FFinalistSouthampton · 2027
Neurology
AKT · Neurology/Cord & peripherallow yield

Restless legs syndrome

Sensorimotor disorder — dopaminergic dysfunction; iron-linked

Overview

A common sensorimotor disorder: an irresistible URGE to move the legs, worse at rest and in the evening/night, relieved by movement. Often associated with iron deficiency (check ferritin) and certain drugs; can disturb sleep significantly.

Recognise

  • Irresistible urge to move the legs ± unpleasant crawling sensations, WORSE at rest and at night, RELIEVED by movement
  • Disturbed sleep; periodic limb movements of sleep
  • Associations: iron deficiency, pregnancy, CKD/uraemia, diabetes; drugs (antidepressants, antihistamines, metoclopramide)

Red flags

  • Severe sleep disruption; secondary causes to treat (iron deficiency, drugs)

Differentials & how to tell them apart

Akathisiadrug-induced (antipsychotics) restlessness — generalised, not the leg-specific night-time urge
Peripheral neuropathysensory loss/glove-and-stocking, not a movement urge relieved by walking
Nocturnal leg crampspainful muscle contraction, not an urge to move
Peripheral vascular diseaseclaudication on exertion, not at rest

Investigations

Clinical. Check ferritin/iron studies (low iron is a common, treatable cause); review medications; consider renal function/glucose.

Management

Correct iron deficiency + remove offending drugs; dopamine agonist/gabapentinoid if persistent

  1. 1Check ferritin and replace iron if low; review and stop aggravating drugs (antidepressants, antihistamines, metoclopramide); lifestyle measures.Gate: Treat a low ferritin first — iron deficiency is a common and reversible driver, and correcting it can resolve the symptoms without other drugs
  2. 2Persistent/troublesome → a dopamine agonist (ropinirole/pramipexole) or a gabapentinoid; watch for augmentation with dopamine agonists.
Iron replacement — if ferritin low — can resolve symptoms
Dopamine agonists (ropinirole/pramipexole) — or gabapentin/pregabalin for troublesome symptoms

Key points

Urge to move worse at rest/night and relieved by movement = restless legs; always check ferritin (treatable). Distinguish from drug-induced akathisia.

Monitor & prognosis

Symptoms/sleep, ferritin, drug review, augmentation.

Often controllable; secondary forms improve with the cause treated.

Source: NICE CKS Restless legs syndrome