[The restless leg syndrome (restless legs)].
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An algorithm for the management of restless legs syndrome.
Restless legs syndrome (RLS) is a common disorder with a prevalence of 5% to 15%. Primary care physicians must become familiar with management of this disorder. This algorithm for the management of RLS was written by members of the Medical Advisory Board of the Restless Legs Syndrome Foundation and is based on scientific evidence and expert opinion. Restless legs syndrome is divided into intermittent, daily, and refractory types. Nonpharmacological approaches, including mental alerting activities, avoiding substances or medications that may exacerbate RLS, and addressing the possibility of iron deficiency, are discussed. The role of carbidopa/levodopa, dopamine agonists, opioids, benzodiazepines, and anticonvulsants for the different types of the disorder is delineated.
Algorithms↗
Overview of restless legs syndrome.
Restless legs syndrome is a common movement and sleep disorder, which can significantly reduce quality of life. Restless legs syndrome is probably related to dopamine imbalance and may have a primary or secondary aetiology. It is greatly underdiagnosed, yet potentially treatable.
Anti-Anxiety Agents↗
Bilateral thalamic gray matter changes in patients with restless legs syndrome.
Restless legs syndrome (RLS) is a common neurological disorder of a primary unpleasant sensation with an urge to move the legs occurring at rest. The etiology of idiopathic RLS is unknown and structural cerebral abnormalities have so far not been detected. We studied 51 right-handed patients with an idiopathic restless legs syndrome in two independent samples (Regensburg RLS-group: n = 28, Munich RLS-group: n = 23) and compared them to 51 sex- and age-matched healthy volunteers. High-resolution T1-weighted magnetic resonance imaging (MRI) of each subject was obtained and analyzed using voxel-based morphometry (VBM) to detect regionally specific differences in gray matter between patients and controls. Conjunction analysis was used to combine results from both centers. In patients with idiopathic RLS, both study centers observed independently a bilateral gray matter increase in the pulvinar. In the conjunction analysis including all patients and controls from both study centers, a significant gray matter increase in the pulvinar bilaterally (right: x = 16, y = -21, z = 12, Z = 4.57; left: x = -16, y = -24, z = 12, Z = 4.10) was present. This is the first demonstration of structural changes in the brain of patients with idiopathic RLS. These changes in thalamic structures are either involved in the pathogenesis of RLS or may reflect a consequence of chronic increase in afferent input of behaviorally relevant information.
Adult↗
Restless legs syndrome.
Restless legs syndrome is a very common and still under-diagnosed neurologic condition that can cause severe morbidity. The pathology centers around central nervous system iron homeostatic dysregulation with subsequent alterations in dopaminergic functioning. Genetic studies will hopefully soon identify specific abnormalities. Treatment of restless legs syndrome with dopaminergic medications is highly effective, although augmentation may occur eventually and require dosing flexibility.
Brain↗
Possible efficacy of alprazolam in restless leg syndrome.
Restless leg syndrome is a frequently misdiagnosed and often misunderstood condition contributing to a complaint of insomnia in geriatric patients. Various pharmacologic agents used to treat the condition are often ineffective and have not consistently provided relief for the majority of patients with this condition. Our recent experience with Xanax suggests its possible effectiveness in controlling symptoms of the restless leg syndrome. Further, more controlled double blind studies--especially comparing other benzodiazepines at appropriate dosages--are called for.
Aged↗
Restless legs syndrome.
Restless legs syndrome is a common condition characterized by unpleasant limb sensations that are precipitated by rest and relieved by activity. Symptoms are worse during the evening and may result in insomnia. Most cases are idiopathic, although the condition is sometimes familial and may be associated with a range of medical illnesses, including chronic renal failure and iron deficiency anemia. Restless legs syndrome is responsive to several medications, including levodopa, dopamine agonists, benzodiazepines, opioids, and some anticonvulsants. A practical approach to management involves a stepwise plan, commencing with intermittent therapy with less potent agents for mild cases and progressing to medications with greater potency but a higher potential for side effects.
Diagnosis, Differential↗
Arm restlessness in patients with restless legs syndrome.
