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A 50-year-old man presents to the office complaining of a œcreepy-crawly sensation in his legs, mostly at night when he is about to go to sleep. He says the sensation is temporarily relieved by moving his legs or getting up to walk. His symptoms have been worsening over the past few months, and he now has difficulty sleeping. He has never been told that he was a loud snorer nor does his wife report any periods of apnea when he is asleep. What is the next best step in management?
A. Refer for a sleep study
B. Electromyography with nerve conduction studies on his legs
C. Measure serum ferritin level and iron saturation
D. Measure thyroid-stimulating hormone level
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maybe b too
i m hesistating
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C.
The patient has restless legs syndrome (RLS), which is characterized by a distressing urge to move the legs, accompanied by an uncomfortable deep-seated sensation in the legs that is brought on by rest, relieved with movement or walking, and is usually worse at night or in the evening. Since RLS may be a symptom of iron-deficiency anemia, iron status (serum ferritin and iron saturation) should be assessed. No other laboratory tests are routinely indicated. Diagnosis is based on the history. Treatment depends on the frequency of symptoms and the presence or absence of pain. Preferred first-line treatments are dopamine agonists, such as pergolide mesylate (Permax), pramipexole (Mirapex), and ropinirole HCl (Requip). Other options are levoÂdopa (Larodopa), gabapentin (Neurontin), carbamazepine (Carbatrol, Epitol, Tegretol), or the opiates oxycodone HCl (OxyContin, Roxicodone) and propoxyphene (Darvon).
Source
Earley CJ. Clinical practice. Restless legs syndrome. N Engl J Med. 2003;348:2103-2109.
