[Restless legs. A much neglected syndrome]

Ekbom's syndrome, or 'restless legs syndrome' (RLS), not only causes symptoms in the extremities during waking hours, but also sleep disturbance and daytime fatigue. Although the prevalence of RLS has been estimated to be 1-5%, the condition is probably underdiagnosed and undertreated. Its onset may occur at any age, and there may be long periods of remission, but the condition is generally chronic. In its primary form, there is often a family history of the disorder suggestive of an autosomal dominant mode of inheritance, where the results of EMG (electromyography) and nerve conduction studies are normal. In secondary forms, clinical signs and laboratory evidence of an associated abnormality are present. The most characteristic symptom of RLS is the spontaneous occurrence of paraesthesia or dysaesthesia during waking hours. The symptoms of RLS are worse or exclusively present during rest, and are partially or temporarily relieved by activity. About 80 per cent of RLS patients also suffer from 'periodic limb movements during sleep' (PLMS), which may cause microarousals during sleep. The diagnosis of RLS is based on characteristic clinical criteria, and the sleep disturbance is diagnosed polysomnographically. L-dopa and clonazepam have been found successful in the treatment of primary RLS, though lifelong treatment is often necessary.