Download Restless Legs Syndrome

Restless Legs Syndrome:
Classification, Diagnosis and
Approaches to Treatment
Part 2 of 3
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RLS Slide Library Version 1.0 - All Contents Copyright © WE MOVE 2001
Additional Clinical Characteristics
• More than 60% of patients have
progressive disease
• Symptoms become worse with
increasing age
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Additional Assessment Issue
• Current medication regimen for potential
causative agents, such as…
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Antiemetics
Lithium
Neuroleptics
Antidepressants
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RLS Associated with...
• Iron deficiency
• Uremia
• Pregnancy
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Differential Diagnosis
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Neuroleptic-induced akathisia
ADHD (in children)
Anxiety
Growing pains
Other neurologic condition
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Differential Diagnosis, cont’d
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Burning feet syndrome
Fibromyalgia
Meralgia paresthetica
Arthritis
Possible psychogenic disorder
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Pathophysiology of RLS
• CNS abnormality (cerebral generators)
• Dopaminergic dysfunction
• Disinhibition of the flexor reflex during
sleep
• Possible involvement of the endogenous
opiate system
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Pathophysiology of RLS, cont’d
• TMS: impaired motor cortex
excitability in RLS
• Impaired flexor reflexes
• Dopaminergic dysfunction
• Blink Reflex: enhanced R2 excitability
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Central Mechanism Suggested...
• PLMS resemble Babinski response
• Hyperactive brainstem and spinal cord
reflexes
• Observed in patients with complete spinal
cord lesions
• Circadian rhythms to RLS
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Polysomnographic Findings
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RLS/Peripheral Involvement
• Peripheral nerve involvement
– RLS secondary to peripheral neuropathy
clinically identical to idiopathic RLS
– Subclinical evidence of neuropathy
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Etiology of RLS
• Idiopathic or primary RLS
– Sporadic
– Familial
• Secondary or symptomatic RLS
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Familial RLS
In some patients…
• RLS appears to be inherited as
an autosomal dominant genetic trait
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RLS Genetics
• Family history in >50%
• Autosomal dominant
• Genetic anticipation
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Secondary RLS
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Anemia
Low Levels of Iron
Diabetes/Amyloidosis
Alcoholism
Increased BMI
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Parkinson’s Disease
Peripheral Neuropathy
Depression
Carcinoma
Myokymia
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Secondary RLS, cont’d
• End Stage Renal
Disease
• Folate Deficiency
• Nonspecific Prostatitis
• Low Testosterone
Level
• Magnesium
Deficiency
• Rheumatoid Arthritis
• Pregnancy
• Porphyria
• Postgastrectomy
Complication
• COPD
• Dermatological
Disorders
• Caffeine Consumption
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Epidemiology of RLS
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Prevalence of 2% to 5% in adults
Estimated prevalence from 5% to 30%
Up to 12 million in the U.S.
Affects about 5% of population
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Electrophysiology of RLS
• Lack of bereitschaftspotential
• NCV is normal
• Somatosensory-evoked responses are
normal
• EMG demonstrates mild increase in
polyphasic units
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Subjective Clinical Assessment
Using this scale, how would you rate
the following symptoms where
0 = none
1 = mild
2 = moderate
3 = severe
4 = very severe
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Subjective Clinical Assessment
• Uncomfortable feelings in the legs and/or
arms at rest in the evening or at night?
• Need or urge to move around for relief
when at rest in the evening or at night?
• Relief with movement?
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Clinical Assessment Questions
• Uncontrollable jerks in your legs and/or
arms that occur when you rest in the
evening or at night?
• Difficulty in getting to sleep when
you first lie down?
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Clinical Assessment Questions, cont’d
• Difficulty staying asleep during the night,
after falling asleep?
• Sleepiness or fogginess during the daytime?
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RLS Slide Set Presented by:
WE MOVE
204 West 84th Street
New York, NY 10024
Phone: (800) 437-MOV2 (in U.S.)
(212) 241-8567 (outside U.S.)
Fax:
(212) 875-8389
E-mail: [email protected]
Web site: www.wemove.org
Executive Director: Judy Blazer, MS
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Additional RLS Resource
Restless Legs Syndrome Foundation
819 Second Street SW
Rochester, MN 55902 US
Telephone:
Fax:
E-mail:
Web Site:
(507) 287-6465
(507) 287-6312
[email protected]
http://www.rls.org
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