Cardiovascular risk factors in restless legs syndrome

We conducted a population‐based cross‐sectional study to assess prevalence of cardiovascular risk factors in subjects with and without restless legs syndrome (RLS). Adults attending their annual checkup completed the International RLS Study Group questionnaire and underwent an interview by a neurologist. Data from the annual checkup were compared between subjects with and without RLS. The prevalence of RLS was 6.7% (95% CI 5.45–7.95) among 1,537 responders. RLS subjects' blood tests showed significantly higher fasting blood glucose level (P = 0.029), higher prevalence of hypercholesterolemia (P = 0.029) and reduced renal function (P = 0.013), and increased prevalence of low hematocrit (P = 0.008). RLS subjects weighed more (P = 0.029), had a higher BMI (P = 0.033), larger hip circumference (P = 0.033), and were less fit (P = 0.010). To control for interactions among statistical predictors, we also employed multivariate logistic regression models adjusted for age, gender, smoking, BMI, hemoglobin, glucose, HDL/LDL cholesterol, triglycerides, and creatinine. We found that female gender (OR 2.16; 95% CI 1.11–4.17), smoking (OR 1.82; 95% CI, 1.10–3.00), and HDL/LDL cholesterol (OR 0.18; 95% CI 0.034–0.90) were significantly associated with RLS compared with subjects without RLS. RLS was associated with cardiovascular risk factors. © 2009 Movement Disorder Society     

Prevalence of restless legs syndrome in blood donors

Iron deficiency anemia has been linked to restless legs syndrome (RLS) and regular blood donation may lead to iron deficiency. It has been reported that blood donations may be associated with RLS. A recent study from Sweden found that 25% of the women donors were affected by RLS. However, this type of study has not been replicated in the United States. We conducted a study in our blood donation unit between September and October 2008. To identify those with RLS, we used the RLS diagnostic index questionnaire by Benes et al. The proportion of blood donors with RLS was estimated and the number of blood donations and hemoglobin levels were compared according to RLS status. One hundred and fifty one patients were interviewed; 7 patients who donated only platelets were excluded, leaving 144 patients for analysis. There were 13 (9.0%, 95% confidence interval [CI]: 4.9–14.9%) patients with RLS. Of these, 7 (4.9%, 95% CI: 2.0–9.8%) had possible RLS and 6 (4.2%, 95% CI: 1.5–8.9%) had major or clinically relevant RLS. There was no dramatic association between RLS and number of blood donations or hemoglobin level (all P ≥ 0.21). In our sample of blood donors in the United States, the prevalence of major RLS was 4%. We could not demonstrate an association between RLS and the frequency of blood donation or hemoglobin level in our relatively small sample; a larger sample is needed to better identify any associations. © 2010 Movement Disorder Society     

Clinical outcome after acute ischaemic stroke: the influence of restless legs syndrome

Background and purpose: The objective was to evaluate the presence of Restless Legs Syndrome (RLS) in acute stroke, its association with sleep disturbances and clinical outcome during long‐term follow‐up. Methods: This was a longitudinal study (N = 96, 59 men, mean age 64.0 ± 8.9) of cases with acute ischaemic stroke. Patients were asked about the occurrence of RLS symptoms before the cerebrovascular event. RLS was diagnosed using the criteria established by the International RLS Study Group. Stroke outcome was estimated by the Barthel Index and the modified Rankin Scale. Daytime somnolence (Epworth Sleepiness Scale –ESS > 10), poor sleep quality (Pittsburgh Sleep Quality Index –PSQI > 5) and risk of obstructive sleep apnea (OSA) (Berlin questionnaire) were evaluated. Results: Twelve patients (12.5%) met the diagnostic criteria for RLS. All cases had symptoms of RLS before stroke. However, none of the cases had a previous medical diagnosis of RLS or were on use of specific medication. In only one case, a family history of RLS was found. In all patients, RLS symptoms started after the age of 40 (mean age 64 ± 6.7). Daytime sleepiness (44.8%) and poor quality sleep (62.8%) were present. Patients with RLS (12.5%) presented greater neck circumference (P = 0.04) and worse sleep quality (P = 0.007). Risk of OSA (56.2%) was associated with hypertension [OR = 0.12; CI=0.03–0.42]. Stroke outcome was significantly worse at three and 12 months (ancova , P < 0.005) in patients with RLS, remaining after adjustment for diabetes and body mass index (P < 0.05). Conclusions: Patients with acute stroke and RLS have worse clinical outcome, at three and 12 months of follow‐up.     

