New paradigms in the treatment of restless legs syndrome

Restless legs syndrome (RLS) is a common neurologic disorder occurring in 3% to 15% of the general population, which contributes to poor quality of life. Many patients go undiagnosed for years after onset of symptoms, which delays or prevents effective treatment. Extensive research over the past decade has led to a better understanding of RLS and effective treatment options. This review encompasses the most recently published pathophysiology, epidemiology, criteria for diagnosis, and clinical drug efficacy trials to provide clinicians with the information to effectively manage RLS. A comprehensive review of the medical literature was conducted and original research articles pertaining to RLS were evaluated. The pathophysiology of primary RLS is associated with dopaminergic dysfunction and abnormal brain iron metabolism. Secondary RLS is most often a consequence of iron deficiency. The prevalence of primary RLS is twofold greater in women and increases with age in men and women, although onset of symptoms may occur in up to 45% of patients before age 20 years. Patients may present with a variety of complaints including sleep disruption. Several studies have demonstrated the efficacy of low-dose levodopa and dopamine agonists. Ropinirole is the most widely studied. Other drugs that may help control symptoms include gabapentin, opioids, and clonazepam. Clinicians must be aware of the high prevalence of RLS, the potential for onset before age 20, and the various clinical presentations. Dopamine agonists are first-line therapy and provide symptom relief in 70% to 100% of patients.