Restless Leg Syndrome (RLS) has been around for a long time.  It is often under diagnosed.  Up to 10% of adults have some issues with RLS.  Part of the issue with under diagnosis is the poor recognition of symptoms and poor discovery efforts by providers.  The 4 criteria used to diagnose RLS include:  1) desire to move extremities associated with discomfort or disagreeable sensations in the extremities, 2) motor restlessness-moving extremities to relieve discomfort, 3) symptoms worse at rest, relieved by activity and 4) symptoms that are worse late in the day or at night.    Differential diagnosis includes other conditions that may cause daytime fatigue or sleep-related disorders.  Peripheral neuropathy, leg cramps and other issues must be screened for.  Drug-induced RLS must be screened for.  Coffee, nicotine and alcohol, as well as iron deficiencies can cause or worsen the symptoms of RLS.

Treatment for RLS is usually a life-long process.  Dopamine agonists, such as pramipexole and ropinirole, have received FDA approval as first-line RLS treatment options.  Life style changes must be addressed, such as smoking cessation, decreased alcohol intake, increased iron intake, and increased exercise.  Opiates and benzodiazepines have been used to help improve sleep.  Other drugs used to control RLS include ropinirole, transdermal rotigotine, pergolide, cabergoline.  Adverse effects for dopaminnergic agents are mild. RLS can be exacerbated by drugs like SSRIs, tricycilics and antipsychotic drugs.  The use of Botox for RLS is still under study.