RESTLESS LEGS SYNDROME-SCIENTIFIC

Definition

A disorder characterized by an almost irresistible urge to move, usually associated with disagreeable leg sensations , worse during inactivity, and often interfering with sleep.

Primary Features

(IRLSSG Criteria)

•Desire to move the limbs, usually associated with paresthesias/dysesthesias

•Motor restlessness

•Symptoms worse at rest, partially relieved by activity

•Symptoms worse in the evening or at night

RLS vsPLMS (periodic limb movements)

•RLS is a symptom

•RLS is diagnosed in the physician’s office

•80% of people who have RLS will have PLM’s

•PLM’sare an electromyographicfinding

•PLM’sare diagnosed in the sleep laboratory

•30% of individuals who have PLM’shave RLS symptoms

Primary RLS

•No identifiable predisposing factor

•Tends to occur in families

•May be genetic

Secondary RLS

•Iron-deficiency anemia

•Uremia (20-40% of dialysis patients)

•Pregnancy (up to 27%)

•Neurological lesions

–both spinal cord and peripheral nerve lesions

•Drug-induced

–tricyclics,SSRI’s, lithium, dopamine blockers (e..g.,neuroleptics),xanthines

Assessment-Making the Diagnosis

•History-general medical and sleep histroy

•Physical examination-focusing on the Neurological exam, particular attention to the legs

•Laboratory tests-(see below)

Laboratory Evaluation of RLS

•Polysomnography is not indicated in evaluation of RLS!

•Serum ferritin

•Screen for uremia

•Screening for diabetes

•Other tests for potential secondary causes if suspected

Nonpharmacologic Treatment

•Listen, support, and validate

•Reconsider medications known to exacerbate RLS (Lithium,SSRI’s,tricyclics, dopamine antagonists)

•Not helpful:sclerotherapy, electrical stimulation

•Possibly beneficial in some patients: hot baths, delayed sleep time/rise time, exercise, avoid alcohol and nicotine

Pharmacologic Treatment

•Dopaminergic medications – very effective and safe; ReQuip, Mirapex, Sinemet (L-Dopa/carbidopa)

•Benzodiazepines – Klonepin is standard, others (eg, diazepam, lorazepam) can be effective

•Opioids- careful use for refractory and severs cases, very effective

•Anticonvulsants- some benefit (eg Tegretol, Neurontin, Lyrica)

•Others

Conclusions

•RLS is common, treatable, and underdiagnosed

•The pathophysiology of RLS is unknown

•RLS can be both secondary and idiopathic

•The diagnosis is made by history

•Treatment is mainly pharmacologic