Restless Legs Syndrome:: Classification, Diagnosis And Approaches To Treatment
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Restless Legs Syndrome: Classification, Diagnosis and Approaches to Treatment Part 2 of 3
www.wemove.org RLS Slide Library Version 1.0 - All Contents Copyright © WE MOVE 2001
Additional Clinical Characteristics • More than 60% of patients have progressive disease • Symptoms become worse with increasing age
www.wemove.org
Additional Assessment Issue • Current medication regimen for potential causative agents, such as… – – – –
Antiemetics Lithium Neuroleptics Antidepressants
www.wemove.org
RLS Associated with... • Iron deficiency • Uremia • Pregnancy
www.wemove.org
Differential Diagnosis • • • • •
Neuroleptic-induced akathisia ADHD (in children) Anxiety Growing pains Other neurologic condition
www.wemove.org
Differential Diagnosis, cont’d • • • • •
Burning feet syndrome Fibromyalgia Meralgia paresthetica Arthritis Possible psychogenic disorder
www.wemove.org
Pathophysiology of RLS • CNS abnormality (cerebral generators) • Dopaminergic dysfunction • Disinhibition of the flexor reflex during sleep • Possible involvement of the endogenous opiate system
www.wemove.org
Pathophysiology of RLS, cont’d • TMS: impaired motor cortex excitability in RLS • Impaired flexor reflexes • Dopaminergic dysfunction • Blink Reflex: enhanced R2 excitability
www.wemove.org
Central Mechanism Suggested... • PLMS resemble Babinski response • Hyperactive brainstem and spinal cord reflexes • Observed in patients with complete spinal cord lesions • Circadian rhythms to RLS
www.wemove.org
Polysomnographic Findings
www.wemove.org
RLS/Peripheral Involvement • Peripheral nerve involvement – RLS secondary to peripheral neuropathy clinically identical to idiopathic RLS – Subclinical evidence of neuropathy
www.wemove.org
Etiology of RLS • Idiopathic or primary RLS – Sporadic – Familial
• Secondary or symptomatic RLS
www.wemove.org
Familial RLS In some patients… • RLS appears to be inherited as an autosomal dominant genetic trait
www.wemove.org
RLS Genetics • Family history in >50% • Autosomal dominant • Genetic anticipation
www.wemove.org
Secondary RLS • • • • •
Anemia Low Levels of Iron Diabetes/Amyloidosis Alcoholism Increased BMI
• • • • •
Parkinson’s Disease Peripheral Neuropathy Depression Carcinoma Myokymia
www.wemove.org
Secondary RLS, cont’d • End Stage Renal Disease • Folate Deficiency • Nonspecific Prostatitis • Low Testosterone Level • Magnesium Deficiency • Rheumatoid Arthritis
• Pregnancy • Porphyria • Postgastrectomy Complication • COPD • Dermatological Disorders • Caffeine Consumption www.wemove.org
Epidemiology of RLS • • • •
Prevalence of 2% to 5% in adults Estimated prevalence from 5% to 30% Up to 12 million in the U.S. Affects about 5% of population
www.wemove.org
Electrophysiology of RLS • Lack of bereitschaftspotential • NCV is normal • Somatosensory-evoked responses are normal • EMG demonstrates mild increase in polyphasic units
www.wemove.org
Subjective Clinical Assessment Using this scale, how would you rate the following symptoms where 0 = none 1 = mild 2 = moderate 3 = severe 4 = very severe www.wemove.org
Subjective Clinical Assessment • Uncomfortable feelings in the legs and/or arms at rest in the evening or at night? • Need or urge to move around for relief when at rest in the evening or at night? • Relief with movement?
www.wemove.org
Clinical Assessment Questions • Uncontrollable jerks in your legs and/or arms that occur when you rest in the evening or at night? • Difficulty in getting to sleep when you first lie down?
www.wemove.org
Clinical Assessment Questions, cont’d • Difficulty staying asleep during the night, after falling asleep? • Sleepiness or fogginess during the daytime?
