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Introduction
Restless leg syndrome (RLS) is a chronic neurological disorder that interferes with rest and sleep, leading to poor quality of life and productivity. Sir Thomas Willis, a British anatomist and physician, first described the condition in 1685. In 1944, Karl-Axel-Ekbom, a Swedish physician who later became a pioneer in RLS research, described all the clinical features and coined the term RLS. 1 In 1982, Akpinar first reported dramatic benefits of levodopa, 2 and subsequently dopamine agonists became a mainstay of therapy. However, chronic dopaminergic treatment can aggravate symptoms in some people with RLS. This phenomenon, known as augmentation, has changed the way we approach therapy in RLS. 3 4 Here we discuss a practical approach to the management of RLS.
Clinical features
Box 1 International Restless Legs Syndrome Study Group consensus diagnostic criteria for restless legs syndrome An urge to move the legs usually, but not always, accompanied by, or felt to be caused by, uncomfortable and unpleasant sensations in the legs
The urge to move the legs and any accompanying unpleasant sensations begin or worsen during periods of rest or inactivity such as lying down or sitting
The urge to move the legs and any accompanying unpleasant sensations are partially or totally relieved by movement, such as walking or stretching, at least as long as the activity continues
The urge to move the legs and any accompanying unpleasant sensations during rest or inactivity only occur in the evening or night or are worse at night than during the day
The occurrence of the above features is not solely accounted for as symptoms primary to another medical or a behavioural condition (eg, myalgia, venous stasis, leg oedema, arthritis, leg cramps, positional discomfort and habitual foot tapping).
Patients often have difficulty articulating their symptoms and therefore may be reluctant to raise it with the physician. People use a wide range of descriptive terms to describe their leg paraesthesia, which include 'crawling', 'tingling', 'restless', 'cramping', 'creeping', 'pulling', 'painful', 'electric', 'tension', 'itching', 'burning' and 'prickly'. 7 Isolated pain with an urge to move is not RLS. The urge to move the legs is sometimes experienced as a sense of intense anxiety or inner restlessness, and patients may not immediately recognise the accompanying urge to move the legs....