LAUSR

Restless legs syndrome (RLS) of a severity requiring medical attention has a prevalence of 2–3% in Caucasian populations. This significant cause of neurological morbidity is defined by an insistent urge to move the legs, and is often accompanied by uncomfortable and unpleasant sensations deep in the legs themselves. Symptoms typically begin or worsen at rest, especially in the evening and night, and are often relieved by activities such as rubbing, stretching, or walking. There is a family history of RLS in approximately 50% of cases, suggesting genetic risk factors, and significant associations have been shown with low serum ferritin, uraemia, and pregnancy. In addition, individuals with various chronic medical conditions such as cardiovascular disease, hypertension, multiple sclerosis, Parkinson’s disease, spinal cord disease, and neuropathy have been shown to have an increased risk of RLS although proving cause-and-effect is difficult. People with RLS have impaired sleep, often associated with periodic limb movements, and increased risk of depression and anxiety, all of which combine to reduce quality of life. Treatment of RLS involves lifestyle changes, such as increased exercise, and management of chronic comorbidities. Reversible causes such as low serum ferritin should be corrected. Effective medications include dopamine agonists (pramipexole or ropinirole), α2δ agonists (gabapentin or pregabalin), or opioids. RLS symptoms can paradoxically worsen with extended use of dopamine agonists (‘augmentation’) leading to a difficult clinical situation where dopamine agonist withdrawal is required, often with opioid cover. This month’s journal club examines three papers looking at the causes and consequences of RLS. The first is a metaanalysis of genome-wide association studies that highlight genetic risk factors for RLS. The second and third papers demonstrate associations between RLS and suicide or selfharm and resistant hypertension, respectively, and highlight some of the significant morbidities linked to RLS.