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Treatment of restless legs syndrome
Spolador, Tiago;Allis, Johanna Clair Sá;Pondé, Milena Pereira;
Revista Brasileira de Psiquiatria , 2006, DOI: 10.1590/S1516-44462006005000001
Abstract: objective: restless legs syndrome is a neurological disorder characterized by a desire to move limbs, which is usually only present or worsens during rest or at night. the objective of this article was to review the available literature about pharmacological treatment for this disorder. method: a search of recent literature was undertaken on online databases (medline, pubmed, scielo and lilacs). results: 502 articles were retrieved, of which 30 were selected. dopaminergic agents, anticonvulsants, opioids, benzodiazepines, zolpidem, entacapone and ketamine were all effective on the restless legs syndrome treatment. one study showed that iron was not effective. conclusions: based on few double-blind, randomized, controlled trials, it seems that the best options to treat restless legs syndrome patients are gabapentin and l-dopa associated to its sustained release formulation.
Restless legs syndrome: literature review
Symvoulakis, Emmanouil;Anyfantakis, Dimitrios;Lionis, Christos;
Sao Paulo Medical Journal , 2010, DOI: 10.1590/S1516-31802010000300008
Abstract: restless legs syndrome is a distressing condition, with negative effects on sleep and daytime activities that affect personal, family and occupational life. the overall impact of restless legs syndrome on quality of life is comparable to that of chronic and frustrating conditions such as depression and diabetes. misdiagnosis and inappropriate treatment may increase patients' suffering in terms of uncertainty, overuse or misuse of care services and lack of trust. presenting a synthesis of the main topics in the literature on restless legs syndrome facilitates for a better understanding and its management in primary care settings.
Restless legs syndrome
Ovallath S, Deepa P
Journal of Parkinsonism & Restless Legs Syndrome , 2012, DOI: http://dx.doi.org/10.2147/JPRLS.S37451
Abstract: tless legs syndrome Review (774) Total Article Views Authors: Ovallath S, Deepa P Published Date October 2012 Volume 2012:2 Pages 49 - 57 DOI: http://dx.doi.org/10.2147/JPRLS.S37451 Received: 28 August 2012 Accepted: Published: 17 October 2012 Sujith Ovallath, P Deepa James Parkinson's Movement Disorder Research Centre, Kannur Medical College, Kerala, India Background: Restless legs syndrome (RLS) is a common sleep-related disorder characterized by abnormal sensation and an urge to move the lower limbs. Symptoms occur at rest in the evening or at night, and they are alleviated by moving the affected extremity or by walking. Although the exact etiopathogenesis of RLS remains elusive, the rapid improvement of symptoms with dopaminergic agents suggests that dopaminergic system dysfunction may be a basic mechanism. Dopaminergic agents are the best-studied agents, and are considered first-line treatment of RLS. Objective: To review the diagnostic criteria, clinical features, etiopathogenesis, and the treatment options of RLS. Methods: The suggestions are based on evidence from studies published in peer-reviewed journals, or upon a comprehensive review of the medical literature. Results/conclusion: Extensive data are available for proving the link between the dopaminergic system and RLS. A possible genetic link also has been studied extensively. Dopamine agonists, especially pramipexole and ropinirole, are particularly useful in the treatment of RLS. Pharmacological treatment should however be limited to those patients who suffer from clinically relevant RLS with impaired sleep quality or quality of life.
