RESTLESS LEGS AND PERIODIC LIMB MOVEMENTS

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RESTLESS LEGS AND PERIODIC LIMB MOVEMENTS

• ANTONIO CULEBRAS, MD, FAAN, FAHA, FAASM
• Professor of Neurology
• SUNY Upstate Medical University
• Syracuse, N.Y. USA
• SLEEP CENTER TEACHING DAY PROGRAM
• May 7, 2016

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The Crucial Points
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RLS Defined
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RLS Pathophysiology The Dopaminergic System
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RLS Pathophysiology A Clue From CNS Iron
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Primary Secondary RLS

• Primary RLS
• No apparent cause, except perhaps genetic
  predisposition1-3
• Severe cases appear to be a chronic condition4
• Since many patients do not seek treatment, little
  is known about the clinical course in milder and
  intermittent cases4
• Secondary RLS
• Associated with iron deficiency,5,6 end-stage
  renal disease,7 and pregnancy8
• May remit on resolution of the causative
  condition (eg, after pregnancy)9

1. Allen RP, et al. Sleep Med. 20023S3-S7.
2. Garcia-Borreguero D, et al. Neurology. 200361(6
   suppl 3)S49-S55.
3. Desautels A, et al. Am J Hum Genet.
   2001691266-1270.
4. Allen RP, et al, for the International Restless
   Legs Syndrome Study Group. Sleep Med.
   20034101-119.

1. Akyol A, et al. Clin Neurol Neurosurg.
   200310623-27.
2. O'Keeffe ST, et al. Age Ageing. 199423200-203.
3. Winkelman JW, et al. Am J Kidney Dis.
   199628372-378.
4. Berger K, et al. Arch Intern Med.
   2004164196-202.
5. Lee KA, et al. J Womens Health Gend Based Med.
   200110335-341.

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RLS Genetics Familial Patterns
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RLS Genetics Specific Genes Implicated
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RLS Prevalence in a Primary Care Population
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RLS Prevalence by Age
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RLS is Often Undiagnosed
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Impact on QOL RLS Patients vs the General
Population
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RLS Impact on QOL Resembles the Impact of Major
Diseases
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Moderate to Severe RLS Patients US (n
158) Patients in the General Population with
Type 2 Diabetes Mellitus (n 541)
Osteoarthritis (n 175) Depression (n 502)
80
60
Mean Score
40
20
0
Physical
Role Physical
Bodily Pain
General
Energy/
Social
Role
Mental Health
Functioning
Health
Vitality
Functioning
Emotional
SF-36 Health Survey Domain
Adapted from Allen RP, et al. Arch Intern Med.
20051651286-1292.
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Most Troublesome RLS Symptoms Rated by Patients
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Some Informal Clues to the Diagnosis
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RLS Essential Diagnostic Criteria

• Urge to move legs, usually accompanied by
  uncomfortable leg sensations
• Worsening of symptoms at rest or with inactivity,
  such as when lying or sitting
• Worsening of symptoms in the evening and at night
• Relief with movement partial or total relief
  from discomfort by walking or stretching

Allen RP, et al, for the International Restless
Legs Syndrome Study Group. Sleep Med.
20034101-119.
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A Single Screening Question1,2
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Related Clinical Features
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Diagnosis of RLS

• History
• Review essential diagnostic criteria
• Physical examination
• Laboratory tests

• Screen for renal failure2
• Screen for diabetes2
• Other tests for potential secondary causes if
  suspected2

• Polysomnography1
  
• Serum ferritin2

1. Kushida CA, et al. Sleep. 200528499-521.
2. Allen RP, et al, for the International Restless
   Legs Syndrome Study Group. Sleep Med.
   20034101-119.

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Differential Diagnosis
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An Algorithm for Diagnosis
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and for RLS Management
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Augmentation Defined
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Prevalence by Age and Gender from the REST
Population-based Survey
Allen RP, Walters AS, Montplaisir J, et al.
Restless Legs Syndrome Prevalence and Impact
REST General Population Study. Arch Intern Med
2005165(11)1286-92.
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Restless Legs Syndrome in Pregnancy Prevalence
Prevalence by Month of Pregnancy
Prevalence ()
3-4 Mo. 5-6 Mo. 7-8 Mo. gt 9
Mo.
Suzuki K, Ohida T, Sone T, et al. The prevalence
of restless legs syndrome among pregnant women in
Japan and the relationship between restless legs
syndrome and sleep problems. Sleep
200326(6)673-7.
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Educating Patients About RLS
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