Le syndrome des jambes sans repos

The Restless Legs Syndrome (RLS) is a common sensory motor disorder, characterized by an unpleasant (and sometimes painful) sensation, most often localized deep within both legs, manifested by an urge to move the legs that worsens with inactivity, in the evening and during the night. In addition to be tiresome, RLS mostly impacts sleep. RLS is a clnical diagnosis based entirely on patien'ts symptoms. Its severity depends on how frequent, long lasting and painful the symptoms are, and on how much they impact on sleep, mood and quality of life. Seventy to 90 % of the patients present atso involuntary, periodic leg movements during sleep (PLMS) or awake. As many as 8.5% French adults (10.8% women, 5.8% men) experience RLS once a year, while 4.4% patients are suffering from RLS at least once a week. Although the physiopathology of RLS is incompletety elucidated, several factors may contribute to its expression: genetics and circadian factors, and a central dysfunction of dopamine, opioid and iron storage. RLS is generaly idiopathic with family aggregation in 63% to 92% patients. RLS can be secondary to iron brain deficiency, pregnancy, uremia and neuropathy. Serum ferritin levels (norms >50 mg/L) shouid be determined, and iron supplementation may be beneficiai in iron-deficient patients. Patients with minor symptoms may try to avoid caffeine, alcohol and sport in the evening, to have regular sleep schedules, and to walk or have an important mental activity (eg writing, doing cross-words) during symptoms. For other patients, three classes of drugs are mostly used and best analyzed: dopaminergic agents, antieplieptics (including benzodiazepines), and opioids. The evening intake of 50 to 200 mg of levodopa can be enough to improve RLS and sleep symptoms, but its short half-life exposes patients to the risk of end-of-the-night rebounds and augmentations (development of RLS earlier, in the afternoon and in the arms), so that dopamine agonists have become the drugs of choice. They have demonstrated efficacy not only in RLS but aiso in PLMS, using large, double blind, placebo-controlled trials. Opioids and antiepileptics can be used in painful RLS, with the risk of rapid addiction.