Restless legs syndrome in patients with hemodialysis
Hüseyin Atl?,Mehmet ??lbay,Serap Demir,?eref Yüksel
Medical Journal of Bakirk?y , 2008,
Abstract: Objective: The restless legs syndrome (RLS) is characterized by unpleasant sensations and pain in the legs, irresistible urge to move the legs, especially when resting and often accompanied by sleep disorders. RLS prevalence is up to 80% in hemodialysis patients. It is such an important clinical condition that is associated with increased mortality. Moreover etiopathogenesis is not clear. We aimed to evaluate vascular disorders, heart rate variability, oxidative stress parameter in hemodialysis patients with RLS. Material and Methods: Study was conducted with hemodialysis patients. Twenty five patients diagnosed as RLS with International Restless Legs Study Group criteria, and twenty five patients without RLS (control group) were included to the study. Patients were examined with complete blood count and biochemical assays, Kt/V, oxidative stress parameter such as malon dialdehyde and sulphydryl, lower extremity Doppler ultrasonography and 24 hour holter heart rate variability. Results: Patients with RLS had significantly lower hemoglobin and sodium levels (p:0.025 ve p:0.038). Tibialis posterior and anterior artery ow was significantly reduced in patients with RLS (p:0.011 ve p:0.010). There was significant correlation about low hemoglobin and sodium level and reduced tibialis posterior and anterior artery ow. With logistic regression analysis, only hemoglobin was determined as independent factor on RLS (OR 6.211 [%95 CI 1.368-26.176] p=0.018). Conclusion: It is concluded that hemoglobin is an important independent factor for progression to RLS. Therefore hemoglobin level must be maintained in normal range especially in patients with RLS.
Restless legs syndrome in patients on hemodialysis  [cached]
Salman Saleh Mohammad
Saudi Journal of Kidney Diseases and Transplantation , 2011,
Abstract: Restless legs syndrome (RLS) is common among dialysis patients, with a reported prevalence of 6-60%. The prevalence of RLS in Syrian patients on hemodialysis (HD) is not known. The purpose of this study is to determine the prevalence of RLS in patients on regular HD, and to find the possible correlation between the presence of RLS and demographic, clinical, and biochemical factors. One hundred and twenty-three patients (male/female = 70/53, mean age = 41.95 ± 15.11 years) on HD therapy at the Aleppo University Hospital were enrolled into the study. RLS was diagnosed based on criteria established by the International Restless Legs Syn-drome Study Group (IRLSSG). Data procured were compared between patients with and without RLS. Applying the IRLSSG criteria for the diagnosis, RLS was seen in 20.3% of the study pa-tients. No significant difference in age, gender, and intake of nicotine and caffeine was found between patients with and without the RLS. Similarly, there was no difference between the two groups in the duration of end-stage renal disease (ESRD), the period of dialysis dependence, dialysis adequacy, urea and creatinine levels, and the presence of anemia. The co-morbidities and the use of drugs also did not differ in the two groups. Our study suggests that the high prevalence of RLS among patients on HD requires careful attention and correct diagnosis can lead to better therapy and better quality of life. The pathogenesis of RLS is not clear and further studies are required to identify any possible cause as well as to discover the impact of this syndrome on sleep, quality of life, and possibly other complications such as cardiovasculare disease.
Restless legs syndrome in patients on dialysis  [cached]
Al-Jahdali Hamdan,Al-Qadhi Waleed,Khogeer Haithm,Al-Hejaili Fayez
Saudi Journal of Kidney Diseases and Transplantation , 2009,