www.wemove.org
RLS Slide Set Presented by: WE MOVE 204 West 84th Street New York, NY 10024 Phone: (800) 437-MOV2 (in U.S.) (212) 241-8567 (outside U.S.) Fax: (212) 875-8389 E-mail: [email protected] Web site: www.wemove.org Executive Director: Judy Blazer, MS www.wemove.org
Additional RLS Resource Restless Legs Syndrome Foundation 819 Second Street SW Rochester, MN 55902 US Telephone: (507) 287-6465 Fax: (507) 287-6312 E-mail: [email protected] Web Site: http://www.rls.org www.wemove.org
www.wemove.org RLS Slide Library Version 1.0 - All Contents Copyright © WE MOVE 2001
Additional Clinical Characteristics • More than 60% of patients have progressive disease • Symptoms become worse with increasing age
www.wemove.org
Additional Assessment Issue • Current medication regimen for potential causative agents, such as… – – – –
Antiemetics Lithium Neuroleptics Antidepressants
www.wemove.org
RLS Associated with... • Iron deficiency • Uremia • Pregnancy
www.wemove.org
Differential Diagnosis • • • • •
Neuroleptic-induced akathisia ADHD (in children) Anxiety Growing pains Other neurologic condition
www.wemove.org
Differential Diagnosis, cont’d • • • • •
Burning feet syndrome Fibromyalgia Meralgia paresthetica Arthritis Possible psychogenic disorder
www.wemove.org
Pathophysiology of RLS • CNS abnormality (cerebral generators) • Dopaminergic dysfunction • Disinhibition of the flexor reflex during sleep • Possible involvement of the endogenous opiate system
www.wemove.org
Pathophysiology of RLS, cont’d • TMS: impaired motor cortex excitability in RLS • Impaired flexor reflexes • Dopaminergic dysfunction • Blink Reflex: enhanced R2 excitability
www.wemove.org
Central Mechanism Suggested... • PLMS resemble Babinski response • Hyperactive brainstem and spinal cord reflexes • Observed in patients with complete spinal cord lesions • Circadian rhythms to RLS
www.wemove.org
Polysomnographic Findings
www.wemove.org
RLS/Peripheral Involvement • Peripheral nerve involvement – RLS secondary to peripheral neuropathy clinically identical to idiopathic RLS – Subclinical evidence of neuropathy
www.wemove.org
Etiology of RLS • Idiopathic or primary RLS – Sporadic – Familial
• Secondary or symptomatic RLS
www.wemove.org
Familial RLS In some patients… • RLS appears to be inherited as an autosomal dominant genetic trait
www.wemove.org
RLS Genetics • Family history in >50% • Autosomal dominant • Genetic anticipation
www.wemove.org
Secondary RLS • • • • •
Anemia Low Levels of Iron Diabetes/Amyloidosis Alcoholism Increased BMI
• • • • •
Parkinson’s Disease Peripheral Neuropathy Depression Carcinoma Myokymia
www.wemove.org
Secondary RLS, cont’d • End Stage Renal Disease • Folate Deficiency • Nonspecific Prostatitis • Low Testosterone Level • Magnesium Deficiency • Rheumatoid Arthritis
• Pregnancy • Porphyria • Postgastrectomy Complication • COPD • Dermatological Disorders • Caffeine Consumption www.wemove.org
Epidemiology of RLS • • • •
Prevalence of 2% to 5% in adults Estimated prevalence from 5% to 30% Up to 12 million in the U.S. Affects about 5% of population
www.wemove.org
Electrophysiology of RLS • Lack of bereitschaftspotential • NCV is normal • Somatosensory-evoked responses are normal • EMG demonstrates mild increase in polyphasic units
www.wemove.org
Subjective Clinical Assessment Using this scale, how would you rate the following symptoms where 0 = none 1 = mild 2 = moderate 3 = severe 4 = very severe www.wemove.org
Subjective Clinical Assessment • Uncomfortable feelings in the legs and/or arms at rest in the evening or at night? • Need or urge to move around for relief when at rest in the evening or at night? • Relief with movement?
www.wemove.org
Clinical Assessment Questions • Uncontrollable jerks in your legs and/or arms that occur when you rest in the evening or at night? • Difficulty in getting to sleep when you first lie down?
www.wemove.org
Clinical Assessment Questions, cont’d • Difficulty staying asleep during the night, after falling asleep? • Sleepiness or fogginess during the daytime?
www.wemove.org
RLS Slide Set Presented by: WE MOVE 204 West 84th Street New York, NY 10024 Phone: (800) 437-MOV2 (in U.S.) (212) 241-8567 (outside U.S.) Fax: (212) 875-8389 E-mail: [email protected] Web site: www.wemove.org Executive Director: Judy Blazer, MS www.wemove.org
Additional RLS Resource Restless Legs Syndrome Foundation 819 Second Street SW Rochester, MN 55902 US Telephone: (507) 287-6465 Fax: (507) 287-6312 E-mail: [email protected] Web Site: http://www.rls.org www.wemove.org
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