Restless Leg Syndrome
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Transcript Restless Leg Syndrome
Restless Leg Syndrome
•“The most common
disorder you have
never heard of.”
What are Restless legs?
Neurological movement disorder
Irresistible urge to move legs when at
rest
Difficulty sleeping
Involuntary periodic leg movements
Uncomfortable sensation in limbs
subjective & difficult to describe
Symptoms eased by movement
Why should we know about it?
Excess 5 million in UK are sufferers (MEMO
2000)
Estimated prevalence 2-15%
Sufferers will present to primary care
Important physical cause of sleep
disturbance
Clinical diagnosis which can be made in
primary care
Why should we know about it?
Unrecognised & under-diagnosed
Incorrectly labeled as stress / anxiety
Managed poorly
Wide spectrum
Affects any age group
Mild
More common in middle age + women
Minimal distress
Severe
Episodes occur >2 per week
Can be disabling
Why is it important?
Large impact on quality of life: (REST Study)
Poor sleep
Inability to get comfortable / relax
Poor concentration / fatigue
Pain
Depression
Problems in day to day functioning / employment
Implications for partner
Common descriptive terms
used by patients
How do we diagnosis RLS?
International Restless Legs Syndrome
Study Group - 2003
Supporting Features
Positive FHx (50-92%)
Involuntary limb movements (80%)
Sleep disturbance
What investigations should we
do?
Exclude secondary cause.
Examination
Vascular dx / Neuropathy / nocturnal cramp
/ anxiety
Neuro / vascular
Bloods
FBC, ferritin, B12, Folate, U&E, Glucose,
TFT
Aetiology
Primary
No underlying cause found.
Positive FHx >50%
Earlier onset / slower progression
Secondary
Fe deficiency
Pregnancy
End stage renal disease
Peripheral neuropathy / DM / RA / Fibromyalgia
Later onset / more severe
Pathophysiology
Genetic
Susceptibility loci identified on 3
chromosomes
Positive FHx >50%
Neurochemical
Dopaminergic dysfunction - universal
response to dopaminergic agents
Ferritin level - inverse relation between
severity and serum ferritin
What are the treatment
options?
Non Pharmacological
Preventative measures
Symptomatic control
Pharmacological
PRN treatment - mild / intermittent
Maintenance treatment - moderate / severe
Majority of treatments used ‘off license’
Non pharmacological
treatment
Preventative
Avoid caffeine / alcohol / nicotine
Avoid medication which may aggravate
SSRI / antihistamine / antiemetic / CaChannel blockers
Keep active into evening
Good sleep hygiene
Symptom control
Mental alerting activities
Walking / stretching
Massage
Hot / cold bath
Relaxation / biofeedback
Pharmacological options
Drug
Advantage
Disadvantage
Iron
Helpful if serum
ferritin low
Slow response
Dopamine
agonist
Pramipexole /
ropinirole
High efficacy
(70-100%)
Less
augmentation
Daytime
sleepiness
Long term effect
not known
Dopaminergic
agent
Carbidopa /
levodopa
Can be used
PRN basis
Shown to be
effective
Up to 80%
develop
augmentation
Pharmacological options
Drug
Advantage
Disadvantage
Anticonvulsants Useful in
Gabapentin /
neuropathy /
Carbamazepine associated pain
Side effect profile
Benzos
PRN use + help
sleep
Cognitive
impairment,
dependence
Opioids
PRN use /
daytime use
Cognitive
impairment,
dependence
Rx Flow chart - RLS:UK
Mirapexin (pramipexole)
First drug treatment / ONLY treatment
licensed in EU for RLS
For use in moderate / severe disease
Quick onset of symptom relief (<1/52)
Start low dose 125mcg od
Titrate up (max 750mcg od)
What should we be doing?
Have raised awareness about diagnosis
Exclude / treat secondary causes
Symptoms generally mild + reassurance
& non-pharmacological measures
suffice
In moderate / severe cases consider
onward referral
Useful Info
Resources
www.ekbom.org.uk
www.restlesslegs.org.uk
www.restlesslegs.com
Review
DTB Nov 2003
Bandolier 118