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PubMed2004

Restless legs syndrome in blood donors.

BACKGROUND AND PURPOSE: Restless legs syndrome (RLS) may be a cause of significant sleep disturbance. In a Swedish survey, the prevalence of RLS has been estimated to be 5.8% among men and 11.4% among women. Blood donation may result in iron deficiency, which is hypothesized to be one substantial cause of RLS. PATIENTS AND METHODS: Nine hundred and forty-six (618 men, 328 women) consecutive blood donors aged 18-64 years, who attended a blood donation unit in mid-Sweden, answered a questionnaire that included questions about sleep habits. Frequency of blood donation was recorded and intake of iron tablets was assessed. Red blood cell distribution width (RDW) was also recorded. The value of RDW increases in relation to iron deficiency. RESULTS: RLS affected 14.7% of male and 24.7% of female blood donors. The mean intake of iron among the blood donors after each blood donation was only 781 mg, although the recommended intake is 2000 mg. Among the women, 7.4% presented an RDW of >14.5%, which strongly indicates iron deficiency. In this group of women, 37.5% were affected by RLS. The female RLS-sufferers were more affected than the female non-RLS subjects by problems initiating sleep (P=0.006 maintaining sleep (P<0.0001) and were also less refreshed upon awakening (P<0.001). RESULTS: This study showed that RLS was common among female blood donors. Women with RLS were more iron-deficient than those without and were affected by impaired sleep.

Adolescent↗
PubMed2002

Long-term course of restless legs syndrome in dialysis patients after kidney transplantation.

Restless legs syndrome (RLS) is a common cause of sleep disturbance and is frequently experienced by hemodialysis patients. Factors triggering the disease in uremia have not yet been identified. To our knowledge, the course of RLS symptoms after kidney transplantation has not been investigated systematically. We investigated the clinical long-term course of RLS in hemodialysis patients who underwent kidney transplantation. Patients were given a standardized questionnaire three times: at baseline, and twice after their kidney transplants. The severity of RLS was rated by the patients (0 =no symptoms, 10 = very severe symptoms). The description of the final outcome was based on the last follow-up visit. Eleven of 64 hemodialysis patients with RLS received a transplant (5 men, 6 women; severity of RLS at baseline, 7.8 +/- 0.7 [mean +/- SEM]). In all patients, RLS symptoms disappeared within 1 to 21 days after transplantation. At follow-up visits, 4 patients whose transplanted kidneys still functioned well were still free of RLS symptoms up to the longest follow-up period of 9 years. In 3 other patients, RLS symptoms gradually reappeared (severity, 1 +/- 0). In 3 of 11 patients, the transplant failed and RLS symptoms reoccurred within 10 days to 2 months (severity, 7.3 +/- 2.6). RLS symptoms reoccurred in 1 patient with failure of the transplant but disappeared again after a second, successful transplant. Kidney transplantation has a strong and positive influence on RLS symptoms in hemodialysis patients. Hemodialysis patients can expect a substantial improvement of RLS symptoms after a successful kidney transplant.

Adult↗
PubMed2001

Restless legs syndrome: a review of clinical and pathophysiologic features.

Restless legs syndrome (RLS), although long ignored and still much underdiagnosed, disrupts the life and sleep considerably of those who have it. Recent clinical and basic research provides for better definition and pathophysiologic understanding of the disorder. The body of knowledge about this disorder has been expanding rapidly during the past decade and it has altered our concepts of this disorder. This review of RLS covers history, diagnosis, morbidity of sleep disturbance, relation to periodic limb movements in both sleep and waking, secondary causes, severity assessment methods, phenotypes for possible genetic patterns, epidemiology, pathophysiology, and medical treatment considerations. The emphasis on pathophysiology includes consideration of central nervous system localization, neurotransmitter and other systems involved, and the role of iron metabolism. Studies to date support the authors' recently advanced iron-dopamine model of RLS.

Anemia, Iron-Deficiency↗
PubMed2005

Effects of rest-duration, time-of-day and their interaction on periodic leg movements while awake in restless legs syndrome.

BACKGROUND AND PURPOSE: The diagnostic criteria for restless legs syndrome (RLS) indicate that both time-of-day and rest effects induce or aggravate symptoms. Periodic limb movements while awake (PLMW) provide an objective motor sign of RLS that can be measured during an awake suggested immobilization test (SIT). This study uses the SIT at different times of the day and analyzes time-of-day and duration-of-rest effects and their interaction on the PLMW. PATIENTS AND METHODS: Twenty-eight RLS patients who were not on medications had SIT tests at 10 pm, 8 am and 4 pm on two consecutive days. PLMW for each 20-min period were analyzed for time-of-day and rest effects and their interaction. PLMW increase from the first to last 20-min SIT period assessed the rest-effects. RESULTS: Significant effects were found for rest, time-of-day and rest-time-of-day interaction. The rest-effect increased most from morning to afternoon while total PLMW increased more from afternoon to night. Males compared to females had significantly more PLMW and a larger rest-effect change with time-of-day. CONCLUSIONS: Rest and time-of-day effects and their interaction all increase RLS symptoms. PLMW increase with rest may provide a sensitive measure of symptom severity.

