RESTLESS LEGS AND PERIODIC LIMB
MOVEMENTS
ANTONIO CULEBRAS, MD, FAAN, FAHA, FAASM
Professor of Neurology
SUNY Upstate Medical University
Syracuse, N.Y. USA
SLEEP CENTER TEACHING DAY PROGRAM
May 7, 2016
RLS Defined
Primary & Secondary RLS
Primary RLS
– No apparent cause, except perhaps genetic
predisposition1-3
– Severe cases appear to be a chronic condition4
– Since many patients do not seek treatment, little is known
about the clinical course in milder and intermittent cases4
Secondary RLS
– Associated with iron deficiency,5,6 end-stage renal
disease,7 and pregnancy8
– May remit on resolution of the causative condition (eg,
after pregnancy)9
1. Allen RP, et al. Sleep Med. 2002;3:S3-S7.
5. Akyol A, et al. Clin Neurol Neurosurg. 2003;106:23-27.
2. Garcia-Borreguero D, et al. Neurology. 2003;61(6 suppl
3):S49-S55.
3. Desautels A, et al. Am J Hum Genet. 2001;69:1266-1270.
4. Allen RP, et al, for the International Restless Legs
Syndrome Study Group. Sleep Med. 2003;4:101-119.
6.
7.
8.
9.
O'Keeffe ST, et al. Age Ageing. 1994;23:200-203.
Winkelman JW, et al. Am J Kidney Dis. 1996;28:372-378.
Berger K, et al. Arch Intern Med. 2004;164:196-202.
Lee KA, et al. J Womens Health Gend Based Med. 2001;10:335-341.
RLS Genetics: Familial Patterns
RLS Prevalence in a Primary Care Population
RLS Prevalence by Age
25
Ohayon (2002)
Rothdach (2000)
Phillips (2000)
Lavigne (1994)
Berger (2004)
Ulfberg (2001)
% of Patients With RLS
20
15
10
5
0
18-29
30-49
50-79
Age (years)
≥80
RLS is Often Undiagnosed
Impact on QOL: RLS Patients vs
the General Population
100
80
RLS Impact on QOL Resembles the
Impact of Major Diseases
Moderate to Severe RLS Patients US (n = 158)
Patients in the General Population with:
Type 2 Diabetes Mellitus (n = 541)
Osteoarthritis (n = 175)
Depression (n = 502)
Mean Score
60
40
20
0
Physical
Functioning
Role Physical
Bodily Pain
General
Health
Energy/
Vitality
Social
Functioning
SF-36 Health Survey Domain
Adapted from Allen RP, et al. Arch Intern Med. 2005;165:1286-1292.
Role
Emotional
Mental Health
Most Troublesome RLS Symptoms
Rated by Patients
Some Informal Clues to the Diagnosis
RLS Essential Diagnostic Criteria
• Urge to move legs, usually accompanied by uncomfortable leg
sensations
• Worsening of symptoms at rest or with inactivity, such as when
lying or sitting
• Worsening of symptoms in the evening and at night
• Relief with movement —partial or total relief from discomfort by
walking or stretching
Allen RP, et al, for the International Restless Legs Syndrome Study Group. Sleep Med. 2003;4:101-119.
A Single Screening Question1,2
Related Clinical Features
Diagnosis of RLS
• History
– Review essential diagnostic criteria
• Physical examination
• Laboratory tests
• Screen for renal failure
2
• Polysomnography1
• Serum ferritin2
• Screen for diabetes2
• Other tests for potential secondary
causes if suspected2
1. Kushida CA, et al. Sleep. 2005;28:499-521.
2. Allen RP, et al, for the International Restless Legs Syndrome Study Group. Sleep Med. 2003;4:101-119.
Differential Diagnosis
…and for RLS Management
Augmentation Defined
Prevalence by Age and Gender from the
REST Population-based Survey
Allen RP, Walters AS, Montplaisir J, et al. Restless Legs Syndrome Prevalence and Impact: REST General Population Study.
Arch Intern Med 2005;165(11):1286-92.
Restless Legs Syndrome in
Pregnancy: Prevalence
Prevalence
Pregnacy
Prevalence by
by Months
Month ofofPregnancy
25
Prevalence
Prevalence(%)
(%)
20
15
10
5
0
5-6 Mo.
7-8 Mo.
>9
s
th
s
s
th
hs
on
on
th
on
t
on
m
m
m
m
8
6
4
> 9 Mo.
7-
5-
3-
3-4 Mo.
Suzuki K, Ohida T, Sone T, et al. The prevalence of restless legs syndrome among pregnant women in Japan and the relationship
between restless legs syndrome and sleep problems. Sleep 2003;26(6):673-7.
Educating Patients About RLS