Restless leg syndrome is a common chronic movement disorder, in which patients have an irresistible urge to move their legs.
The disorder that is characterized by intense restlessness and unpleasant creeping sensations deep inside the lower legs. Symptoms appear when the legs are at rest and are worst in the evening and at night.
They force patients to keep moving their legs, and often to get out of bed and wander about. Periodic limb movements
Between 5% to 15% of the population may have restless legs syndrome. It means it is very common disorder.
Patients describe sensations such as crawling, creeping, pulling, itching, drawing, or stretching, all localized to deep structures rather than the skin.
Symptoms can range from very mild problems to others having major disruption of sleep and impairments in quality of life.
The urge to move the extremities is less during the day but gets progressively worse in the evenings and at night. The symptoms also can appear on the upper extremities.
The urge to move the lower extremities may partially or completely be relieved by ambulation or stretching the legs. As long as the activity is continued, the symptoms are mild or absent.
The condition is not painful, but strong perceived need to move their legs when their legs are at rest is relieved with leg motion.
Restless leg syndrome has a diurnal pattern wherein symptoms worsen at night, and sleep disturbance is often a problem.
There is an association with involuntary jerking movements of the legs during sleep, known as periodic leg movements of sleep.
The disorder may start in childhood, but the diagnosis is often not made until the 3rd decade of life.
Psychiatric factors, stress, and fatigue may also exacerbate symptoms.
Restless leg syndrome is two types. First, Primary, which represents around 70 % of cases. And there is no defined underlying cause, but it has genetic bases.
And Secondary restless legs syndrome, can occur secondary to some disorders including:
Iron deficiency, End-stage renal disease, Diabetes mellitus, Rheumatic disease, Venous insufficiency
Peripheral neuropathy, Lumbosacral radiculopathy, Fibromyalgia, Celiac disease and medications like antidepressants. Alcohol and caffeine.
Restless leg syndrome affects close to 1/3rd of pregnant patients, but luckily the symptoms subside in a few weeks after delivery.

The pathogenesis of restless legs syndrome is not completely known. Most cases are idiopathic. In idiopathic restless legs syndrome, a dysfunction of the dopaminergic system and iron stores in specific regions in the brain diminish.
Treatment
Treatment for restless legs syndrome is usually not commenced in patients with sporadic or mild symptoms.
Patients should be advised to avoid caffeine, antidepressants, antipsychotics, dopamine-blocking anti-emetics, and centrally-acting antihistamines.
Today, the first-line treatment is either an alpha2 delta calcium channel ligand or a dopamine receptor agonist. Supplemental iron is recommended for all patients who have low serum ferritin levels.
Dopamine agonists, including pramipexole, ropinirole, rotigotine, and cabergoline, have reduced symptoms, improved sleep quality and quality of life. Pramipexole and ropinirole have adverse effects, including gambling addiction and extreme weight gain.
The rotigotine transdermal patch can also be used. It is well tolerated and has a relatively low risk of clinically significant augmentation of restless legs syndrome.
Most medications are effective 1-5 years, after the time they loss their effectivity.
Gabapentin is effective for 1 year, levodopa for 2 years, and rotigotine for 5 years - Probably effective for durations ranging between 1 and 5 years

Prognosis:
Complications of the disease itself are limited to the quality of life due to disturbed sleep and fatigue. In most patients, the symptoms progress over time and cause significant quality of life issues.
Restless leg syndrome also called Willis-Ekbom disease.

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