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Restless legs syndrome (RLS) and the often associated periodic limb movement disorder in sleep (PLMD) frequently occur in the general population as a primary disorder. In addition to organic disease, secondary forms are caused by psychotropic medication. Several antidepressants, antipsychotics, lithium, and opioid withdrawal have been shown to induce or exacerbate RLS and PLMD, while several antiepileptics used as mood stabilizers and some benzodiazepines demonstrate therapeutic potential for treating RLS/PLMD. Systematic or controlled studies for evaluating these side effects still do not exist. Among the antidepressants at higher risk of inducing this disorder are selective serotonin reuptake inhibitors, venlafaxine, and some tetracyclic antidepressants. Under medication with some tricyclic substances, periodic limb movements were observed more often. For some antidepressants with differing transmitter profiles such as bupropion RLS/PLMD ameliorating effects or at least neutral effects (Trazodon, Nortriptylin) have been described in small studies. In case of continued of or newly occurring insomnia a thorough history should be taken to identify a possible RLS/PLMD as an intolerable side effect of treatment. A change in medications should be considered if clinically feasible. In case of RLS/PLMD occurring in psychotic patients switching the antipsychotic and additionally using a second line medication such as antiepileptics or a benzodiazepine should be considered.

Background and Objectives: Many patients on dialysis have a restless legs syndrome (RLS). Drugs may cause as well as relieve RLS symptoms. It was the aim of this study to examine the effect of the prescribed drugs on the occurrence of RLS in patients on hemodialysis., Patients and Methods: The cohort consisted of 82 out-patients undergoing dialysis (38 men and 44 women; mean age 65,4 [21 - 93] years) during 2002 and 2003. In addition to blood analysis the criteria of RLS were analysed, using the Johns Hopkins restless legs severity scale (JHRLSS) and the diagnostic criteria of the International Restless Legs Syndrome Study Group (IRLSSG). Periodic limb movements in sleep (PLMS) were measures by a special device., Results: 25 of 82 patients had RLS symptoms, using the JHRLSS, in 23 this was confirmed by the IRLSSG criteria. PLMS occurred in 46 of 81 patients. The occurrence of RLS correlated significantly with the intake of drugs that could potentially increase RLS severity. But there was no strong correlation with drugs that could potentially decrease it. There was no association between medication and the occurrence of PLMS. There was also no correlation with laboratory parameters., Conclusion: In patients on dialysis those drugs which can potentially worsen RLS should be prescribed with care.