Restless legs syndrome

Opinion statement  

Restless legs syndrome

Opinion statement In the past 10 years, restless legs syndrome (RLS) has gained recognition as a common sleep disorder. There are several therapeutic options in treating patients with RLS. RLS causes significant sleep disturbance and negatively impacts on patient quality of life. Pharmacologic treatment can result in improved sleep and quality of life issues. RLS patients should be evaluated for iron deficiency anemia; iron replacement in deficient patients may lead to a resolution of symptoms or may reduce the severity of their symptoms. For patients with daily symptoms, the initial therapy is dopamine agonists. Low doses given in the evening or 2 hours before bed provide adequate relief of symptoms for many RLS patients. Augmentation can be seen with all dopamine agents, but is most prevalent with levodopa. Levodopa therapy is best used for milder intermittent symptoms or in aggravating situations, such as long car rides. Opiates and antiepileptics remain a beneficial therapy for RLS and are useful in patients who experience pain as part of their RLS. Newer anticonvulsants may provide additional treatment options, but they have yet to undergo clinical trials. Intravenous iron also may provide relief of RLS symptoms; however, dosing and safety issues have not been fully evaluated in a RLS population.     

Restless legs syndrome in children with chronic kidney disease

Background

Restless legs syndrome (RLS) is considerably more common among adults with chronic kidney disease (CKD) than in the general population and is associated with increased morbidity and mortality. There is limited information on RLS in children with CKD. Failure to account for conditions that might mimic RLS can lead to overdiagnosis of this syndrome.

Methods

In a prospective, cross-sectional study, RLS prevalence was compared between pediatric CKD patients and healthy children. RLS was assessed via a questionnaire that included exclusion of mimics. Sleep characteristics and health-related quality of life (HRQoL) were also assessed.

Results

Restless legs syndrome was more prevalent in CKD patients (n?=?124) than in 85 normal children (15.3 vs. 5.9 %; p = 0.04). There was no significant association between RLS and CKD stage, CKD etiology, CKD duration, and dialysis or transplant status. Children with RLS were more likely to rate their sleep quality as fairly bad or very bad (41.2 vs. 8.8 %; p?=?0.003) and report using sleep medications (42.1 vs. 14.7 %; p?=?0.01). RLS was associated with lower HRQoL by parent report (p?=?0.03). Only five of the 19 patients (26.3 %) with CKD and RLS had discussed RLS symptoms with a healthcare provider, and only one of these patients had been diagnosed with RLS prior to this study.

Conclusions

The prevalence of RLS is increased in children with CKD and appears to be underdiagnosed. Systematic screening for RLS and sleep problems would therefore appear to be warranted in children with CKD.     

Restless legs syndrome in pediatric patients with chronic kidney disease

Sleep disorders have been shown to be more prevalent in adults and children with chronic kidney disease (CKD) and on dialysis. To date, the prevalence and impact of restless legs syndrome (RLS) in various stages of CKD has not been evaluated. The object of this study was to determine the prevalence of RLS in children with CKD in different stages, and to evaluate its impact on sleep and daytime functioning. We conducted a clinic-based or telephone survey of 26 patients in varying stages of CKD to assess for RLS, sleep schedule, and daytime sleepiness. Thirty-five percent of children met criteria for RLS, the majority being in CKD stages 1–4. There were no significant differences seen in sleep schedule and daytime sleepiness between those children with or without RLS. We found that there is an increased prevalence of RLS in children with CKD compared to the general population. This suggests that children with all stages of CKD should be routinely screened for RLS symptoms.     

