When should I consider referring a patient with Restless Legs Syndrome to a specialist for further evaluation?

Consider referring a patient with Restless Legs Syndrome (RLS) to a specialist (sleep specialist or neurologist) if:

• There is doubt about the diagnosis of RLS.
• Treatment is unsuccessful, defined as an insufficient initial response despite adequate dose and duration, loss of response despite dose increase, intolerable adverse effects, reaching maximum recommended dosage with loss of efficacy, or symptoms suggestive of augmentation.
• Specialist advice or referral is needed for initiating dopamine agonist treatment or for support when tapering and switching therapies.

Referral is appropriate to ensure accurate diagnosis and management, especially when first-line treatments fail or complications arise.

Additionally, address any underlying causes such as iron deficiency before referral, and consider self-help and initial drug treatments in primary care.

This approach aligns with expert consensus and UK clinical practice guidelines.

References: NICE CKS