Managing RLS

There currently is no cure for idiopathic restless legs syndrome (RLS). The central aim of treatment is to manage RLS symptoms effectively and control the impact of this condition on daily activity. Ameliorating RLS symptoms lessens the psychological burden on the patient during the day while reducing sleep disturbance and insomnia at night. The end result of alleviating symptoms is both mood elevation and the resolution of daytime fatigue, which may lead to an overall improvement in quality of life and daily functioning.^1,4

The International Restless Legs Severity scale is a validated measure used to rate the severity of RLS.²¹ This 10-item scale is widely used to assess RLS symptom frequency, intensity, and impact on daily activity.²¹ As the severity of RLS symptoms varies from patient to patient, treatment must be individualized based on clinical presentation.⁵

Patients with mild to moderate RLS symptoms often benefit from nonpharmacologic treatments and general lifestyle changes.¹⁸

Nonpharmacologic treatment strategies:

• Decrease or discontinue use of alcohol, caffeine, nicotine¹⁴
• Relaxation therapy, stress reduction, and biofeedback¹⁸
• Massage and acupuncture¹⁴
• Taking a warm bath or using a heating pad⁴
• Counterstimulation using mental alerting activities²²

In more severe cases of RLS, and in cases where lifestyle management is ineffective, pharmacologic intervention may be beneficial.

Pharmacologic treatment strategies:

• Dopamine precursors²³
• Dopamine agonists: ergot¹⁸ and non-ergot¹⁸
• Opioids¹⁸
• Benzodiazepines¹⁸
• Antiepileptics²⁴

Dopamine agonists are the only medications approved for the treatment of moderate to severe RLS.