终末期肾脏病血液透析患者不安腿综合征

不安腿综合征属周围神经系统疾病,分原发性和继发两种类型。大多发生于终末期肾脏病(ESRD)或患者开始透析治疗以后,症状较原发性患者重。但具体发病机制迄今仍然尚不清楚。本文就终末期肾病透析患者不安腿综合征病因、发病机制、临床表现、检查、诊断、治疗及目前进展情况作一综述。     

Restless legs syndrome: an unusual cause for a perplexing syndrome

Restless legs syndrome (RLS) is a well-defined symptom complex, occurring either as idiopathic RLS or in association with many other disorders. Although no definite etiology is known for this condition, several pathophysiological mechanisms have been proposed. There is supportive evidence that RLS is a central nervous system (CNS) dysfunction, suggesting involvement of the descending dopaminergic (DA) pathways, but it can also occur with spinal disorders. We present a patient suffering from RLS who eventually was diagnosed with a foramen magnum tumor. Based on the available evidence, we attempt to correlate the location of the tumor with the patient's symptoms of RLS.     

Restless legs syndrome in a primary contact setting: a case report

Objective

To describe the diagnostic features of a patient who presented to a chiropractor with restless legs syndrome (RLS), a common but often under-diagnosed condition.

Clinical Features

A 42-year-old male patient presented with twitching and deep pressure in the legs bilaterally; described also as an uncomfortable urge to move the legs that followed a circadian rhythm occurring in the evening. The symptoms were initiated after periods of rest and they were relieved by movement. Physical examination was non-contributory which is common in RLS except in secondary forms of the condition.

Discussion

The pathophysiology of RLS is still unknown but several treatments have been studied. Non-pharmacologic treatment options include education on improving sleep hygiene, decreasing alcohol and caffeine intake, moderate exercise and supplements. Pharmacological treatment options are available, with L-dopa being the most effective.

Conclusion

The symptoms of RLS were 65% resolved in the case presented in one month. Awareness and proper diagnosis by all primary contact practitioners is necessary for effective management of RLS.     

Restless legs syndrome in maintenance hemodialysis patients: an epidemiologic survey in Hefei

International Urology and Nephrology - To investigate the prevalence of restless legs syndrome (RLS) in maintenance hemodialysis (MHD) patients and its possible influencing factors. MHD patients...     

Restless legs syndrome related to hemorrhage of a thoracic spinal cord cavernoma

Context: Restless legs syndrome (RLS) is a common neurological disorder characterized by an irresistible urge to move the lower limbs often accompanied by unpleasant sensations in the legs, worsened at rest and in the evening. Symptoms are improved by movement. Its pathophysiology remains poorly understood. Lesion-related RLS has been reported, mainly in cases of stroke-related RLS involving the brainstem and lenticulostriate nuclei. Only few data of RLS in a context of spinal cord injury have been reported.

Findings: We report the case of a woman with secondary RLS due to hemorrhage of a spinal cord cavernoma located at T9-T10. Following recovery from the acute phase of the hemorrhage, the patient began to complain about restlessness in her legs causing impaired sleep and daytime somnolence. Polysomnographic investigations found a high index of periodic leg movements during sleep (71/hour), but no sleep disordered breathing. Iron stores were normal. Relief of symptom’s severity was obtained with gabapentin 600mg in the evening.

Conclusion/Clinical Relevance: We hypothesize a possible involvement of the diencephalospinal pathway in the patient’s RLS pathophysiology. A systematic study of focal lesions associated with RLS may contribute to improving our understanding of the pathophysiological mechanisms underlying this condition. The frequency of RLS associated with lesions of the spinal cord might be underestimated. Clinicians should be aware of spinal cord lesion-related RLS, especially as efficient treatments are available.     

Restless legs syndrome, insomnia and quality of life in patients on maintenance dialysis.

BACKGROUND: In a cross-sectional study, we analysed the complex relationship between restless legs syndrome (RLS), insomnia and specific insomnia symptoms and health-related quality of life (QoL) in patients on maintenance dialysis. METHODS: Data were obtained from 333 patients on chronic maintenance dialysis. To assess the prevalence of RLS, we used the RLS Questionnaire (RLSQ). The Athens Insomnia Scale (AIS) was used to assess insomnia and QoL was measured with the Kidney Disease Quality-of-Life Questionnaire. RESULTS: The prevalence of RLS was 14%. The number of comorbid conditions was significantly higher in patients with vs without RLS (median: three vs two; P<0.05). RLS patients were twice as likely to have significant insomnia as patients without RLS (35% vs 16%; P<0.05). Furthermore, RLS was associated with impaired overall sleep quality (median AIS score: 8 vs 4; P<0.01) and poorer QoL. RLS was a significant and independent predictor of several of the QoL domains after statistical adjustment for clinical and socio-demographic covariables. Importantly, this association remained significant even after adjusting for sleep quality. CONCLUSIONS: RLS is associated with poor sleep, increased odds for insomnia and impaired QoL in patients on maintenance dialysis. Based on the present results, we suggest that both sleep-related and sleep-independent factors may confer the effect of RLS on QoL.     