Association between restless legs syndrome and essential tremor.

After observing that several families with essential tremor (ET) clinically cosegregated with restless legs syndrome (RLS), we prospectively evaluated for the presence of RLS in 100 patients presenting to the Baylor College of Medicine with ET and prospectively examined all patients presenting with RLS for the presence of tremor during the same time frame. Of 100 consecutive ET patients (60 women and 75 with a family history of ET) seen over 19 weeks (current age, 65.2 +/- 16.3 years; age at tremor onset, 37.8 +/- 19.9 years) 33 met all criteria for RLS, of which 25 had never been diagnosed previously. A family history of RLS was reported in 57.6% of these 33 patients and was the only significant predictor of RLS in the ET population. Their International Restless Legs Syndrome Rating Scale score was 16.6 +/- 8.1. Over 19 weeks, we also examined 68 consecutive RLS patients (63.2% women and 54.4% with a family history of RLS) for the presence of tremor. Their current age was 55.8 +/- 14.4 years, and age at RLS onset was 33.7 +/- 19.5 years. Overtly pathological tremor was rare, but trace tremor was very common. Overall, we found a very high rate of undiagnosed RLS in patients presenting for tremor, but unlike other "secondary" forms of RLS, this finding was also associated with a high familial history of RLS, suggesting that they share some genetic similarities.     

The prevalence of restless legs syndrome in Taiwanese adults

Aim: Few studies have examined the prevalence of restless legs syndrome (RLS) in Asian populations, with existing data suggesting substantially lower rates of RLS in Asian populations compared with Caucasians. However, varying definitions of RLS as well as problematic methodology make conclusions about RLS prevalence in Asian populations difficult to interpret. The current study therefore examines the prevalence of RLS in Taiwanese adults. Methods: Subjects were 4011 Taiwanese residents over the age of 15 years. Data was collected using a computer‐assisted telephone interviewing (CATI) system between 25 October 2006 and 6 November 2006. Results: The prevalence of RLS in Taiwanese adults was found to be 1.57%. In addition, individuals with RLS had a higher body mass index (BMI) and incidence of chronic conditions and comorbidities including insomnia, hypertension, cardiovascular disease, respiratory disease, arthritis, backache and mental illness. Women with RLS also had a higher incidence of post‐menopausal syndrome. Conclusion: Findings from the current study suggest that the prevalence of RLS in Taiwan is 1.57% by telephone interview. Individuals with RLS had a higher incidence of chronic insomnia and many other chronic disorders. The association and long‐term consequences of RLS with these chronic disorders warrants further longitudinal observation and study.     

Prevalence of restless legs syndrome in non-institutionalized Japanese elderly

The purpose of the present paper was to evaluate the prevalence of restless legs syndrome (RLS) in a non-institutionalized Japanese elderly population. The subjects consisted of 8900 elderly people >65 years of age belonging to the Seniors Association in Izumo City in November 2000. The present study was conducted in two parts. The phase 1 investigation was a screening by mailed questionnaire and the phase 2 investigation was diagnosis by face-to-face interview. Subjects with possible cases of RLS in phase 1 proceeded to phase 2 and definite cases of RLS were then detected. In phase 1, a total of 3287 subjects completely answering all questionnaire items, were defined as the subjects of the present study. A total of 150 were classified as having 'probable RLS', resulting in a prevalence of 4.6%. These subjects with probable RLS in phase 1 were detected as the subjects of phase 2. By face-to-face interview and various clinical examinations, a total of 35 subjects (nine male, 26 female) were diagnosed as having definite RLS, resulting in a prevalence of 1.06%. Furthermore, seven subjects (two male, five female) with symptomatic RLS were detected and finally 28 subjects (seven male, 21 female) were diagnosed as having idiopathic RLS. It was significantly higher in women for both the total and idiopathic RLS groups (0.60% male vs 1.46% female; 0.46% male vs. 1.18% female, respectively). The prevalence of RLS may be lower in the Japanese elderly than that in Caucasian subjects. These results could enhance understanding of the differences in predisposition between the races.     