Restless legs syndrome (RLS) is a neurologic disorder characterized principally by leg paresthesia and motor restlessness. Several clinical reports indicated that many patients with RLS also have arm paresthesia and restlessness. In the present study, the incidence of arm restlessness was assessed by questionnaire in 230 patients diagnosed with idiopathic RLS. Arm restlessness was reported by 48.7% of the patients. Patients with and without arm restlessness were compared with regard to clinical and polysomnographic parameters. No between-group differences were found for age at onset of RLS, duration of illness, gender, presence of a family history of RLS, sleep latency, total sleep time, sleep efficiency, and periodic leg movements index during sleep. However, arm restlessness was more frequent in patients with severe RLS. Interestingly, the polysomnographic data failed to differentiate the patients with arm restlessness from those without arm restlessness, except for sleep efficiency, which tended to be lower in patients with arm restlessness. In conclusion, the results of the present study are in agreement with clinical observations that a large proportion of patients with RLS have arm restlessness.
Adult↗
Evaluation of periodic leg movements and associated transcranial magnetic stimulation parameters in restless legs syndrome.
Restless legs syndrome (RLS), a sensorimotor disorder characterized by unpleasant sensations commonly localized in the legs, is frequently associated with periodic limb movements (PLMs) during sleep. We investigated the role of transcranial magnetic stimulation (TMS) and cortical silent period (CSP) duration as diagnostic and monitoring tools in 20 patients with primary RLS before and after 1 month of treatment and also studied 15 normal age- and gender-matched subjects. Polysomnographic assessment was undertaken and the PLM index determined in 17 of the 20 patients. We also studied the correlation between sleep efficiency index and CSP duration because of the increasing severity of the sleep disturbance and PLMs in patients with RLS. Our results demonstrate that the duration of the CSP was reduced in patients with RLS, and that dopaminergic treatment normalized this duration. There was no correlation between the PLM index and CSP duration. It may be speculated that PLMs and the CSP are due to different inhibitory mechanisms and they may be used separately as diagnostic and monitoring tools in patients with primary RLS.
Adult↗
Ropinirole for restless legs syndrome.
Restless legs syndrome (RLS) is a common and underdiagnosed condition that results in a desire to move the extremities often associated with paresthesia/dysesthesia, motor restlessness, worsening of symptoms at rest with at least temporary relief by activity, and worsening of symptoms in the evening or night. We tested the new dopamine agonist ropinirole in 16 patients with RLS in an open-label trial. The mean daily dose was 2.8+/-2.3 mg (range, 0.5-12.0). The 13 patients who completed the study reported a 58.7% improvement (p = 1.08 x 10(-8)) as judged by the abbreviated International Restless Legs Study Group questionnaire. Three patients discontinued the medication secondary to adverse events (rash and nervousness) and other extenuating circumstances. These encouraging preliminary results justify larger and more controlled trials of ropinirole in patients with RLS.
Adult↗
Clinical presentation, diagnosis, and quality of life issues in restless legs syndrome.
Restless legs syndrome (RLS) is a generally underdiagnosed and undertreated condition. It is a common cause of sleep disturbance that can severely disrupt normal life functioning. However, because of the failure to recognize RLS as a distinct disorder, clinicians have minimized the significance of the morbidity experienced by some patients. A positive family history is present in >50% of patients with RLS. Indeed, a person with RLS is 3 to 6 times more likely to have a positive family history of RLS than is an individual who does not have the disease. The differential diagnosis of RLS includes both movement and sleep disorders. Establishing an accurate diagnosis is crucial because effective treatment is available. In 2002, RLS experts revised diagnostic criteria and established 4 essential criteria for the diagnosis. Assessing the most bothersome symptoms and quantifying the severity of RLS are important because not all patients require medical therapy. Moreover, therapy may vary according to which symptom represents the major problem.
Depression↗
Current treatment options for restless legs syndrome.