Abstract: Restless legs syndrome (RLS) is an extremely distressing problem experienced by patients on dialysis; the prevalence appears to be greater than in the general population, with a wide variation from 6.6% to 80%. The diagnosis of RLS is a clinical one, and its definition has been clarified and standardized by internationally recognized diagnostic criteria, published in 1995 by the International Restless Legs Syndrome Study Group (IRLSSG). This study was designed to find out the prevalence of RLS in Saudi patients with end-stage renal disease (ESRD) on maintenance dialysis. This is a cross sectional study carried out between May and Sept 2007 at two centers, King Abdulaziz Medical City-King Fahad National Guard Hospital (KAMC-KFNGH), Riyadh and King Faisal Specialist Hospital and Research Centre (KFHRC), Jeddah, Saudi Arabia. Data were gathered on 227 Saudi patients on chronic maintenance hemodialysis or chronic peritoneal dialysis. The prevalence of RLS was measured using IRLSSG′s RLS Questionnaire (RLSQ). Potential risk factors for RLS including other sleep disorders, underlying cause of chronic renal failure, duration on dialysis, dialysis shift, biochemical tests and demographic data were also evaluated. The overall prevalence of RLS was 50.22% including 53.7% males and 46.3% females. Their mean age was 55.7 ± 17.2 years and mean duration on dialysis 40.4 ± 37.8 months. Significant predictors of RLS were history of diabetes mellitus (DM), coffee intake, afternoon dialysis, gender and type of dialysis (P= 0.03, 0.01, < 0.001, 0.05 and 0.009 respectively). Patients with RLS were found to be at increased risk of having insomnia and excessive daytime sleepiness (EDS) (P= < 0.001 and 0.001, respectively). Our study suggests that RLS is a very common problem in dialysis population and was significantly associated with other sleep disorders, particularly insomnia, and EDS. Optimal care of dialysis patient should include particular attention to the diagnosis and management of sleep disorders
Restless legs syndrome in institutionalized elderly
Dantas, Fábio Galv?o;Medeiros, Jovany Luis Alves;Farias, Kelly Soares;Ribeiro, Clarissa Dantas;
Arquivos de Neuro-Psiquiatria , 2008, DOI: 10.1590/S0004-282X2008000300008
Abstract: restless legs syndrome (rls) is characterized by disturbing leg sensations associated to sleep complaints and excessive daytime somnolence. in the elderly, it affects 10 to 35%. our objective was to determine the prevalence of rls in institutionalized elderly, analyzing its relationship with clinical, laboratorial and neurophysiological features. we conducted a cross-sectional study of all the subjects under treatment on a chronic-care geriatric service by using face-to-face interviews, which include sleep complaints, the epworth sleepiness scale and standardized questions addressing the four minimal criteria for rls. the patients with rls diagnosis received neurological examination, laboratorial tests and three of them, neurophysiological evaluation. the prevalence of rls was 15.6%. women were more affected and sleep complaints were frequent. there was no significance on other clinical, laboratorial or neurophysiological findings. we conclude that rls is a prevalent condition in elderly, may lead to sleep complaints and is often underdiagnosed.
Translation and validation into the Brazilian Portuguese of the restless legs syndrome rating scale of the International Restless Legs Syndrome Study Group
Masuko, Alice H.;Carvalho, Luciane B.C.;Machado, Marco A.C.;Morais, José F.;Prado, Lucila B.F.;Prado, Gilmar F.;
Arquivos de Neuro-Psiquiatria , 2008, DOI: 10.1590/S0004-282X2008000600011
Abstract: background: restless legs syndrome (rls) is a chronic sensory-motor disorder characterized by unpleasant limb sensations and an irresistible urge to move. the international restless legs syndrome study group developed the restless legs syndrome rating scale (irls) to assess the severity of rls symptoms. the objective of this study was to translate and validate the irls into brazilian portuguese. method: the irls was translated into brazilian portuguese, analyzed, back translated to english, and compared to the original version. it was applied to 10 patients for cultural verification. the language was adjusted and the final version was administered to 30 patients (13 male, mean age 58.88±14.82). results: there was correlation among the irls evaluation of three experts. many linguistic adaptations were required to achieve cultural adequacy and the cronbach's alpha coefficient showed reliability of 80%. conclusion: irls was translated, adapted, and validated to brazilian portuguese language, showing good reliability and validity.
