Restless legs syndrome

The restless legs syndrome (RLS) is a common neurological disorder to take possession of increasing attention. RLS is characterized by an urge to move the legs, usually accompanied by uncomfortable or unpleasant sensations, that occurs or worsen at rest and is relieved by activity. The symptoms of RLS have a major impact on nocturnal sleep and daytime functions. The clinical diagnostic criteria were established and published in 2003 by International Restless Legs Syndrome Study Group (IRLSSG). All four essential criteria must be met for a positive diagnosis. However, RLS encompassed an idiopathic form of genetic or unknown origin and secondary forms associated with many causes. Special awareness should be kept for differential diagnosis such as uremia, iron deficiency anemia, polyneuropathy, rheumatoid arthritis, and other neurodegenerative diseases. Polysomnography, actinography, L-dopa loading test, and suggested immobilization test (SIT) are helpful tools to reduce the diagnostic puzzle of false positive and false negative. Pathophysiological concepts of RLS are essentially based on the neuroimaging and neurophysiological data to assume a dysfunction of the dopaminergic system, possibly on the All neuron group localized in the hypothalamus. These neurons modulate spinal excitability and alter the sensory processing predominantly of leg afferents. Treatment may be closely linked to the dopaminergic system and iron metabolism. Dopaminergic stimulation with levodopa or dopamine agonists is the first choice in idiopathic restless legs syndrome, but the long-term adverse effect of augmentation should be carefully monitored.     

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.     

Restless legs syndrome

PURPOSE OF REVIEW: In the review period since February 2004 a number of papers have been published that make significant contributions to the current understanding of the epidemiology, clinical assessment, pathophysiology and treatment of restless legs syndrome. Those with the most significant findings were selected and will be reviewed. RECENT FINDINGS: Several epidemiological studies about restless legs syndrome have become available in the review period. A new susceptibility locus for restless legs syndrome has been reported. Neuropathological studies have provided profound insights into the key role of iron regulation in the pathophysiology of restless legs syndrome. Several randomized, double-blind, placebo-controlled studies have demonstrated that dopamine agonists are efficacious in the treatment of restless legs syndrome. A few pilot treatment studies with intravenous iron have been performed. SUMMARY: In this paper, recent advances in the field of restless legs syndrome are reviewed. Special emphasis is placed on pathophysiology and treatment. Restless legs syndrome is still an underdiagnosed disorder. The evidence basis for its treatment has been considerably increased in the review period.     

Restless legs syndrome

Restless legs syndrome is a very common and still underdiagnosed 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.     

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.     

Restless legs syndrome and paroxetine

Restless legs syndrome is a frequent dyssomnia with well-known clinical features but uncertain origin and treatment. This paper describes a case of restless legs syndrome worsened by paroxetine. A possible pathogenic hypothesis related to the attributed neurochemical properties of the drug is proposed.     

Restless legs syndrome and polyneuropathy.

Restless legs syndrome (RLS), diagnosed according to the International RLS Study Group criteria, was investigated in 97 consecutive patients with polyneuropathy and found in 29 patients. RLS patients were more often women (22 of 29 vs. 33 of 68; P = 0.015), mainly with sensory neuropathy of small fiber type (15 of 29 vs. 16 of 68; P = 0.009). Changes of sensory action potentials were significantly less severe in RLS patients. In the RLS group, acquired neuropathies, and in particular dysimmune neuropathies, were significantly more frequent (27/29 vs. 46/68; P = 0.009). Thus, RLS is frequent in acquired polyneuropathy of sensory type and mild entity, mainly in women.