Keywords
restless legs syndrome - case report - iron deficiency
Introduction: Restless legs syndrome (RLS), also known as Willis-Ekbon disease, is a movement disorder
associated with sleep, characterized by an urgency to move the legs and unpleasant
sensations when resting. In Brazil, the prevalence is 6.4%, increasing with age and
predominating in females. It may be associated with iron deficiency, pregnancy, inflammatory
processes and chronic kidney disease.
Objective: The objective of this case report is to provide descriptive information about the
presentation, management and evolution of three cases of RLS in a Brazilian Sleep
Medicine service.
Methods: Descriptive report of three clinical cases of patients diagnosed with RLS treated
at a Sleep Medicine service in the state of São Paulo.
Results: CASE 1: Patient I.C.S., female, 60 years old, with fibromyalgia and spondyloarthritis.
She complains of snoring and sleep apnea, as well as leg pain that worsens at rest
and with contact between her legs, making it difficult to sleep. Her BMI is 32 kg/m2 and her waist circumference is 104 cm. Her ferritin is 81 ng/dL. She received guidance
on sleep hygiene and parenteral iron replacement (1000 mg) for 3 weeks. She is awaiting
polysomnography and medical reevaluation. CASE 2: Patient M.I.I.S.C., female, 55 years
old, with diabetes, hypertension, obesity and moderate OSA, who has been using CPAP
for 5 years. She reports an uncontrollable urge to move her legs for 10 years. Her
BMI is 47 kg/m2, and she doesn’t have iron deficiency. She received behavioral measures and gabapentin
600 mg/day. She reports partial improvement of symptoms and restful sleep. CASE 3:
Patient A.M.A., a 57-year-old female, with an ischemic stroke in 2006 and severe OSA.
She reported an uncontrollable urge to move her legs since the stroke. She was initially
treated with pramipexole, which proved ineffective. She presented iron deficiency
(ferritin 42.7 ng/dL) and a corrected gastric ulcer. Gabapentin 800 mg/day was introduced
with significant improvement, but she still had non-restorative sleep because of inadequate
treatment of OSA.
Conclusion: Despite the lack of definitive therapy for RLS, first-line treatment includes alpha-2-delta
ligands, such as gabapentin and pregabalin. Iron supplementation has shown improvement
in the severity of RLS when compared to placebo. However, the management of the disease
must be individualized, and it is a great challenge, requiring the expansion of the
bibliographic substrate on the subject.