Restless Legs Syndrome as a Comorbidity in Rheumatoid Arthritis  [PDF]
John A. Gjevre,Regina M. Taylor Gjevre
Autoimmune Diseases , 2013, DOI: 10.1155/2013/352782
Abstract: Rheumatoid arthritis (RA) is a multisystem disease with a complex immunologic pathophysiology. Likewise, sleep disorders can involve a complicated interplay between the neurologic pathways, immune system, and respiratory system. Recent studies have shown an elevated prevalence of sleep abnormalities in connective tissue disorders compared to the general population. Restless legs syndrome (RLS) may be present in up to 30% of RA patients. These findings may be related to cytokine release and other immunomodulatory responses. TNF-α levels relate to sleep physiology and anti-TNF-α therapy may improve sleep patterns. Most of the patients with this disorder can distinguish their RLS sensations from their arthritic symptoms. RLS is a common comorbidity seen with RA, and prompt recognition and treatment can improve patient quality of life. 1. Introduction Restless legs syndrome (RLS), also called Willis-Ekbom’s disease, is a common clinical syndrome which consists of an uncomfortable sensation in one’s legs and an irresistible desire to move them usually occurring in the evening. This disorder has been underrecognized and misunderstood by many health care providers as well as the general public. While the original description of RLS was first reported by Dr. Karl Ekbom in 1945, this entity was mainly ignored by clinicians and researchers until the late 1980s [1]. Due to the lack of clear criteria, the International Restless Legs Syndrome Study Group (IRLSSG) was formed and developed clinical criteria in 1995 [2]. Subsequently, the IRLSSG has released revised guidelines to help in the clinical diagnosis and epidemiologic research of RLS [3]. This has helped to both significantly raise awareness of this disorder as well as to further basic scientific and clinical research into RLS. 2. RLS Diagnosis and Background The Willis-Ekbom (RLS) Foundation describes this disease as a disruptive neurologic disorder that seriously affects 2-3% of the population and may affect up to 10% of the U.S. population [4]. Patients will describe an uncomfortable itching or “creepy-crawling” sensation on the legs in the evenings, and this may impact negatively on sleep and quality of life. The 2003 IRLSSG criteria originally listed four essential criteria to clinically diagnose RLS with a 2011 revision adding a fifth criteria. 2011 Revised IRLSSG Diagnostic Criteria(1)An urge to move the legs usually but not always accompanied by or felt to be caused by uncomfortable or unpleasant sensations in the legs.(2)The urge to move the legs and any accompanying unpleasant sensations begin or
Restless Legs Syndrome as the Initial Presentation of Multiple Sclerosis  [PDF]
Ceyla Irkec,Doga Vurall?,Sebnem Karacay Ozkalayc?
Case Reports in Medicine , 2013, DOI: 10.1155/2013/290719
Abstract: The restless legs syndrome (RLS) is a common central nervous system disorder. It is characterized by complaints of unpleasant sensation in the legs occurring during periods of leg inactivity which worsen or only occur in the evening or at night and relieved partially or totally by movement. The RLS may be idiopathic or due to secondary causes. It is associated with several pathological or physiological conditions. Iron metabolism and dysfunctions of the dopaminergic system are the most important factors in the pathophysiology. There are several studies suggesting multiple sclerosis as one of the causes of symptomatic RLS. Here, we report a case of RLS as the initial presentation of MS. The sudden onset of RLS symptoms in our patient suggested the possibility of an underlying cause. His diagnostic evaluation excluded other causes of RLS and his clinical course suggested that RLS was due to MS. MS with the spinal cord involvement is mostly associated with RLS, but any lesion in the hypothalamic-spinal connection may cause disinhibition of lower spinal levels, resulting in RLS. RLS as the initial presentation of MS reflects that the pathophysiology of RLS in MS is related to inflammatory demyelination rather than axonal degeneration. 1. Introduction The restless legs syndrome (RLS) is a common central nervous system disorder with a prevalence in the general population ranging between 2.5 and 15% [1]. It is characterized by complaints of unpleasant sensation in the legs occurring during periods of leg inactivity which worsen or only occur in the evening or at night and relieved partially or totally by movement [2]. The diagnosis of RLS is established by the clinical features based on the criteria of International Restless Legs Syndrome Study Group (IRLSSG) [3]. The RLS maybe idiopathic or due to secondary causes. It is associated with several pathological or physiological conditions such as iron deficiency, diabetes mellitus, peripheral neuropathies, Parkinson’s disease, essential tremor, spinocerebellar ataxias, myelopathies, renal failure, rheumatoid arthritis, and pregnancy [4–6]. Iron metabolism and dysfunctions of the dopaminergic system are the most important factors in the pathophysiology [7]. There are several studies suggesting multiple sclerosis as one of the causes of symptomatic RLS [6, 8–10]. Here, we report a case of RLS as the initial presentation of MS. 2. Case Report A 44-year-old man presented with a sudden onset of lower extremity paresthesias, with an urge to move his legs when he rests in bed or sits for a long time. The patient was
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