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| Restless Leg Syndrome |
| Overview |
 | Uncomfortable feeling in the legs |
| Predominantly when the patient is supine. |
| Difficulty in describing the exact nature of the discomfort: ache,
burning, crawling sensation |
| May involve the arms and trunk |
|
| Diagnosis |
| Lower extremity paresthesias and motor restlessness |
| Aggravated by nightfall and rest |
| Relieved by standing and walking around. |
| Sleep is often disturbed. |
| Resting dyskinesias while awake |
| Periodic movements in sleep |
|
| Exam |
| Normal neurologic examination |
|
| Testings |
| Diagnosis: based on clinical criteria |
| Laboratory testing: anemia, B12, ferritin, and folate levels |
| EMG: done to evaluate for neuropathy |
| Sleep Lab: polysomnography |
|
| Treatment |
| Medication treatment:
 | Start at low dose hs & titrate. |
| Patient may become tolerant to medications. |
| May be necessary to rotate 2 or 3 drugs every 1-2 months. |
|
| Levodopa: start with half of 25/100 tablet qHS and titrate up. |
| Dopamine agonists:
| Pergolide (Permax) 0.05-1.0 mg |
| Bromocriptine (Parlodel) 1.25-10 mg |
| Pramipexole (Mirapex) 0.125-4.5 mg |
| Ropinirole (Requip) 0.25-24 mg |
|
| Benzodiazepine:
| Clonazepam (Klonopin) 0.25-1.5 mg |
| Diazepam 2-15 mg |
|
| Opioids:
| Propoxyphene (Darvocet) 50-200 mg |
| Codeine 30-60 mg |
|
| Other:
| Gabapentin (Neurontin): 300 - 600 mg |
| Clonidine (Catapres) 0.1-0.3 mg |
| Baclofen (Lioresal) 10-80 mg |
| Carbamazepine (Tegretol) 200-600 mg |
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| Further reading |
| Trenkwalder, C. Walters, As. Hening, W. Periodic Limb Movements And Restless Legs Syndrome. Neurologic Clinics. Vol 14: 629-650. 1996. |
| Restless
Legs Syndrome Foundation |
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