Restless legs syndrome

Restless legs syndrome is a symptomatic urge to move the legs, usually accompanied or caused by uncomfortable/ unpleasant sensations deep within the legs that begin or are worsened during periods of rest or inactivity in the evening or night and are partially or totally relieved by movement. It can occur intermittently or daily. Nonpharmacologic treatments include moderate exercise; good sleep hygiene; elimination of alcohol, caffeine, and nicotine; and hot baths, massage, and stretching. Activities promoting mental alertness may improve symptoms. Moderate exercise and use of nasal continuous positive airway pressure are the only nonpharmacologic treatments with proven benefit. For intermittent restless legs syndrome, carbidopa/levodopa and nonpharmacologic therapy are recommended as primary treatments. For daily restless legs syndrome, dopamine agonists, particularly ropinirole and pramipexole, are suggested as the drugs of choice. Carbidopa/levodopa could be considered for daily restless legs syndrome, but augmentation is a significant drawback to its use. Carbamazepine and gabapentin have limited data to support their use.