Restless Legs Syndrome and Periodic Limb Movements

This article describes the diagnostic criteria of restless legs syndrome (RLS) and periodic limb movements. The pathophysiology of RLS and its management are discussed. The approach to address RLS augmentation is also reviewed.

In the 2025 American Academy of Sleep Medicine RLS treatment guidelines, long-term dopamine agonist therapy for RLS was downgraded because of the accumulating evidence of augmentation. In this context, it is important to optimally use IV iron therapy in patients with RLS. Ferric carboxymaltose is more likely to cause hypophosphatemia compared with other IV iron therapy formulations. Bilateral peroneal nerve stimulation demonstrated efficacy and safety, and it can be used as adjunct therapy in patients with refractory RLS. Data from the National RLS Opioid Registry demonstrated reassuring findings, reiterating the role of opioids in the treatment of patients with RLS. An increased periodic limb movement index can often be seen in patients with RLS.

Dopamine agonists are no longer considered first-line pharmacologic therapy in patients with RLS. The mainstay of treatment is α2δ calcium channel ligands.