Restless legs syndrome
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Restless legs syndrome
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USMLE® Step 1 style questions USMLE
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A 50-year-old woman comes to the clinic due to sleeping disturbances for the past 2 months. The patient reports an uncomfortable sensation of the legs that occurs especially at night or during prolonged inactivity. She describes the sensation as a “crawling” and “tingling” sensation which makes her wake up multiple times throughout the night. After waking up, walking and moving her legs provides temporary relief. Medical history is significant for hypertension and diabetes mellitus type 2. The patient’s most recent HbA1C was 7.0% one month ago. Vitals are within normal limits. Physical examination shows bilateral flat foot, for which she uses orthoses. Monofilament examination of the foot is within normal limits. Achilles reflex is 2+ bilaterally. Which of the following is the most likely diagnosis?
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Summary
Restless legs syndrome, also known as Willis-Ekbom disease, is a neurological disorder characterized by an irresistible urge to move one's body to stop uncomfortable or odd sensations. It is often bilateral and most commonly affects the legs, but can affect the arms, torso, head, and even phantom limbs. Moving the affected body part modulates the sensations, providing temporary relief. The exact cause of RLS is not known, but it is believed to be related to a dysfunction of the brain's dopamine system. RLS can be treated with medications like dopamine agonists and benzodiazepines; and lifestyle changes, such as avoiding aggravating factors like caffeine intake.