Prevalence of restless legs syndrome in patients with chronic pain in Maputo, Mozambique

Restless Legs Syndrome in Hemodialysis Patients: Clinical and Electrophysiological Study

Background

Hemodialysis-related restless legs syndrome (HD-RLS) is a common sensorial and motor disorder. The diagnosis of this disease is based on clinical criteria, and it has recently been proposed to use physiological parameters of the nerves related to the duration of the F wave as a supplementary diagnostic modality. The aim of the study is to determine the value of these parameters in the diagnosis of HD-RLS by comparing the differences between patients with HD-RLS and hemodialysis patients without RLS (HD-nRLS).

Methods

A total of 20 HD-RLS patients, 33 HD-nRLS patients, and 30 age-and gender-matched healthy controls (HCs) were included in the study. The motor nerve conduction of the median and ulnar nerves in the upper limbs, as well as the tibial and peroneal nerves in the bilateral lower limbs, and the sensory nerve conduction of the sural nerve bilaterally and the superficial peroneal nerve, along with the F waves of the ulnar nerves, median nerve, and bilateral tibial nerve, were assessed.

Results

Both groups of HD patients had variable levels of axonal degeneration and demyelination, with the HD-RLS patients having more severe lower limb involvement. The HD-RLS patients showed an extension of the F-wave duration (FWD) of the bilateral tibial, median, and ulnar nerves, along with an increased ratio between FWD and compound muscle action potential duration (CMAPD).

Conclusion

Peripheral neuropathy occurs in patients with HD-RLS, and the FWD/CMAPD ratio could potentially serve as an adjunctive diagnostic tool for HD-RLS.

Association between restless legs syndrome and peripheral neuropathy: A systematic review and meta-analysis

BACKGROUND AND PURPOSE

The coexistence of peripheral neuropathy (PN) and restless legs syndrome (RLS) or Willis-Ekbom disease is relatively frequent, but its prevalence has shown a high variability across studies. In addition, several reports have shown data suggesting the presence of PN in patients with idiopathic RLS.

METHODS

A search was undertaken using the PubMed, Embase and Web of Science Databases, from 1966 to 6 December 2020, crossing the search term 'restless legs syndrome' with 'neuropathy', 'polyneuropathy' (PNP) and 'peripheral neuropathy', and the references of interest for this topic were identified; a meta-analysis was performed, according to PRISMA guidelines, and a calculation of pooled prevalences, where appropriate, was made using standard methods.

RESULTS

Restless legs syndrome has been reported in 5.2%-53.7% of patients with PN (average 21.5%; 95% confidence interval 18.6%-24.5%), and PN has been reported in 0%-87.5% of patients with RLS (average 41.8%; 95% confidence interval 39.9%-43.6%), both being significantly more frequent than in controls. The heterogeneity across studies could be due to differences in the diagnostic criteria used for both RLS and PN. RLS is a frequent clinical complaint in patients with PN of different aetiologies, mainly diabetic PN, uraemic PNP, familial amyloid PNP, Charcot-Marie-Tooth disease and chronic dysimmune inflammatory PNP. Recent neurophysiological findings suggest the presence of small sensory fibre loss in patients diagnosed with idiopathic RLS, but it remains to be determined whether RLS associated with small sensory fibre loss and idiopathic RLS are different clinical entities.

CONCLUSIONS

Future studies including clinical and neurophysiological assessment and skin biopsy involving a large series of patients with PN and RLS are needed for a better understanding of the association between these two entities.

Chronic pain and associated factors in Maputo, Mozambique: a pilot study

Introduction

Studies estimate that 20% of adults suffer from chronic pain. A meta-analysis in low- and middle-income countries (LMICs) found 34% had chronic pain. There are few studies on pain prevalence gathered in Africa. This study surveyed the capital city of Mozambique.

Methods

This was a cross-sectional study employed in a community setting. The Vanderbilt Global Pain Survey comprised questions on the behaviour and attitudes of respondents regarding pain, including previously validated metrics: the Pain Catastrophizing Scale, the World Health Organization Disability Assessment Schedule, the Brief Pain Inventory, Widespread Pain Index and Symptom Severity Score, and the Michigan Body Map.

Results

Ninety-seven surveys were completed out of 100. Pain every day lasting for more than 6 months in their lifetime was reported as 39.2% (CI: 29.4-49.6), and 52% of respondents had pain the day of the interview. However, the pain resulted in little difficulty with activities of daily living and maintaining relationships (61%-89%). Although none reported mental health disorders, 53.6% had experienced a traumatic event in their life, with 45.2% having related nightmares, anxiety, or fear. Most respondents (99%) would take oral medication if it helped their pain, with a large proportion willing to spend significant money for these (49% would pay >US$40) and willing to travel long distances to get help (55.2% would travel >40 kilometer).

Conclusion

The prevalence of chronic pain in Maputo, Mozambique is similar to the average for LMICs. Trends in high-income countries suggest that multimodal pain management and multidisciplinary treatments may improve optimal pain control in LMICs.

Restless Legs Syndrome in a Nigerian Elderly Population

STUDY OBJECTIVES

The prevalence of restless legs syndrome (RLS) is highest in the elderly in Caucasian populations; the prevalence of RLS in elderly Africans is not known. This study aimed at determining the frequency and associations of RLS in a Nigerian elderly population.

METHODS

The study population comprised of 633 consecutive elderly individuals aged 65-105 years attending the general outpatient clinic of the State Hospital, Ilesa, for minor complaints and routine check-up. The diagnosis of RLS was made using the 2003 minimal criteria of the International Restless Legs Syndrome Study Group. Relevant sociodemographic and clinical data, including sleep duration, were also obtained.

RESULTS

Restless legs syndrome was found in 3.5% of the study population with a male-female ratio of 2:1. There was no significant age (p = 0.427) or gender (p = 0.178) influence on the prevalence of RLS except in the 75- to 84-year age group where there was significant male preponderance (p = 0.044). A strong independent association between RLS and sleep duration (OR, 3.229; 95% CI, 1.283-8.486; p = 0.013) and past history of head injury (OR, 4.691; 95% CI, 1.750-12.577; p = 0.002) was found.

CONCLUSIONS

Our finding support previous reports of a possible lower prevalence of RLS in Africans. Restless legs syndrome independently increases the odds of habitual sleep curtailment in elderly individuals. Head injury may be a risk factor for future RLS; this requires further investigation as indirect evidence for a possible link between RLS and traumatic brain injury exists.

Restless legs syndrome associated with major diseases: A systematic review and new concept

Recent publications on both the genetics and environmental factors of restless legs syndrome (RLS) defined as a clinical disorder suggest that overlapping genetic risk factors may play a role in primary (idiopathic) and secondary (symptomatic) RLS. Following a systematic literature search of RLS associated with comorbidities, we identified an increased prevalence of RLS only in iron deficiency and kidney disease. In cardiovascular disease, arterial hypertension, diabetes, migraine, and Parkinson disease, the methodology of studies was poor, but an association might be possible. There is insufficient evidence for conditions such as anemia (without iron deficiency), chronic obstructive pulmonary disease, multiple sclerosis, headache, stroke, narcolepsy, and ataxias. Based on possible gene-microenvironmental interaction, the classifications primary and secondary RLS may suggest an inappropriate causal relation. We recognize that in some conditions, treatment of the underlying disease should be achieved as far as possible to reduce or eliminate RLS symptoms. RLS might be seen as a continuous spectrum with a major genetic contribution at one end and a major environmental or comorbid disease contribution at the other.