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
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