming need or urge to move the legs. Often associated with abnormal, unpleasant, or uncomfortable sensations. Deep aching, throbbing pulling, itching, crawling, creeping, burning) The urge to move the legs starts or gets worse during rest or inactivity. The urge to move is relieved by movment The urge to move gets worse in the evening or nights

Investigations Blood Tests Polysomnography FBC, Iron studies, Renal Function. Polysomnography 80% to 90% will have PLMS; but most patients with PLMS don’t have RLS. Excludes other sleep disorders

Treatment 1 Often not required if intermittent and not associated with distress Lifestyle Reassurance and empathic support Avoid alcohol and nicotine Structured evening exercise Warm baths Massage Stretches

Treatment 2 If Ferritin is in the lower third (lower half) of the normal range Iron supplements (Oral, but constipation; IV, but expensive) Medical compression devices

Treatment 3 Gabapentin Pregabalin as effective as Dopaminergic agents. Dopamine (LevoDopa with Carbidopa) but augmentation & impulsive, OCD Dopaminergic agents (Ropinerol, pramipexole, rotigotine) Opiates (methadone, codeine, oxycodone) Benzodiazepines

Its more about how you use the drugs! Escalating doses Augmentation Drug holidays “Ring the changes”