Restless legs syndrome in hemodialysis patients: health-related quality of life and laboratory data analysis

AIMS: To compare clinical data, sleep quality and health-related quality of life (HRQOL) with and without RLS in HD patients. MATERIALS AND METHODS: The international RLS study group diagnosis questionnaire was completed by 228 HD patients. The Pittsburg Sleep Quality Index (PSQI) for the evaluation of sleep quality and the Kidney Disease Quality of Life (KDQOL-SF) for the analysis of HRQOL were also used. RESULTS: 53 (23%) patients were diagnosed as RLS. Age and age at the initiation of HD were significantly younger in the RLS group. Serum calcium concentration (Ca) was significantly higher in the RLS group. Sleep quality evaluated by PSQI was significantly lower in the RLS group. In SF-36 domains of KDQOL-SF, bodily pain, general health perceptions, vitality, role functioning emotional, mental health and mental component score were significantly lower in the RLS group. In kidney targeted scales of KDQOL-SF, symptoms/problems, burden of kidney disease, cognitive function, quality of social interaction, sleep and patient satisfaction were significantly lower in the RLS group. CONCLUSION: High Ca was possibly connected to the pathophysiology of RLS which impaired sleep quality as well as HRQOL including mental health and many kidney disease related scales.     

Restless leg syndrome in maintenance haemodialysis patients

Sir, In the May issue of Nephrology Dialysis Transplantation, Sabbatiniet al. [1] discussed     

Management of restless legs syndrome augmentation

Opinion statement  Augmentation is the main complication of long-term dopaminergic treatment of restless legs syndrome (RLS). Although augmentation was first described in 1996 and is characterized by an overall increase in severity of RLS symptoms (earlier onset of symptoms during the day, faster onset of symptoms when at rest, spreading of symptoms to the upper limbs and trunk, and shorter duration of the treatment effect), precise diagnostic criteria were not established until 2003. These criteria were updated in 2007 to form a new definition of augmentation based on multicenter studies. Augmentation should be differentiated from early morning rebound, natural progression of the disease, tolerance, and neuroleptic-induced akathisia. Treatment strategies will depend on the degree of clinical significance but will be based on the use of longer-acting drugs and a reduction or substitution of the dopaminergic agents. The most effective preventive measure is to keep the dose of the dopaminergic medication as low as possible, ensuring that it does not exceed the dose recommended by regulatory authorities. RLS augmentation needs to be treated only if it is clinically relevant—that is, if it has a significant impact on the patient’s daily activities. Mild cases should be followed closely, however. In severe cases, a change of treatment (sometimes even within the same class of drugs) can be effective, although before taking this step, it should be verified that all factors that may affect augmentation (changes in lifestyle, iron deficiency, serotonin reuptake inhibitors) have been excluded.     

Restless leg syndrome and periodic limb movements of sleep

Opinion statement Restless leg syndrome is one of the most common causes of severe insomnia, and is easily diagnosed by patient history alone. Formal sleep studies are rarely, if ever, indicated. The only routine laboratory study indicated is a serum ferritin level. The majority of patients with restless leg syndrome obtain substantial relief with a variety of medications. Although the majority of restless leg syndrome patients demonstrate periodic limb movements on polysomnographic study, the true clinical significance, if any, of periodic limb movements identified by polysomnographic study in the absence of restless leg syndrome symptoms remains to be determined.