Aetiology and treatment of restless legs syndrome

The restless legs syndrome (RLS) is a common disorder, characterised by an imperative desire to move the extremities often associated with paraesthesi as, motor restlessness, worsening of symptoms at rest with at least tempora ry relief by activity, and worsening of symptoms in the evening or at night . The aetiology of RLS remains unknown. It has been divided into idiopathic and symptomatic (secondary) forms of RLS. Based on pharmacological, neurop hysiological and imaging studies it is suggested that RLS is a disease of t he subcortical CNS, with involvement of the brainstem and spinal cord. Levodopa/decarboxylase inhibitors (carbidopa, benserazide) and dopamine ago nists are regarded as the treatment of choice for RLS. The development of t ime shift and/or augmentation of symptoms is a major problem with dopaminer gic treatment, mainly with levodopa. Alternative medications are opioids an d benzodiazepines. In secondary RLS the primary illness should be treated f irst.