A 35-year-old woman presents to her family physician with a chief complaint of unusual sensations in her legs that feel like "worms deep in her muscles."

She first developed the sensations about 3 weeks ago, and they are worse at bedtime and whenever she is resting or sitting down for a long period of time. When she stretches her legs, rubs her legs, or gets up and walks around, she experiences temporary relief lasting a few seconds or minutes but then the sensations recur. The sensations usually last for several hours in the early-to-late evening, and they have frequently prevented her from falling asleep at night. She reports that she feels slightly tired on days when she has been unable to fall asleep the night before; however, she denies significant drowsiness or sleepiness and reports that she is able to be fully alert at work and has not had trouble staying awake while driving. She is worried that her symptoms are due to parasites in her legs that she might have acquired during a trip to Africa several months ago. Her husband has also told her that about twice a month he is awakened because she is kicking him during her sleep, but she has no recollection of these episodes and she reports that once she falls asleep she doesn't wake up at all throughout the night until her alarm awakens her in the morning. She exercises on a treadmill or a stationary bike 3 times a week after work but has not noticed any difference in her symptoms between the days she exercises and those that she doesn't.

The patient's medical and surgical history includes seasonal allergic rhinitis and iron-deficiency anemia. She has no known drug allergies and takes fluticasone propionate for her seasonal allergies. Her family history is significant for hypertension and diabetes mellitus, but there is no family history of a condition similar to the one she is currently describing. She does not smoke and drinks 1 glass of wine with dinner 3-4 times per week. She works as an accountant and lives with her husband and an 8-year-old son. The review of her systems is otherwise unremarkable, except that she reports that her period is 2 days late and she is concerned that she might be pregnant.

The physical examination reveals that her vital signs are within normal limits and her other physical findings are unremarkable except for enlarged nasal turbinates. Of note, her neurologic examination is normal, and examination of her legs reveals no abnormal findings.

1-What is your next diagnostic step?
2-What is the disease/syndrome name?
3-How would you treat her?

Correct Mustafa, you got it right

1- Serum ferritin level and pregnancy test.
The correct next step is to perform a serum ferritin level and pregnancy test, since this patient exhibits classic symptoms of a secondary form of restless legs syndrome (RLS).

This patient's ferritin level was 120 mcg/L, which is within normal limits, and her pregnancy test was negative, so secondary forms of RLS associated with iron deficiency or pregnancy can be excluded.

2- Restless legs syndrome "RLS"

3- The dopamine agonists pramipexole and ropinirole are first-line treatment for patients with RLS and are the only FDA-approved medications for the treatment of RLS in adults. Initiation of therapy with either one of these agents would be appropriate for this patient.

thanks for replying