Age Factors↗
PubMed1997

Restless legs and periodic leg movements in sleep syndromes.

Restless legs syndrome (RLS) is a common sensorimotor disorder with an estimated prevalence of between 1% and 5%. The symptomatology is characterized by unpleasant sensations experienced predominantly in the legs and rarely in the arms. The symptoms occur only at rest and become more pronounced in the evening or at night. In addition, the patients suffer from a strong urge to move the limbs, typically manifest as walking around, which leads to complete but only temporary relief of the symptoms. Most of the patients with RLS have periodic leg movements (PLMS) during sleep and relaxed wakefulness that are characterized by repetitive flexions of the extremities. PLMS can occur as an isolated phenomenon, but often they occur together with other sleep disorders including RLS, narcolepsy, sleep apnoea syndrome or REM sleep behaviour disorder. In all these disorders, PLMS, contribute considerably to disturbed sleep, as the movements may lead to brief arousals or repeated full awakenings. The aetiology of RLS and PLMS is unknown. It is hypothesized that periodic leg movements result from a suprasegmental disinhibition of descending inhibitory pathways. Based on the efficacy of the drugs listed below, the dopaminergic, adrenergic and opiate systems are thought to play a major role in the pathogenesis of RLS/PLMS. Since the cause is unclear, therapy of RLS and PLMS remains symptomatic except for some secondary forms. Studies on the pharmacological treatment of RLS have shown the efficacy of levodopa, dopamine agonists, benzodiazepines, opioids, clonidine and carbamazepine. With regard to the drug treatment of PLMS in other sleep disorders including their isolated occurrence, indications and efficacy have been poorly defined until now.

Humans↗
PubMed2004

The restless legs syndrome and periodic limb movement disorder: a review of management.

The restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) are distinguishable but overlapping disorders. Both feature nocturnal involuntary limb movements (periodic limb movements) that can cause sleep disruption, but each has distinct clinical features that are relevant to the diagnosis and management of the patient. The diagnosis of RLS is made by meeting established clinical criteria, not from discovery of periodic limb movements of sleep (PLMS) on a sleep study. PLMD, however, does require the presence of PLMS on polysomnography as well as an associated sleep complaint. Moreover, PLMS are themselves nonspecific, occurring both with RLS and with other sleep disorders as well as in normal individuals. The diagnosis of PLMD, then, requires not merely finding a significant number of PLMS but also excluding other potential causes for the associated sleep complaint. Treatment of RLS is based on consideration of the pattern and severity of the disorder, with dopaminergic drugs generally favored for initial treatment. Anticonvulsants, opioids, and sedative/hypnotics also have a role. A treatment algorithm is provided to assist with the management of RLS. Treatment of PLMD relies on many of the same medications, but is generally more straightforward and places a greater reliance on levodopa compounds and sedative-hypnotics.

Diagnosis, Differential↗
PubMed1987

Restless legs syndrome treatment with dopaminergic drugs.

Sixteen patients with symptoms of restless legs syndrome and resulting insomnia are included in this study. They were nine women and seven men with a mean age of 50.8 years and with a mean duration of symptoms of 6.3 years. The purpose of the study is to determine the drugs that are useful for the treatment of restless legs syndrome. In 13 patients L-Dopa plus benserazide, in two patients bromocriptine, and in the remaining one patient piribedil were used orally at night approximately 1 h before bedtime. Compared with placebo these dopaminergic drugs decreased the times of waking up and staying awake periods at a statistically significant level (p changed between 0.025 and 0.01, t test). In this susceptibility of CNS there is dysfunction of the dopamine system triggered by sleep, and resting and dopaminergic potentiation by drugs affect the symptoms.

Adult↗
PubMed2003

Clinical and psychological aspects of restless legs syndrome in uremic patients on hemodialysis.

