Restless legs syndrome is a common but not well-recognized central nervous system disorder that leads to insomnia and daytime distress.A MEDLINE search of the recent English language literature was undertaken with review of appropriate articles and references.A growing body of work has added to an understanding of the epidemiology, diagnostic criteria, appropriate evaluation, and effective management of restless legs syndrome.Restless legs syndrome occurs in about 6% of the adult population, more so in the elderly. Affected patients experience uncomfortable sensations in the legs with inactivity, more pronounced late in the day and at bedtime, which are temporarily relieved by moving the limbs. Affected patients can suffer from insomnia, disrupted sleep, daytime fatigue, and difficulty with sedentary activities. Most cases are idiopathic, although secondary causes, such as iron deficiency, should be excluded. Dopaminergic agents are highly effective in treating restless legs syndrome, but side effects can be problematic. Alternative medications include benzodiazepines, opioids, gabapentin, and clonidine.