Restless arm symptoms as an extension of restless leg syndrome.

SIR—It is not widely appreciated, but up to half of all patients with restless leg syndrome can have unwanted movements and sensations in the upper extremities [1]. I give here a brief illustrative case history. An 88-year-old gentleman with restless leg syndrome diagnosed 3 years earlier presented complaining of being unable to sleep at night due to feelings of prickling and pain in both arms, mainly in the forearms. He thought it might be a sign of ‘losing his mind’. The patient had multiple medical problems including iron deficiency anaemia from diverticulosis, chronic obstructive pulmonary disease dependent on night-time oxygen, and coronary artery disease. For his restless leg syndrome, he was taking pramipexole 0.25 mg daily and niferex 150 mg daily (also for correction of the anaemia). I doubled his pramipexole to 0.5 mg and transfused him with 2 units of blood because his haemoglobin had dipped below 10 mg/dl. With these two interventions, the discomfort in his arms completely abated by follow-up in 1 week. Physicians caring for the elderly need to ask about arm symptoms when evaluating patients with restless leg syndrome. Upper extremity discomfort may even be the initial symptom [1]. Management of the upper extremity variant of restless leg syndrome is the same as for the more typical form—dopaminergic agonists, carefully chosen hypnotics like desyrel if the patient has trouble sleeping, analgesics for pain and aggressive correction of any iron deficiency anaemia.