Aetiology and treatment of restless legs syndrome

The restless legs syndrome (RLS) is a common disorder, characterised by an imperative desire to move the extremities often associated with paraesthesias, motor restlessness, worsening of symptoms at rest with at least temporary relief by activity, and worsening of symptoms in the evening or at night. The aetiology of RLS remains unknown. It has been divided into idiopathic and symptomatic (secondary) forms of RLS. Based on pharmacological, neurophysiological and imaging studies it is suggested that RLS is a disease of the subcortical CNS, with involvement of the brainstem and spinal cord. Levodopa/decarboxylase inhibitors (carbidopa, benserazide) and dopamine agonists are regarded as the treatment of choice for RLS. The development of time shift and/or augmentation of symptoms is a major problem with dopaminergic treatment, mainly with levodopa. Alternative medications are opioids and benzodiazepines. In secondary RLS the primary illness should be treated first.