Severe restless legs syndrome presenting as intractable insomnia

A 62-year-old man consulted the sleep clinic. He had a 20-year history of severe insomnia that was considered of psychiatric origin, although the symptoms were not alleviated by benzodiazepines (clonazepam, flunitrazepam, loflazepam), antidepressants (amitriptyline, mianserin), phenothiazine (alimemazin), amantadine, biperiden, or magnesium salts. He had frequent and long-lasting nocturnal arousals, and slept less than 4 hours a night. He had a strong feeling of discomfort (but no pain) in his legs during the night, which he was …