Treatment wish of individuals with known and unknown restless legs syndrome in the community

Study objectives   Restless legs syndrome (RLS) is a frequent sleep disorder with a prevalence of 5 % to 15 % in Caucasion populations. Dopaminergic treatment is known to reduce sensorimotor RLS symptoms and is approved for RLS, but not all patients ask for treatment. About 2 % to 3 % of patients presenting to a primary care physician require RLS-specific treatment. The overall treatment preference of RLS sufferers, however, is still unknown. The aim of this study was to assess the prevalence and treatment preference in patients with previously diagnosed and those with yet undiagnosed RLS in a population-based survey in Germany. Design and setting   Cross-sectional health survey with face-to-face interviews with 1312 participants in the Dortmund Health Study. RLS was assessed with standardized, validated questions addressing the four minimal diagnostic criteria for RLS defined by the International Restless Legs Syndrome Study Group. Participants   Participants were aged 25 to 75 years and were randomly selected from the city register. Results   The overall prevalence of individuals with a known doctor diagnosis of RLS was 2.3 %. In addition, 6.5 % fulfilled the four minimal criteria but did not know about this diagnosis yielding an overall prevalence of 8.8 %. Prevalence was higher in women (10.2 %) and German descendents (9.2 %) compared to men (7.1 %) and migrants (6.7 %). Almost 60 % of all RLS cases reported symptoms at least once a week. 33.3 % of cases with a known RLS diagnosis and 14.1 % with an unknown diagnosis had an RLS treatment wish. The latter is determined by knowledge of the diagnosis, daily symptoms, diabetes and sleep disturbance. Conclusion   About every fourth RLS case knows about the diagnosis and overall every fifth RLS case wishes medication to effectively reduce symptoms, corresponding to 1.6 % of the whole study population. Disclosure: The Dortmund Health Study was supported by the German Migraine & Headache Society and by unrestricted grants of equal share from Almirall, Astra Zeneca, Berlin Chemie, Boehringer, Boots Health Care, Glaxo-Smith-Kline, Janssen Cilag, McNeil Pharma, MSD Sharp & Dohme and Pfizer to the University of Muenster. Klaus Berger, MD, MPH, had full access to the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.     

Prevalence of restless legs syndrome and associated factors in the Korean adult population: the Korean Health and Genome Study

The present study was purposed to identify the prevalence of restless legs syndrome (RLS) and its associated factors in the Korean adult population. Among a total of 9939 participants derived from the Korean Health and Genome Study, 12.1% of subjects (men, 8.5%; women, 15.4%) suffered from RLS. Factors independently related with RLS were older age and frequent fatigue in both men and women.     

Clonazepam and vibration in restless legs syndrome

There have been no controlled therapeutic trials in Restless Legs Syndrome (RLS). In 6 patients with RLS, a randomized double-blind cross-over trial vs placebo showed a significant efficacy of clonazepam in improving subjective quality of sleep and leg dysaesthesia. Vibratory stimulation of the leg showed a less pronounced and non-significant effect. Clonazepam is a safe and effective drug for treatment of RLS; however its long-term efficacy needs confirmation.     

Diagnostic indicators of restless legs syndrome in primary care consultations: the DESYR study.

The objective of this study is to determine whether spontaneous complaints about sleep or the legs could be used as potential indicators of restless legs syndrome (RLS) in primary care. A total of 351 general practitioners participated in the study. In a first historical patient identification phase, all patients with spontaneous complaints of sleep or leg symptoms over the previous year were identified. A control group without such complaints was identified. In a second prospective data collection phase, those who consulted a participating physician were interviewed to assess consensus diagnostic criteria of RLS. Severity was assessed with the International Restless Legs Syndrome Study Group severity rating scale. Of 1,405,823 patients consulting during the historical phase, a leg complaint was reported in 61,685 and a sleep complaint in 40,568. A total of 1,432 consulted during the prospective phase. A diagnosis of RLS was assigned to 42.6% of patients with leg complaints, 35.5% of those with sleep complaints, 54.9% of those with both complaints, and 12.9% of those with no complaints. Median RLS severity scores were 18.8 to 20.4. A total of 63.7% of patients were prescribed a venotonic, 43.7% a hypnotic, and 41.5% an anxiolytic. Complaints of sleep or leg symptoms are frequently associated with a diagnosis of RLS, and their presence should alert the physician to the possibility of a differential diagnosis of RLS.     

