How to help patients with restless legs syndrome. Discerning the indescribable and relaxing the restless

The burden of restless legs syndrome: an assessment of work productivity, sleep, psychological distress, and health status among diagnosed and undiagnosed individuals in an internet-based panel

BACKGROUND

Restless legs syndrome (RLS) affects approximately 10-15% of the general population and has deleterious effects on sleep and subsequent daytime performance. The disorder may also give rise to long-term complications such as psychological distress and diminished quality of life. The condition is often unrecognized or misdiagnosed, and the magnitude of the effects of RLS on the sizeable proportion of undiagnosed (and therefore untreated) individuals has not previously been evaluated.

OBJECTIVES

This study examined the impact of RLS on overall health status, sleep, psychological functioning, work productivity, and daily activities in individuals with diagnosed and in those with undiagnosed (self-reported) RLS.

METHODS

An internet-based survey was conducted on a multimillion-member panel of US adults. Eligible participants were currently experiencing RLS symptoms as determined using established diagnostic criteria. Participants provided information related to self-reported RLS diagnosis, treatment, symptom frequency and severity, and responses to validated instruments (Medical Outcomes study [MOS] Short Form 12, version 2 [SF-12v2], MOS Sleep Scale, Center for Epidemiological Studies Depression Scale [CES-D], Work Productivity and Activity Impairment - General Health Questionnaire [WPAI-GH] and Work Limitations Questionnaire [WLQ]). Analysis of co-variance (ANCOVA) models were developed to evaluate the relationships among symptom severity, diagnosis status, age, and sex, and the impact of RLS.

RESULTS

Participants included 702 adults with RLS symptoms. Means for the SF-12v2 scores (physical component score = 35.6, mental component score = 42.6) were at least 1 standard deviation lower than sex- and age-adjusted general population norms. Participants reported poorer sleep quality scores across each MOS Sleep Scale domain, with differences from published norms of >16 points on 100-point scales, as well as approximately 1 hour less sleep per night on average. A majority (64%) met the cut-off score for depression. Compared with population norms, the sample reported greater limitations in time management, physical demands, mental/interpersonal demands, general work output, and usual activities. Symptom intensity and frequency were shown to be the primary predictors of RLS impact on the various outcomes.

CONCLUSION

These results support previous reports that RLS often goes undiagnosed or misdiagnosed. The results of this survey also suggest that regardless of whether RLS is recognized, the burden of the disorder is substantial, implying a need for improved diagnosis and management of RLS.

Diagnosing restless legs syndrome (RLS) in primary care

This paper represents a review of current opinion and information on the effective diagnosis of restless legs syndrome (RLS) in a primary care setting. RLS can be a distressing condition--it can cause serious sleep disturbance and has a significant impact on quality of life comparable to that of depression or type 2 diabetes. The prevalence of adults whose RLS is severe enough to warrant medical advice has been estimated to be approximately 3%, but only a small proportion of these patients currently report having been diagnosed in primary care, despite stating that they have presented to their GP. The benefits of increased understanding of the symptoms of RLS and how patients present in primary care are discussed, with emphasis on how this will help GPs more effectively diagnose and manage the patients affected. Guidelines on how to diagnose RLS in a primary care setting are given--when a patient presents with sleep disturbance, RLS should be routinely considered and, where existing, be readily diagnosed in a primary care setting on the basis of the patient's clinical history, a physical examination and with the aid of four questions based on the International RLS Study Group (IRLSSG) four essential diagnostic criteria.

Piribedil for restless legs syndrome: a pilot study

Thirteen consecutive patients with restless legs syndrome (RLS) were treated with piribedil and were rated using an RLS rating scale (0-10) and subjective response (0-100%); 11/13 (85%) had improvement of their mean RLS scores with subjective response ranging from 30% to 100% (mean 74.6%). This pilot study suggests that piribedil is effective for RLS.

Prehension patterns in restless legs syndrome patients

The pathogenesis of restless legs syndrome (RLS) is poorly understood. Previously we have shown that a reach-to-grasp task can be used to differentiate Parkinson's disease (PD) patients from healthy age-matched control subjects. The aim of this study was to determine if performance on this task could be used to differentiate between patients with RLS, PD patients, and healthy control subjects. Results indicated that RLS and control participants produced movement patterns that were nearly identical to one another, while movement patterns produced by the PD patients were significantly different from the other two groups. These results suggest RLS patients do not show any abnormalities in the performance of upper extremity prehension movements. Thus, these movements can be used to effectively differentiate between patients with Parkinson's Disease and Restless Legs Syndrome. While RLS patients respond favorably to dopaminergic therapies, this study suggests that PD and RLS may not share the same basal ganglia pathophysiology.

Use of Tramadol to Control Restless Legs Syndrome after Orthopedic Surgery

A patient with a history of severe osteoarthritis and restless legs syndrome (RLS), who had recently undergone orthopedic surgery, began to experience the involuntary movement and pain associated with RLS. These symptoms, which also deprived the patient of sleep, complicated her postsurgical rehabilitation. The onset of symptoms coincided with attempts to discontinue her opiate analgesic regimen. The patient was evaluated; no significant comorbid conditions or drug therapies that might have aggravated her RLS symptoms were noted. After a discussion of the risks and benefits of the pharmacologic options, it was decided that Tramadol was the best therapy for this patient. A follow-up review of the patient's clinical course at 7, 30, and 60 days showed that Tramadol was quite effective in controlling her RLS symptoms and joint pain.

Amantadine is beneficial in restless legs syndrome

Twenty-one patients (mean age 70 yrs) with restless legs syndrome (RLS) were treated with amantadine in an open-label trial. Amantadine was started at 100 mg per day and was increased every 3-5 days by 100 mg (up to a maximum of 300 mg per day) until significant relief of symptoms or intolerable side effects were experienced. Patients were rated pre- and posttreatment using an RLS rating scale (0-10). Each patient also rated the degree of response in a continuous scale from 0% (no improvement) to 100% (complete improvement). Eleven of 21 (52%) had subjective benefit to amantadine, with degree of response ranging from 25%-100% (mean 69%) among responders. Six had 95%-100% improvement. The RLS score for all 21 patients dropped from a mean (+/- standard deviation) of 9.8 +/- 0.6 (range, 8-10) pretreatment to 6.6 +/- 3.8 (range, 0-10) posttreatment (p = 0.001). The duration of response was 0-13 months (mean, 3.6 +/- 4.5), with nine responders still remaining on the drug as of last follow up. The mean effective dose was 227 mg per day. The most common side effects were drowsiness (3), fatigue (2), and insomnia (2); only two stopped amantadine because of side effects. We conclude that amantadine is an effective and well-tolerated drug for RLS.