[Restless legs syndrome]

Abstract

The restless legs syndrome (RLS) is a common neurological disorder to take possession of increasing attention. RLS is characterized by an urge to move the legs, usually accompanied by uncomfortable or unpleasant sensations, that occurs or worsen at rest and is relieved by activity. The symptoms of RLS have a major impact on nocturnal sleep and daytime functions. The clinical diagnostic criteria were established and published in 2003 by International Restless Legs Syndrome Study Group (IRLSSG). All four essential criteria must be met for a positive diagnosis. However, RLS encompassed an idiopathic form of genetic or unknown origin and secondary forms associated with many causes. Special awareness should be kept for differential diagnosis such as uremia, iron deficiency anemia, polyneuropathy, rheumatoid arthritis, and other neurodegenerative diseases. Polysomnography, actinography, L-dopa loading test, and suggested immobilization test (SIT) are helpful tools to reduce the diagnostic puzzle of false positive and false negative. Pathophysiological concepts of RLS are essentially based on the neuroimaging and neurophysiological data to assume a dysfunction of the dopaminergic system, possibly on the All neuron group localized in the hypothalamus. These neurons modulate spinal excitability and alter the sensory processing predominantly of leg afferents. Treatment may be closely linked to the dopaminergic system and iron metabolism. Dopaminergic stimulation with levodopa or dopamine agonists is the first choice in idiopathic restless legs syndrome, but the long-term adverse effect of augmentation should be carefully monitored.