Private restless legs syndrome clinic in London, same-day specialist medicine.

The five features

All five are needed for the diagnosis:

• an urge to move the legs, usually with uncomfortable sensations — crawling, fizzing, aching, an electric feeling
• beginning or worsening during rest or inactivity
• partially or completely relieved by movement, at least while moving
• worse in the evening or at night
• not better explained by another condition

Things that make it worse

• Medicines — sedating antihistamines (including in cold and sleep remedies), most antidepressants, antipsychotics, metoclopramide and prochlorperazine. Reviewing these is often the single most useful step.
• Caffeine, alcohol and nicotine, particularly in the evening.
• Sleep deprivation, which worsens symptoms and is worsened by them.
• Pregnancy, particularly the third trimester — usually resolving after delivery.
• Kidney disease and dialysis.
• Some people find intense exercise late in the evening aggravates it.

Self-management

Medication

• Correct the iron first. Oral iron, or intravenous iron where absorption is poor or the need is urgent.
• Alpha-2-delta ligands — gabapentin or pregabalin — are now generally preferred as first-line drug treatment.
• Dopamine agonists are effective but are used more cautiously than they once were, because of augmentation: symptoms starting earlier in the day, spreading to the arms and becoming more intense over months or years. It is caused by the treatment, it is common with long-term use, and it is difficult to reverse. If your symptoms have worsened on a dopamine agonist, that is a reason to be reviewed, not to increase the dose.
• Impulse control problems — gambling, compulsive shopping or eating — are a recognised and under-reported effect of dopamine agonists. Tell us if anything like this has changed.