Restless legs syndrome and painful legs/moving toes

Restless legs syndrome (RLS), which has been recently renamed Willis-Ekbom disease (WED), is a neurological disorder characterized by unpleasant sensations in the legs, with an urge to move. Symptoms mainly occur at rest in the evening or at night, and they are alleviated by moving the affected extremity. In the general population, a RLS prevalence of 5 % has been reported. Concerning the pathophysiology of RLS, some possible primary factors as brain iron deficiency, central nervous system dopamine regulation, and genetics have been identified. Recent guidelines indicated that pharmacological treatment should be limited to those patients who suffer from clinically relevant RLS, that is, when symptoms significantly impair the patient’s daytime functioning, quality of life, and sleep. In patients affected by chronic RLS, a nonergot dopamine agonist or an a-2-d calcium channel ligand are indicated. In the clinical practice, a dopamine agonist is more appropriate in case of depression and overweight presence. In case of comorbidities, such as chronic pain, anxiety, or insomnia, the a-2-d ligands should be considered. RLS symptoms that are present through large part of the day and night may favor the use of long-acting agents, such as the rotigotine patch or gabapentin enacarbil. In refractory RLS patients, oral prolonged release oxycodone-naloxone should be appropriate. Painful legs and moving toes syndrome (PLMTS) is a rare and underdiagnosed disorder. The pathophysiology of PLMTS is unknown, but most reports suggest an association with a peripheral lesion. Treatment is often unsatisfactory, but botulinum toxin and pramipexole showed long-term beneficial effect.