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Restless legs syndrome during pregnancy: an overview

Restless-Legs-Syndrom in der Schwangerschaft: eine Übersicht

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Abstract

Restless legs syndrome (RLS) is a frequent neurological disorder that is twice as common in women as in men. RLS affects up to 20% of pregnant women, particularly in the third trimester. In most cases, symptoms disappear after delivery, but the risk of developing RLS after pregnancy and during future pregnancies is increased in these women. The diagnosis of RLS during pregnancy is made using the essential criteria of the International Restless Legs Study Group (IRLSSG). The differential diagnosis and exclusion of mimics such as venous stasis, legs cramps, and leg edema are important. Aggravating factors (anemia, sleep apnea, medications that aggravate RLS) should be eliminated before initiation of a specific treatment. Nonpharmacological treatments such as moderate exercise and yoga should be considered first. Pharmacological treatment including iron supplementation, levodopa/carbidopa, clonazepam, and oxycodone can be applied during the course after critical assessment of the indication.

Zusammenfassung

Das Restless-Legs-Syndrom (RLS) ist eine häufige neurologische Erkrankung, die bei Frauen doppelt so häufig wie bei Männern auftritt. Auch in der Schwangerschaft sind bis zu 20 % der Frauen davon betroffen, die Häufigkeit steigt hierbei bis zum dritten Trimenon an. In den meisten Fällen verschwinden die Symptome nach der Geburt wieder, das Risiko, auch nach der Geburt weiterhin an einem RLS zu leiden oder bei der nächsten Schwangerschaft erneut RLS-Symptome zu entwickeln, bleibt bei diesen Frauen allerdings erhöht. Die RLS-Diagnose wird unter Anwendung der essenziellen Kriterien der International Restless Legs Study Group (IRLSSG) gestellt. Der ausführlichen Differenzialdiagnostik und dem Ausschluss so genannter Imitatoren („mimics“), wie einer venösen Stauung, Muskelkrämpfen der Beine oder Beinödemen, kommt hierbei eine besondere Bedeutung zu. Aggravierende Faktoren wie Anämie, Schlafapnoe oder Medikamente, die ein RLS verstärken können, sollten vor der Initiierung einer Therapie erkannt und – wenn möglich – ausgeschaltet werden. Eine nichtpharmakologische Behandlung wie moderates Ausdauertraining oder Yoga sollte zuerst erwogen werden. Als pharmakologische Behandlungen kommen eine Eisensubstitution, die Gabe von L‑Dopa/Carbidopa, Clonazepam oder Oxycodon/Naloxon nach Ausschöpfung nichtpharmakologischer Ansätze und strenger Indikationsstellung in Betracht.

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Authors and Affiliations

  1. Zentrum für Parkinson-Syndrome und Bewegungsstörungen, Paracelsus-Elena Klinik, Klinikstr. 16, 34128, Kassel, Germany

    Maria-Lucia Muntean & Claudia Trenkwalder

  2. Klinik für Neurochirurgie, Universitätsmedizin Göttingen, Robert Koch Str. 40, 37075, Göttingen, Germany

    Claudia Trenkwalder

  3. Klinik für Neurologie, Universitätsmedizin Göttingen, Robert Koch Str. 40, 37075, Göttingen, Germany

    Michael Bartl

Authors
  1. Maria-Lucia Muntean
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Correspondence to Maria-Lucia Muntean.

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Conflict of interest

C. Trenkwalder is in the Advisory Boards of Roche and Abbvie and has received honorary for lectures from UCB. M.‑L. Muntean, and M. Bartl declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors.

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Muntean, ML., Trenkwalder, C. & Bartl, M. Restless legs syndrome during pregnancy: an overview. Somnologie 25, 288–293 (2021). https://doi.org/10.1007/s11818-021-00337-1

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