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Restless legs syndrome

Important information for referring practitioners

This is a disorder characterised by unpleasant sensations in the legs resulting in an uncontrollable urge to move them. Moving the legs eases the discomfort. Lying down and trying to relax activates the symptoms and therefore it is most commonly noticed at night and interferes with sleep.

Over 80% of RLS suffers experience periodic limb movement of sleep (PLMS) which involves involuntary twitching of the legs during sleep and also causes repeated awakenings from sleep.

Cause of RLS

  • In most cases the cause is unknown
  • Theories involve:
    • Basal ganglia dysfunction
    • Low brain iron levels
  • Associated with:
    • Chronic disease states
      • Renal failure
      • Diabetes
      • Peripheral neuropathy
    • Medications
      • Prochlorperazine and metaclopramide
      • Phenothiazines
      • Serotonin antidepressants
      • Antihistamines
    • Pregnancy
    • Alcohol
    • Sleep deprivation

Diagnosis

  • Based on history of :
  • Nocturnal symptoms, absent during the day
  • Overwhelming urge to move the legs associated with relief of symptoms as long as the movement continues
  • Paraesthesias or dysaesthesias
  • Sensory only symptoms that are triggered by rest or relaxation
  • Review and consider the following:
    • FH
    • Associated co-morbidities
    • Medication review
    • Alcohol intake
    • Consider other causes of dysaesthesiae
    • Perform neurological examination
    • Check B12 and folate, renal function, iron studies
    • Sleep study

Treatment

Lifestyle related:

  • Stop aggravating medications
  • Reduce smoking and alcohol intake
  • Encourage exercise
  • Treat associated co-morbidities
  • Correct any deficiencies in iron, magnesium or folate
  • Review caffeine intake

Medication

  • Anti-Parkinsonian medication
    • Pramipexole (Sifrol) in low dose
  • Anti-convulsants
    • Gabapentin
    • Pregabalin
  • Benzodiazepines (not recommended due to habituation)

Referral requirements

A referral may be rejected without the following information.

Essential referral information

  • Reason for referral
  • History of sleep disorder
    • Duration
    • Severity
  • Management to date
    • Include last two specialist letters if seen previously at another centre
  • Other relevant medical conditions
    • Obesity
  • Medications
    • Include previously tried medications and appliances (mandibular advancement splint, CPAP) if associated with treatment failure or problems
    • Include full medication list and allergies
  • Investigations
    • FBC
    • Iron studies
    • Renal function
    • Spirometry
    • CXR
    • Include full results of any sleep studies performed (if done)

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
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