Restless Legs Syndrome:: Classification, Diagnosis And Approaches To Treatment
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Restless Legs Syndrome: Classification, Diagnosis and Approaches to Treatment Part 1 of 3
www.wemove.org RLS Slide Library Version 1.0 - All Contents Copyright © WE MOVE 2001
Restless Legs Syndrome (RLS) Characterized by... • Desire to move in association with paresthesias/dysesthesias of the limbs • Motor restlessness
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Restless Legs Syndrome, cont’d Characterized by... • Provocative factor of rest • Improved by movement • Evening and nighttime accentuation
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RLS Diagnosis: Minimal Criteria
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ICSD Criteria: RLS • • • • • •
Unpleasant sensations in legs at night Sensations of “creeping” in the calves Relief with movement PSG shows limb movement No medical or psychiatric disorder Other sleep disorder may be present
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Sensory Abnormalities Desire to move limbs associated with... • Paresthesias • Dysesthesias
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Motor Abnormalities • Restlessness...Irresistible urge to move • Relief with Movement
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Provocative Factor of Rest • Symptoms worse or exclusively present at rest, such as while lying down or sitting • Partial or temporary relief with motor activity
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Evening and Nighttime Accentuation • Worsening symptoms during the evening or night • Symptoms typically peak near midnight • Seem to follow a Circadian pattern
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RLS: Associated Findings • Periodic Limb Movements in Sleep (PLMS) • Sleep disturbances • Dyskinesias While Awake (see next slide)
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Dyskinesias While Awake • • • • •
Involuntary and occur at rest Flexion jerk of lower extremities Sporadic, aperiodic, periodic, or in clusters Higher frequency than PLMS Perhaps a “waking counterpart” of PLMS
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Two Forms of RLS • Idiopathic or primary RLS – Familial – Sporadic
• Symptomatic or secondary RLS – Renal failure – Neuropathy – Diabetes – Rheumatoid arthritis
– Iron deficiency – Radiculopathy – Pregnancy
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Positive Family History In idiopathic RLS... Fifty to 60% report a close relative or relatives with RLS-associated symptoms
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Disease Course • Idiopathic RLS: variable age of onset • Symptoms may present during late adulthood • Symptoms tend to increase with age • Some patients experience remissions
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Clinical Characteristics • Mean age of onset is 27 years • Unilateral onset in 42% • Arm involvement in 25% to 50%
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Clinical Features of RLS • Affects females more than males • Sleep disturbance in about 94% – Sleep latency insomnia – Fragmented or nonrestorative sleep – Excessive daytime sleepiness in 22%
www.wemove.org
www.wemove.org RLS Slide Library Version 1.0 - All Contents Copyright © WE MOVE 2001
Restless Legs Syndrome (RLS) Characterized by... • Desire to move in association with paresthesias/dysesthesias of the limbs • Motor restlessness
www.wemove.org
Restless Legs Syndrome, cont’d Characterized by... • Provocative factor of rest • Improved by movement • Evening and nighttime accentuation
www.wemove.org
RLS Diagnosis: Minimal Criteria
www.wemove.org
ICSD Criteria: RLS • • • • • •
Unpleasant sensations in legs at night Sensations of “creeping” in the calves Relief with movement PSG shows limb movement No medical or psychiatric disorder Other sleep disorder may be present
www.wemove.org
Sensory Abnormalities Desire to move limbs associated with... • Paresthesias • Dysesthesias
www.wemove.org
Motor Abnormalities • Restlessness...Irresistible urge to move • Relief with Movement
www.wemove.org
Provocative Factor of Rest • Symptoms worse or exclusively present at rest, such as while lying down or sitting • Partial or temporary relief with motor activity
www.wemove.org
Evening and Nighttime Accentuation • Worsening symptoms during the evening or night • Symptoms typically peak near midnight • Seem to follow a Circadian pattern
www.wemove.org
RLS: Associated Findings • Periodic Limb Movements in Sleep (PLMS) • Sleep disturbances • Dyskinesias While Awake (see next slide)
www.wemove.org
Dyskinesias While Awake • • • • •
Involuntary and occur at rest Flexion jerk of lower extremities Sporadic, aperiodic, periodic, or in clusters Higher frequency than PLMS Perhaps a “waking counterpart” of PLMS
www.wemove.org
Two Forms of RLS • Idiopathic or primary RLS – Familial – Sporadic
• Symptomatic or secondary RLS – Renal failure – Neuropathy – Diabetes – Rheumatoid arthritis
– Iron deficiency – Radiculopathy – Pregnancy
www.wemove.org
Positive Family History In idiopathic RLS... Fifty to 60% report a close relative or relatives with RLS-associated symptoms
www.wemove.org
Disease Course • Idiopathic RLS: variable age of onset • Symptoms may present during late adulthood • Symptoms tend to increase with age • Some patients experience remissions
www.wemove.org
Clinical Characteristics • Mean age of onset is 27 years • Unilateral onset in 42% • Arm involvement in 25% to 50%
www.wemove.org
Clinical Features of RLS • Affects females more than males • Sleep disturbance in about 94% – Sleep latency insomnia – Fragmented or nonrestorative sleep – Excessive daytime sleepiness in 22%
www.wemove.org
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