Restless Legs Syndrome

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍restless legs

Severity is ‍mildmoderatesevere

Pattern ‍persistentintermittent

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍leg pain

‍leg cramps

‍tingling

‍swelling

‍sleep disturbances

‍sleep apnea

‍daytime sleepiness

‍depression

‍difficulty concentrating

‍impaired memory



Contributing factors:

‍pregnancy

‍high caffeine intake

‍smoking

‍high alcohol intake

no history of: ‍iron deficiency, ‍kidney failure, ‍diabetes, ‍peripheral neuropathy, ‍Parkinson's disease

no use of: ‍antidepressants, ‍antipsychotics





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Musculoskeletal: joints ‍ ‍normal, ‍limited ROM

Neurologic: cranial nerves ‍intact, strength ‍intact 5/5, sensation ‍intact, reflexes ‍intact 2+, cerebellar function ‍intact, gait ‍steady

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought ‍organized, ‍suicidal ideation, judgment ‍good





ASSESSMENT:

‍Restless legs syndrome ‍likelysuspectedpossible

DDx: restless legs syndrome, iron deficiency anemia, peripheral neuropathy, pregnancy, renal insufficiency, medication-induced restless legs syndrome, neurological disorders, sleep apnea, muscle crampes, varicose veins, diabetes mellitus, thyroid disorders, fibromyalgia, Parkinson's disease, rheumatoid arthritis, spinal cord lesions, caffeine intake, alcohol use, nicotine use, sleep deprivation, antidepressant use, antipsychotic use, dopamine antagonist use





PLAN:

Investigations:

- Blood work: ‍CBC, ‍ferritin, ‍TSH, ‍B12, ‍electrolytes, ‍creatinine, ‍glucose

- Sleep study

Treatments:

- ‍Dopaminergic agents

- ‍Benzodiazepines

- ‍Opioids

- ‍Anticonvulsants

- Stretching exercises before bed

- Regular exercise

- Good sleep hygiene

- Avoidance of caffeine

- Avoidance of alcohol

- Smoking cessation counseling

Further care:

- Referral to neurologist

- Referral to sleep specialist

- Follow-up in ‍ ‍weeksmonths

- Return if symptoms worsen, if new symptoms develop such as pain or numbness, or if symptoms do not improve with treatment