Synopsis
Diagnose restless legs syndrome from its urge–rest–relief–evening pattern, identify iron deficiency, kidney disease, pregnancy and medicine triggers, and prevent dopaminergic augmentation through proportionate first-line treatment and monitoring.
- The diagnostic core is an urge to move the legs, usually with unpleasant sensations, beginning or worsening during rest, relieved by movement and more prominent in the evening or night.
- Walking, stretching, rubbing or moving brings temporary relief; pain that persists unchanged during movement or occurs mainly on exertion suggests another cause.
- Primary RLS can be familial, but iron deficiency, pregnancy, chronic kidney disease and some neurological disorders are important associated states.
Key red flags
Symptoms that start progressively earlier, appear after shorter rest, become more severe or spread from legs to arms during dopamine therapy suggest augmentation rather than simple disease progression.
Investigation priorities
Identify iron depletion, anaemia and a treatable contributor before symptomatic medication is escalated.
Management branches
Night-time leg discomfort, urge or insomnia is reported.
- 1. Ask whether symptoms begin at rest, are temporarily relieved by movement and show evening predominance, documenting exceptions and severity.
- 2. Compare cramps, neuropathy, venous disease, arthritis, positional discomfort and akathisia through sensory description, examination and medication timing.
Key medicines
Oral iron replacementWhen biochemical deficiency is confirmed, a common regimen is ferrous sulfate 200 mg once daily or on alternate days, adjusted to elemental iron, tolerability and the local replacement protocol.
PregabalinA specialist or experienced prescriber may start 25–75 mg in the evening and titrate cautiously to symptom response, reducing dose in renal impairment under current BNF guidance.