PT - JOURNAL ARTICLE AU - Subhashie Wijemanne AU - William Ondo TI - Restless Legs Syndrome: clinical features, diagnosis and a practical approach to management AID - 10.1136/practneurol-2017-001762 DP - 2017 Nov 02 TA - Practical Neurology PG - practneurol-2017-001762 4099 - http://pn.bmj.com/content/early/2017/11/02/practneurol-2017-001762.short 4100 - http://pn.bmj.com/content/early/2017/11/02/practneurol-2017-001762.full AB - Restless legs syndrome (RLS) is a chronic neurological disorder that interferes with rest and sleep. It has a wide spectrum of symptom severity, and treatment is started when symptoms become bothersome. Dopamine agonists and calcium channel apha-2-delta antagonists (gabapentin, gabapentin enacarbil and pregabalin) are first-line treatments; calcium channel alpha-2-deltas are preferred over dopamine agonists because they give less augmentation, a condition with symptom onset earlier in the day and intensification of RLS symptoms. Dopamine agonists can still be used as first-line therapy, but the dose should be kept as low as possible. Iron supplements are started when the serum ferritin concentration is ≤75 µg/L, or if the transferrin saturation is less than 20%. For severe or resistant RLS, a combined treatment approach can be effective. Augmentation can be very challenging to treat and lacks evidenced-based guidelines.