The 2021 version of the Chinese Restless Leg Syndrome Treatment Guidelines is released, and the treatment points are first to see!

Restless legs syndrome (RLS), also known as restless legs syndrome, Willis-Ekbom disease (WED), is a common clinical sensory motor disorder of the nervous system, which is mainly manifested by strong, almost irresistible movement of the legs Desires mostly occur in the evening or night, aggravate during quiet or rest, and get better after activities.

RLS seriously affects the quality of life of patients, especially can cause insomnia, depression and anxiety.

In order to standardize the diagnosis and treatment of RLS, domestic experts in this field have compiled guidelines for the diagnosis and treatment of RLS suitable for my country's national conditions.
The following briefly introduces the treatment of restless legs syndrome.

General treatment of RLS Before the treatment of RLS, it is necessary to evaluate the potential factors that may aggravate the symptoms of RLS, and eliminate or reduce the influence of these secondary factors as much as possible.

 Recommendations: ➤It is recommended to avoid drugs that may induce RLS, such as dopamine receptor antagonists, antidepressants, antihistamines and calcium channel blockers.

[2B] ➤Cultivate healthy sleep habits.
For example, try to fall asleep at the same time every day after the leg discomfort is relieved for a period of time.
It may be effective to take a bath or perform simple activities before going to bed.
Avoid sleep deprivation as much as possible, avoid or reduce caffeine, tea, Ingestion of energy drinks, nicotine, alcohol, etc.

[1C] Drug treatment of RLS 1.
Iron.
Peripheral iron deficiency can further aggravate iron deficiency in certain areas of the brain in some individuals.

Compared with other drugs for the treatment of RLS, iron is more likely to improve the pathophysiological state of iron deficiency in the RLS brain.

 Commonly used oral iron supplements are: ferrous succinate, ferrous sulfate, ferrous fumarate and polysaccharide iron complexes.

Intravenous iron agents include sodium iron gluconate, iron sucrose, iron carboxymaltose, low-molecular-weight iron dextran, iron isomalt 1000, and superparamagnetic nano iron oxide.

 Recommendation: ➤Ferrous sulfate 325mg/time (2 times/d, containing 65mg elemental iron), 100mg vitamin C is used in combination each time.

It may be effective for the treatment of patients with serum ferritin ≤75μg/L [2C], but it may be ineffective for adult patients with serum ferritin>75μg/L [2C].

 ➤In patients with serum ferritin <300μg/L and transferrin saturation <45%, 1000mg carboxymaltose iron is effective for the treatment of moderate to severe RLS [1A].

 ➤It is not recommended that when serum ferritin is less than 45 μg/L, 5 times of 200 mg iron sucrose infusion is used to improve RLS [1B], and when the interval exceeds 24 hours, 500 mg of iron sucrose infusion is less than 300 μg/L for serum ferritin.
L’s RLS may also be invalid [1B].

 2.
Dopamine receptor agonist Pramipexole is a D1, D2, and D3 receptor agonist with a high affinity for D3 receptors.

 Recommendations: ➤Pramipexole is recommended as the first-choice treatment for moderate-to-severe RLS, starting with a small dose (0.
125mg) [1A].

 3.
Dopaminergic agent levodopa is the first dopaminergic drug used in the treatment of RLS.

100~200mg can effectively alleviate the symptoms of RLS.

Symptom deterioration is the main adverse reaction of long-term levodopa treatment.
The incidence of symptom deterioration after 6 months of continuous medication is as high as 40% to 60%.

 Recommendations: ➤Considering its potential risk of exacerbation, levodopa is not recommended as the first choice for patients with chronic persistent RLS [1B].

 4.
α2δ calcium channel ligands such as gabapentin-enakabi, gabapentin, and pregabalin are all alternative therapeutic drugs for dopaminergic therapy.

 Recommendations: ➤It is recommended to use gabapentin-enakabi to improve moderate to severe RLS and subjective sleep quality [1A].

 ➤It is recommended that gabapentin-enakabi be used for RLS patients with sensory symptoms, and it is also effective for difficulty falling asleep and other insomnia symptoms [expert consensus].

 ➤It is recommended to use pregabalin to reduce the severity of RLS symptoms [2C].

 5.
Opioid receptor agonists For a long time, clinicians have used opioid receptor agonists as an alternative treatment for RLS based on clinical experience.

 Recommendations: ➤ When other treatments are ineffective, opioids are recommended [2C].

 ➤It is not recommended to use opioids in RLS patients with obstructive sleep apnea [1B].

 Treatment of RLS after stroke The prevalence of RLS after stroke is 5.
33%~12.
40%, especially strokes in the pons, basal ganglia, and semi-oval center.

 Recommendations: ➤It is recommended to screen RLS for stroke patients, especially stroke patients with pons, basal ganglia, internal capsule and radial coronary area [Expert consensus].

 ➤Drug treatment of stroke combined with RLS should be individualized according to the patient's main symptoms and severity.

Non-ergot dopamine receptor agonists such as pramipexole and ropinirole are preferred [expert consensus].

 The incidence of RLS in PD patients with Parkinson's disease (PD) combined with RLS is 15.
0%, and the incidence in China is 8.
41%-34.
85%.
The possible risk factors are iron deficiency and malnutrition.

Before the treatment of PD combined with RLS, it is necessary to exclude secondary RLS caused by drug factors and other comorbidities, and then choose the treatment plan according to the severity of RLS symptoms.

 Recommendations: ➤Be careful to exclude related factors and accompanying symptoms, such as metabolic disorders, end-stage renal disease, diabetes, pregnancy, and the use of serotoninergic antidepressants [Expert consensus].

 ➤Mild RLS, it is recommended to change lifestyle; other non-drug treatments include massage, cold or warm bath, physical exercise, diversion, etc.
[Expert consensus].

 ➤It is recommended to use dopamine receptor agonists (such as pramipexole sustained-release tablets or rotigotine patches).

To avoid deterioration, start with the lowest effective dose [expert consensus].

 ➤For PD patients with RLS, when serum ferritin is less than 75μg/L or transferrin saturation is less than 20%, oral iron supplementation is recommended; if oral iron cannot be tolerated or contraindications exist, intravenous iron supplementation may be considered [Expert consensus ].

 Yimaitong is compiled from: Sleep Disorder Group of Neurologist Branch of Chinese Medical Doctor Association, Sleep Disorder Group of Neurology Branch of Chinese Medical Association.
Guidelines for Diagnosis and Treatment of Restless Leg Syndrome in China (2021 Edition)[J].
Chinese Medical Journal ,2021,101(13):908-925.