What Is Restless Genital Syndrome?

Bret S. Stetka, MD; Camila Henriques De Aquino, MD


March 03, 2015

What Causes RGS and How Is It Treated?

Medscape: What is known about the underlying pathophysiology of RGS and, relatedly, RLS?

Dr Henriques De Aquino: Our understanding of the pathophysiology of RLS and its variants is far from complete. To date, several mechanisms have been proposed: reduced iron levels in the central nervous system; and abnormalities in circadian rhythm and in various neurotransmitters, such as dopamine, glutamate, and opioids. In 40%-60%, a family history of RLS can be found, so genetics may play an important role in these disorders. So far, six genes have been identified as risk factors. Acquired conditions, including renal failure, iron deficiency, neuropathy, myelopathy, pregnancy, multiple sclerosis, and Parkinson disease, have also been associated with RLS; the exact relationship is still unclear. The extent to which these observations also apply to the RGS variant is not known.

Medscape: What is the relationship of RGS and RLS to Parkinson disease?

Dr Henriques De Aquino: Some studies have suggested that the prevalence of RLS is higher in patients with Parkinson's than in the overall population. The prevalence of RLS in Parkinson's was found to range from 11% to 25%. With respect to RGS, we don't know the prevalence in Parkinson's; however, in the past there were some case reports of genital pain in patients with Parkinson disease that was attributed to "wearing-off" of antiparkinsonian drugs and responded to dopaminergic therapy, such as apomorphine. Also, genital pain has been described as a tardive syndrome associated with drug-induced (ie, neuroleptic) parkinsonism.

Medscape: How should RGS be treated?

Dr Henriques De Aquino: Considering that RGS is probably within the spectrum of RLS, the same drugs can be applied in both conditions. In our experience, dopamine agonists (eg, pramipexole, ropinirole, rotigotine) can be very effective. This is one of the first-line drug classes for RLS, along with pregabalin, gabapentin, and levodopa (although levodopa more often results in a complication known as augmentation, with symptoms occurring earlier in the day and spreading to other body parts). Opioids and clonazepam have also been successfully used. Finally, iron supplementation is recommended in selected patients, mainly in those with low ferritin levels.


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