BACKGROUND: The pathogenesis of restless legs syndrome (RLS) is still unclear. The purpose of this study is to determine relationships of the presence of RLS in uremic patients regularly undergoing hemodialysis (HD) with demographic, clinical, and psychological factors. METHODS: In 490 uremic patients on HD therapy in Japan, RLS was diagnosed based on diagnostic criteria established by the International Restless Legs Syndrome Study Group. Data were compared between patients with and without RLS. RESULTS: There were univariately significant (P < 0.05) differences in serum phosphorus levels, anxiety levels determined using the Hospital Anxiety and Depression Scale, and degrees of emotion-oriented and avoidance-oriented coping determined using the Coping Inventory for Stressful Situations. In multivariate analyses, low hemoglobin levels, high serum phosphorus levels, high anxiety levels, and a great degree of emotion-oriented coping were independently related to the presence of RLS in uremic patients on HD therapy, with statistical significance (P < 0.05). CONCLUSION: Hyperphosphatemia, anxiety, and a great degree of emotion-oriented coping with stress were independently related to the presence of RLS in uremic patients on HD therapy. The pathogenesis of RLS seems to involve more than one mechanism, which leads to restless legs as the final common pathway. These findings may provide new clues to the pathogenesis of RLS.

Adaptation, Psychological↗
PubMed2005

Physostigmine for the acute treatment of restless legs syndrome.

We present a case report of an acute episode of restless legs syndrome that interfered with the performance of a diagnostic imaging procedure of the cervical spine. The patient had a 19-yr history of restless leg syndrome with periodic limb movements during sleep. Treatment with additional sedation and opioids did not alleviate the leg movements. IV administration of 1 mg of physostigmine eradicated all extraneous leg motion.

Aged↗
PubMed2003

Linkage analysis of the candidate genes of familial restless legs syndrome.

This research was performed to investigate the relationship between 16 candidate genes responsible for dopaminergic transmission or iron metabolism and familial restless legs syndrome. Genotyping was performed in a Han restless legs syndrome family using the technique of fluorescence-based genescan with the microsatellite markers selected in chromosomal regions flanking the candidate genes. Classical linkage analysis was conducted under the autosomal dominant genetic mode. Results showed that all of the LOD scores at recombination fraction 0.00 are smaller than -2.00, which indicated that these loci were not linked to familial restless legs syndrome. No linkage was found between the candidate genes and RLS in this family. Familial restless legs syndrome may be caused by another gene related to dopaminergic transmission and iron metabolism or there is new mechanism involved in this disease.

Adolescent↗
PubMed2004

Restless legs syndrome and periodic limb movement disorder in the elderly.

Restless legs syndrome (RLS) is a sensorimotor neurological disorder characterized by an urge to move the extremities, mostly the legs, caused or accompanied by unpleasant sensations in the affected limbs. Symptoms appear or increase in the evening or during the night and at rest. Sleep disturbances are the most frequent reason why patients seek medical aid. The diagnosis of periodic limb movement disorder (PLMD) requires polysomnographic confirmation and relies on the exclusion of other causes of sleep disturbances. The diagnosis of RLS is a clinical one and usually based on the patient's history. Diagnosis criteria should be applied in a modified form in the cognitively impaired elderly. The newly revised criteria emphasize behavioral indicators and supportive features in diagnosing RLS in this special population. Prevalence of both disorders increases strongly with age. Epidemiological studies revealed a 9% to 20% prevalence of RLS and an estimated 4% to 11% prevalence of PLMD in the elderly. Recent studies indicate RLS occurring approximately twice as often in older women than in older men. Treatment with dopaminergic drugs, opioids, anticonvulsants or hypnotics are usually well tolerated in the elderly. However, interaction with other medications and the possibility of severe sedation due to slower metabolism in the elderly should be considered.

Aged↗
PubMed2002

Restless legs syndrome in the older adult: diagnosis and management.

Restless legs syndrome (RLS) is common in the elderly, with an estimated prevalence of 10 to 35% in individuals over 65 years of age. RLS is characterised by paraesthesias and dysaesthesias of the legs, typically occurring in the evening. The symptoms occur at rest and result in motor restlessness; movement often temporarily relieves the symptoms. Patients with poorly controlled RLS may develop related problems including insomnia (due to sleep-onset restlessness or periodic limb movements or related sleep fragmentation) and depression. RLS can be a primary disorder that develops in the young and includes familial cases. Secondary RLS occurs in association with iron-deficiency anaemia, uraemia and polyneuropathies. Typically, RLS is misdiagnosed or undiagnosed for years. In the elderly, both primary and secondary types of the disorder are common. It is thought that RLS represents lower CNS levels of, or reduced responsiveness to, dopamine. The symptoms improve with dopaminergic therapy. Ergotamine dopamine-receptor agonists such as pergolide, and the non-ergotamine dopamine-receptor agonists pramipexole and ropinirole, are becoming more commonly used to treat RLS. The dopamine precursor levodopa, in combination with carbidopa, is another effective therapeutic agent. An advantage of levodopa is lower cost than non-ergotamine and ergotamine dopamine-receptor agonists. However, the adverse effect of symptom augmentation appears to develop more frequently with levodopa than dopamine-receptor agonists; therefore, levodopa may currently be used somewhat less often as first-line therapy. Patients with painful symptoms may respond favourably to the anticonvulsants gabapentin and carbamazepine. Opioids and hypnosedatives are helpful in selected patients; however, these agents may have troubling adverse effects in the elderly. Correction of iron deficiency improves symptoms in patients with low ferritin levels. Lifestyle modification may also be helpful. Therapy is directed at symptoms, and most symptomatic patients benefit from treatment. It is important to consider RLS in the differential diagnosis of any patient with paraesthesias of the limbs.

