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RESTLESS LEGS AND PERIODIC LIMB MOVEMENTS

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

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RESTLESS LEGS AND PERIODIC LIMB MOVEMENTS

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  1. 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

  2. RLS Defined

  3. 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 • Allen RP, et al. Sleep Med. 2002;3:S3-S7. • Garcia-Borreguero D, et al. Neurology. 2003;61(6 suppl 3):S49-S55. • Desautels A, et al. Am J Hum Genet. 2001;69:1266-1270. • Allen RP, et al, for the International Restless Legs Syndrome Study Group. Sleep Med. 2003;4:101-119. • Akyol A, et al. Clin Neurol Neurosurg. 2003;106:23-27. • 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.

  4. RLS Genetics: Familial Patterns

  5. RLS Prevalence in a Primary Care Population

  6. 25 Ohayon (2002) Rothdach (2000) Phillips (2000) 20 Lavigne (1994) Berger (2004) Ulfberg (2001) 15 % of Patients With RLS 10 5 0 18-29 30-49 50-79 ≥80 Age (years) RLS Prevalence by Age

  7. RLS is Often Undiagnosed

  8. Impact on QOL: RLS Patients vs the General Population

  9. RLS Impact on QOL Resembles the Impact of Major Diseases 100 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) 80 60 Mean Score 40 20 0 Physical Role Physical Bodily Pain General Energy/ Social Role Mental Health Functioning Health Vitality Functioning Emotional SF-36 Health Survey Domain Adapted from Allen RP, et al. Arch Intern Med. 2005;165:1286-1292.

  10. Most Troublesome RLS Symptoms Rated by Patients

  11. Some Informal Clues to the Diagnosis

  12. 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.

  13. A Single Screening Question1,2

  14. Related Clinical Features

  15. Diagnosis of RLS • History • Review essential diagnostic criteria • Physical examination • Laboratory tests • Screen for renal failure2 • Screen for diabetes2 • Other tests for potential secondary causes if suspected2 • Polysomnography1 • Serum ferritin2 • Kushida CA, et al. Sleep. 2005;28:499-521. • Allen RP, et al, for the International Restless Legs Syndrome Study Group. Sleep Med. 2003;4:101-119.

  16. Differential Diagnosis

  17. …and for RLS Management

  18. Augmentation Defined

  19. 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.

  20. Restless Legs Syndrome in Pregnancy: Prevalence Prevalence by Month of Pregnancy Prevalence (%) 3-4 Mo. 5-6 Mo. 7-8 Mo. > 9 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.

  21. Educating Patients About RLS

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