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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

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