Restless Legs Syndrome: a common disorder, but rarely diagnosed and barely treated--an Indian experience

Restless Legs Syndrome is a common problem that is under-diagnosed. This disorder has a significant socio-economic impact as it worsens quality of life. There is either no or little data available in terms of the Indian context.

Patients who presented with insomnia or leg pain were screened for Restless Legs Syndrome (RLS) in the Psychiatry and Neurology departments of a tertiary care teaching institution from June 2011 to October 2011. One hundred consecutive patients diagnosed with RLS were included. Duration of symptoms, previous medical consultation history, and treatment received were scrutinized and recorded. Severity of RLS was assessed using the IRLS Hindi version. For statistical analysis, descriptive analysis and independent sample t-test were used.

Out of 653 subjects with insomnia or leg pain, 15.31% of the subjects had RLS. Females outnumbered males by a ratio of 2:1. Ninety-four percent of subjects had a moderate to very severe form of the illness. Only 32% of subjects reported leg symptoms to their physician on each visit. The rest of the patients sought an opinion for other symptoms like insomnia, daytime-fatigue, memory impairment, irritability, etc. Eighty percent of patients visited a general Physician or a primary care Physician. On average, five consultations were made before patients came to see us. None of the patients were diagnosed with RLS by any of their general Physicians or by specialists like neurologists, psychiatrists, etc. Common misdiagnoses (available in just 8% of cases) for legs symptoms were arthritis, calcium deficiency, worms in the stomach, depression, anxiety, stress, and vitamin deficiency. All the patients were prescribed medicines. Benzodiazepines were the most frequently prescribed drugs (97%), followed by injectable vitamin B-Complex (95% cases), calcium tablets (62% cases), selective-serotonin-reuptake-inhibitors (30%), and tri-cyclic antidepressants (25%). Proton pump inhibitors or NSAIDs were prescribed to almost all the patients along with previously mentioned drugs.

Diagnosis of RLS was missed not only by general physicians, but also by specialists like neurologists and psychiatrists. Most of the time diagnosis could not be established, yet medicines were prescribed. Many of these medicines were either ineffective or deleterious to RLS.