Sonographic substantia nigra hypoechogenicity in polyneuropathy and restless legs syndrome

Substantia nigra (SN) hypoechogenicity assessed by transcranial B‐mode sonography (TCS) is typical for idiopathic restless legs syndrome (RLS). Here, we investigated whether SN hypoechogenicity may differentiate between polyneuropathy (PNP) patients with and without RLS. Seventy‐five patients with PNP, 65 healthy controls, and 75 patients with idiopathic RLS were investigated. A total of 41.2% patients with PNP additionally suffered from RLS. A total of 44.1% patients with PNP, 10.2% of healthy controls, and 91.2% of patients with idiopathic RLS exhibited SN hypoechogenicity. SN echogenicity did not differ significantly between PNP patients with and without RLS. Thus, TCS seems not suitable for the diagnosis of RLS in patients with PNP. © 2008 Movement Disorder Society     

Pregabalin in restless legs syndrome with and without neuropathic pain

BACKGROUND: Restless legs syndrome (RLS) is a common neurological disorder complicated in many patients by augmentation to dopaminergic therapy or comorbidities such as neuropathic pain. AIMS: To explore the effectiveness of pregabalin in RLS in a pragmatic clinical setting. METHODS: After observing improvement of restless legs symptoms in seven patients treated with pregabalin for neuropathic pain, we extended the clinical observation to a total of 16 patients with secondary RLS, in most of them due to neuropathy, and to three patients with idiopathic RLS. RESULTS: Three patients discontinued pregabalin because of side effects (rash, fatigue, loss of efficacy). The other 16 patients self-rated a satisfactory or good alleviation of RLS symptoms and maintained pregabalin, five with add-on medication, on a mean daily dose of 305 mg (standard deviation, 185 mg), and with a mean duration of 217 (standard deviation, 183) days. CONCLUSION: These data propose pregabalin as a new option in the treatment of secondary RLS for patients with neuropathic pain, which should be further investigated with randomized, placebo-controlled trials.     

Epidemiology of restless legs in the Netherlands

The prevalence of restless legs syndrome (RLS) in various regions in the world has been estimated between 2.5 and 29%. For The Netherlands these figures are not known. Our observational and cross-sectional study was performed to estimate the prevalence of RLS in The Netherlands. A cross-sectional survey by postal questionnaire was carried out through a general practice in a small town in which one general practice serves 93% of the population. All men and women aged 50 years and older were invited to fill out the questionnaire on leg movements, quality of sleep and daytime symptoms. A total of 1485 (88.2%) persons returned their questionnaire and 1437 (85.4%) patients answered the questions on leg movements. A total of 102 (7.1%) inhabitants answered positively to the questions on leg movements and probably have RLS. The prevalence was higher in women and increased with age. People who complain of RLS have significantly more complaints of disturbances in initiating and maintaining sleep, sleepiness, tiredness during the day and less refreshing sleep. RLS is common in The Netherlands with an estimated prevalence of 7.1% in the population over 50 years of age.     

Co-occurrence of restless legs syndrome and Parkin mutations in two families.

Recent studies have suggested an association between restless legs syndrome (RLS) and Parkinson's disease (PD). We present a large multigenerational family and a smaller family with RLS. A Parkin mutation was found in 10 of 20 patients from both families with idiopathic RLS but was not considered causative. The clinical phenotype did not differ between RLS patients with and without a Parkin mutation. Inheritance of RLS was consistent with autosomal dominant transmission, and linkage analysis excluded all three known loci for RLS.     

Levodopa for idiopathic restless legs syndrome: evidence-based review.

Restless legs syndrome (RLS) is a sensory motor disorder characterized by a distressing urge to move the legs and sometimes also other parts of the body usually accompanied by a marked sense of discomfort or pain in the leg or other affected body part. The prevalence of RLS is estimated at 2.7 to 5% of adults and it is more common in women. The treatment of RLS with levodopa has been reported thus a systematic synthesis of evidence is necessary to evaluate the effectiveness and safety of levodopa for RLS. Systematic review of randomized or quasi-randomized, double blind trials on levodopa. Relief of restless legs symptoms marked on a validated scale, subjective sleep quality, sleep quality measured by night polysomnography and actigraphy, quality of life measured by subjective measures, adverse events associated with the treatments. Nine eligible clinical trials were included. The subjective analyses of these studies showed contradictory results, although the objective analyses showed that treatment group had a statistically significant improvement of periodic leg movement (PLM) index, favoring the treatment group. The most commonly adverse event seen was gastrointestinal symptoms. The short-term treatment with levodopa was demonstrated effective and safety for PLM, but there was only few trials assessing long-term treatment and the augmentation phenomenon in RLS. Further long-term randomized controlled trials using standard follow-up measurements as the International RLS Study Group Rating Scale are necessary.