Aged↗
PubMed2003

Quantitative rest activity in ambulatory monitoring as a physiological marker of restless legs syndrome: a controlled study.

An objective marker of restless legs syndrome (RLS) is needed for developing diagnostic tools and monitoring symptoms. Actometric ambulatory monitoring of 15 RLS patients and 15 healthy controls was undertaken in order to differentiate between RLS-related motor symptoms and normal motor activity. Nocturnal lower-limb activity per minute differentiated and discriminated between groups with no overlap, whereas the periodic limb movement index and the controlled rest activity during sitting showed less discriminative power. The naturalistic recording of nocturnal activity by actometry may prove useful for assessing the severity of RLS and for finding an objective marker to support the diagnosis of RLS.

Adult↗
PubMed2005

Computer-assisted detection of nocturnal leg motor activity in patients with restless legs syndrome and periodic leg movements during sleep.

STUDY OBJECTIVES: To assess the performance of a new method for automatic detection of periodic leg movements during sleep. METHODS: Leg movements during sleep were visually detected in the tibialis anterior muscles recordings of 15 patients with restless legs syndrome and 15 normal controls. Leg movements were detected automatically by means of a new computer method with which electromyogram signals are first digitally band-pass filtered and then rectified; subsequently, the detection of leg movements is performed by using 2 thresholds: one for the starting point and another to detect the end point of each leg movement. Sensitivity and false-positive rate were obtained; the American Sleep Disorders Association parameters were also computed, and the results analyzed by means of the Kendall W coefficient, the linear correlation coefficient and the Bland-Altman plots. SETTING: N/A. PARTICIPANTS: Fifteen patients with restless legs syndrome and periodic leg movements and 15 controls. MEASUREMENTS AND RESULTS: High values of the Kendall W coefficient of concordance between automatic and visual analysis were found with values close to 1 and the linear correlation coefficient for leg movements index and total leg movements index was > 0.950 (p < .000001). The Bland-Altman plots provided the limits of agreement between visual and computer detection, which were -9.01 and +9.89 for the periodic leg movement index. None of the normal controls was found to have periodic leg movement indexes >5 after automatic analysis. CONCLUSIONS: Our method can be applied to the clinical evaluation of periodic leg movements during sleep, with some caution in patients with a low periodic leg movement indexes. Large-scale research application is possible and can be considered as reliable.

Adult↗
PubMed2005

[Quality of life in restless legs syndrome. Influence of daytime sleepiness and fatigue].

BACKGROUND AND PURPOSE: Restless legs syndrome (RLS) is a frequent neurologic disorder characterized by leg paresthesia and motor restlessness. It is still under debate to which amount the disease affects quality of life as it causes daytime sleepiness and fatigue. The presented study evaluates the daytime problems by different scales. PATIENTS AND METHODS: 28 patients (19 women, nine men, aged 58.6 +/- 11.9 years) with RLS (78% with a severe form) were evaluated with the Epworth Sleepiness Scale (ESS), the Fatigue Severity Scale (FSS) and the SF-36 to judge quality of life. Subscales of the SF-36 contain either rather physical or mental components. RESULTS: 17/28 patients showed an increased daytime sleepiness (ESS) and 17/28 increased fatigue (FSS), whereby these symptoms did not correlate. With regard to the SF-36 scores higher values of fatigue caused a greater limitation of the physical health, daytime sleepiness correlated with limitation of the mental health. CONCLUSION: The study clearly demonstrates an impairment by fatigue and daytime sleepiness in RLS patients. Daytime symptoms worsen quality of life. Different scales have to be used to measure the different daytime symptoms. Therapy must be adjusted to the leading symptoms (e. g., stimulants in daytime sleepiness).

Aged↗
PubMed1992

Periodic leg movements in sleep with restless legs syndrome: effect of clonazepam treatment.

Fifteen patients with restless legs syndrome underwent whole-night polysomnographic recordings before and during clonazepam treatment. The treatment with 0.5 to 1.5 mg clonazepam improved subjective complaints of all the 15 patients. All the patients presented periodic leg movements on the polysomnograms before the treatment. The clonazepam treatment significantly decreased the total numbers of leg movements and the numbers of leg movements per hour without affecting the mean intermovement interval.

Aged↗