Restless legs syndrome (RLS) is a common but often underdiagnosed neurological disorder characterised by an imperative desire to move the extremities associated with paraesthesias, motor restlessness, worsening of symptoms at rest in the evening or at night and, as a consequence, sleep disturbances particulary. Additionally, most patients with RLS have periodic limb movements during sleep and relaxed wakefulness. The aetiology of RLS remains unknown. Treatment of RLS is generally symptomatic, a causal therapy is possible only in the secondary forms. Dopaminergic agents including levodopa and dopamine agonists such as pergolide, pramipexole, cabergoline and ropinirole are regarded as the treatment of choice for idiopathic RLS, however, the development of augmentation of symptoms, especially under levodopa therapy, may be a major problem. Except in special circumstances, opioids and anticonvulsants such as gabapentin or benzodiazepines, are regarded as second-line treatment. In secondary RLS, the underlying illness should first be treated, although dopaminergic drugs may also be helpful.
Anticonvulsants↗
Ropinirole in restless leg syndrome.
Restless leg syndrome (RLS) is a disease of unknown etiology, characterized by paresthesias and an irresistible desire to move the legs. Dopaminergic mechanisms have been implicated in the pathogenesis of this disorder. Dopamine agonists have been used to treat RLS. This paper describes the use of ropinirole, a non-ergoline dopamine agonist, in the treatment of RLS. Polysomnograms after treatment, as well as patient assessment of their symptoms, showed clinical improvement.
Dopamine Agonists↗
Restless legs syndrome.
Restless legs syndrome is a trivial complaint, but it may become a nightmare for some patients. Clinicians may either misdiagnose or dismiss it whilst proper scrutiny and treatment could be helpful.
Diagnosis, Differential↗
Mianserin-induced restless legs syndrome.
Restless legs syndrome was observed in three patients receiving mianserin. The symptoms resolved when the treatment was discontinued or reduced.
Adult↗
Restless legs syndrome.
Restless legs syndrome (RLS) is clinically defined as an urge to move the legs with or without paresthesia, worsening of symptoms with rest and transient improvement with activity, and worsening of symptoms in the evening and night. This is often genetic but may also occur in the setting of iron deficiency, uremia, pregnancy, neuropathy, and possibly other conditions. The pathology is probably related to central nervous system iron dysregulation. Effective treatments include dopaminergics and narcotics. Recent advances in our understanding of RLS clinical presentation, epidemiology, etiology, and treatment will be discussed.
Adult↗
Genetic aspects of restless legs syndrome.
Restless legs syndrome (RLS), also known as Ekbom syndrome, is a common movement disorder with sensorimotor symptoms occurring during sleep and quiet wakefulness. The underlying cause for RLS is unknown but genetic influences play a strong part in the pathogenesis of RLS, particularly when the condition starts at a young age. This review explores the genetic basis of RLS and related phenotypic variations. Recently, three loci showing vulnerability to RLS have been described in French-Canadian and Italian families in chromosomes 12q, 14q and 9q, emphasising on an autosomal dominant mode of inheritance. These have been labelled RLS1, RLS2 and RLS3, respectively. However, specific causative mutations remain elusive and no linkage analysis has been identified so far in the candidate genes investigated in RLS.
Chromosome Mapping↗
Restless legs syndrome.
Restless legs syndrome (RLS), first described in 1672 and given its name in 1945, is one of the most common sleep and movement disorders. Modern population-based studies demonstrate a prevalence between 5% and 15% in adult white populations. According to the diagnostic criteria, RLS is defined as an irresistable desire to move limbs, usually associated with paresthesias/dysesthesias and motor restlessness. The symptoms start or worsen at rest and improve with activity. Additionally, the symptoms worsen in the evenings and/or nights, which often results in disturbance of sleep with daytime tiredness. There is often a family history of RLS. Initially, the disease course is usually fluctuating and later may become continuous or chronic-progressive. The diagnosis is based on the patient history and is supported by a normal neurological examination. RLS is confirmed by the finding of periodic limb movements (PLM) in polysomnographic investigations and by a response to dopaminergic medication. A large number of studies have confirmed the effect of levodopa (L-dopa) in the treatment of RLS. A majority of the patients treated over a longer period of time with L-dopa, however, develop problems with an effect called augmentation, where the RLS symptoms begin appearing earlier during the day and involve new parts of the body with increasing severity. A large number of studies have now confirmed that dopamine agonists can also be effective in RLS therapy, and that this treatment seems to involve less risk for augmentation. This paper provides a general review of RLS with a focus on current treatment options.
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