Restless legs syndrome (RLS) is a common sensory motor neurological disorder 
that is characterised by an irresistible urge to move the legs that 
significantly affects the quality of life of the patient. Prevalence in the 
general population is 5-25% and it is twice as prevalent in women as in men. RLS 
is the most common movement disorder in pregnancy with a fourfold increased risk 
of developing this disorder later in life. The pathophysiology of RLS is centred 
on dopaminergic dysfunction, reduced central nervous system iron, genetic 
linkages, or alteration in neurotransmitters such as hypocretins, endorphins 
levels and immune dysfunction and inflammatory mechanisms. With the emergence of 
new evidence, there are changes to the previous treatment recommendations for 
RLS. There is sufficient evidence to conclude that dopamine agonists such as 
rotigotine transdermal patch, pramipexole, ropinirole, gabapentin enacarbil, 
pregabalin and gabapentin are effective in the short-term treatment of RLS and 
rotigotine, followed by gabapentin enacarbil, ropinirole, pramipexole and 
gabapentin for long-term treatment. Based on expert consensus, the 
recommendation for daily RLS is dopamine agonists or gabapentin or low-potency 
opioids. Levodopa is less preferred for treating daily RLS due to its high risk 
of augmentation. For intermittent RLS, it is levodopa or dopamine agonists or 
low-potency opioids or benzodiazepines. For refractory RLS, the choice is to 
change to gabapentin or a different dopamine agonist, addition of a second agent 
like gabapentin or benzodiazepine to the existing drug or changing to a 
high-potency opioid or tramadol. Medications with safety record in pregnancy 
include opioids and antiepileptics such as carbamazepine and gabapentin. There 
are concerns that patients with RLS are at risk for metabolic deregulation, 
autonomic dysfunction and cardiovascular morbidity. However, a recent study 
concluded that RLS is not associated with increased risk of cardiovascular 
complications.