Psych · Specialty psychiatry — sleep medicine interface
Restless legs syndrome
Also known as RLS · Willis-Ekbom disease · Willis–Ekbom disease · Ekbom syndrome · Periodic limb movements of sleep · PLMS · Periodic limb movement disorder · PLMD · Dopamine agonist augmentation
Exam-exhaustive fellowship atlas on restless legs syndrome (Willis–Ekbom disease) for psychiatry — IRLSSG five criteria, primary vs secondary RLS, brain-iron and A11 dopaminergic mechanisms, PLMS/PLMD, akathisia differential, ferritin-led iron therapy, α2δ ligands versus dopamine agonists and augmentation, psychotropic aggravation, pregnancy/CKD/older adult pathways, and AASM/AAN/IRLSSG guideline deltas. FRANZCP-primary, globally tagged.
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10 MCQs with explanations
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Meet the patient
A 58-year-old woman, six weeks into venlafaxine for recurrent depression, returns saying she 'can't sleep, can't sit still at night.' Crawling sensations in both calves, worse the moment she lies down, easing the moment she walks the hallway, peaking around 11 pm. Her ferritin came back 'normal' at 42 ng/mL. The registrar plans to add quetiapine for sleep.[1][9][10]
Two exam questions live in that vignette: 'What is the diagnosis, and which single blood test changes management?' and 'Do you escalate, switch, or stop anything before tonight?' This topic is the answer to both.[6][5]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship atlas.
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- [1]Allen RP, Picchietti DL, Garcia-Borreguero D, et al. Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria--history, rationale, description, and significance Sleep Med, 2014.PMID 25023924
- [2]Trenkwalder C, Allen R, Högl B, et al. Comorbidities, treatment, and pathophysiology in restless legs syndrome Lancet Neurol, 2018.PMID 30244828
- [3]Allen RP, Chen C, Garcia-Borreguero D, et al. Comparison of pregabalin with pramipexole for restless legs syndrome N Engl J Med, 2014.PMID 24521108
- [4]Winkelman JW, Berkowski JA, DelRosso LM, et al. Treatment of restless legs syndrome and periodic limb movement disorder: an American Academy of Sleep Medicine clinical practice guideline J Clin Sleep Med, 2025.PMID 39324694
- [5]Garcia-Borreguero D, Silber MH, Winkelman JW, et al. Guidelines for the first-line treatment of restless legs syndrome/Willis-Ekbom disease, prevention and treatment of dopaminergic augmentation: a combined task force of the IRLSSG, EURLSSG, and the RLS-foundation Sleep Med, 2016.PMID 27448465
- [6]Allen RP, Picchietti DL, Auerbach M, et al. Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis-Ekbom disease in adults and children: an IRLSSG task force report Sleep Med, 2018.PMID 29425576
- [7]Winkelman JW, Armstrong MJ, Allen RP, et al. Practice guideline summary: Treatment of restless legs syndrome in adults: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology Neurology, 2016.PMID 27856776
- [8]Silber MH, Buchfuhrer MJ, Earley CJ, et al. The Management of Restless Legs Syndrome: An Updated Algorithm Mayo Clin Proc, 2021.PMID 34218864
- [9]Becker PM, Sharon D Mood disorders in restless legs syndrome (Willis-Ekbom disease) J Clin Psychiatry, 2014.PMID 25093484
- [10]Yang C, White DP, Winkelman JW Antidepressants and periodic leg movements of sleep Biol Psychiatry, 2005.PMID 16005440
- [11]Walters AS, LeBrocq C, Dhar A, et al. Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome Sleep Med, 2003.PMID 14592342
- [12]Gossard TR, Trotti LM, Videnovic A, et al. Restless Legs Syndrome: Contemporary Diagnosis and Treatment Neurotherapeutics, 2021.PMID 33880737
- [13]García-Borreguero D, Allen RP, Kohnen R, et al. Diagnostic standards for dopaminergic augmentation of restless legs syndrome: report from a World Association of Sleep Medicine-International Restless Legs Syndrome Study Group consensus conference at the Max Planck Institute Sleep Med, 2007.PMID 17544323
- [14]Ohayon MM, Roth T Prevalence of restless legs syndrome and periodic limb movement disorder in the general population J Psychosom Res, 2002.PMID 12127170