Restless legs syndrome

The disease:

Cause	Primary: · Dopamine dysfunction Secondary: · Iron deficiency · Uraemia · Rheumatic disease · Pregnancy · Medications
Epidemiology	· Affects 10% of population · Peak age 65 years · Women > men (2x) · Common in pregnancy · May be triggered or exacerbated peri-op
Presentation	· Urge to move one’s legs · Unpleasant sensation deep within the legs · Exacerbated by inactivity +++ · Relieved by movement · Worse at night
Significance	· Profound effect on QOL

Dopamine agonist	· Only if severe · Use as infrequently as possible · Non-ergoline: pramipexole, rotigotine · Ergoline: cabergoline, pergolide (but fibrosis of heart valves, pericardium lungs, retroperitoneum)
Gabapentinoids	· Effective
Opioids	· Mechanism unknown
Benzodiazepines	· For sleep initiation and maintenance

Main things

· No missed tablets

· No anti-dopaminergics

· Minimise immobility (esp awake on-table)

· Minimise sleep deprivation

· (Other: avoid anaemia, iron deficiency)

Drugs to give

· Regular medications

· +/- L-DOPA via NGT

· +/- parenteral apomorphine (dopamine agonist)

· +/- rotigotine patch

Drugs to avoid

· Metoclopramide

· Droperidol

· Tramadol

· Naloxone

· Tricyclic antidepressants

· Antihistamines

· Most antipsychotics

· Most antidepressants