Indian Journal of Sleep Medicine

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VOLUME 9 , ISSUE 2 ( April-June, 2014 ) > List of Articles

REVIEW ARTICLE

Restless legs syndrome: Common yet an under recognized entity

Keywords : Restless legs syndrome, periodic limb movements during sleep.

Citation Information : Restless legs syndrome: Common yet an under recognized entity. Indian Sleep Med 2014; 9 (2):41-49.

DOI: 10.5958/0974-0155.2014.01103.6

License: NA

Published Online: 01-03-2018

Copyright Statement:  NA


Abstract

Restless legs syndrome (RLS) or Willis–Ekbom disease is a common yet an underrecognized disease despite the fact that awareness is the only equipment required to diagnose this condition. The RLS is diagnosed with four essential criteria that can be abbreviated as “URGE,” that is, urge to move, rest induced, gets better with activity, and evening and night accentuation. Periodic limb movementsduring sleep (PLMS), a component of RLS, in 90% cases needs to be differentiated from RLS as PLMS may also be seen with disorders such as obstructive sleep apnea, upper airway resistance syndrome, narcolepsy, and rapid eye movement sleep disorder in 70% cases. Diagnosis of PLMS contrary to RLS requires sleep study. This review was aimed at increasing awareness about RLS; differentiating RLS from PLMS; and pathogenesis, management options, and recent advances for RLS.


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  1. Byrne R, Sinha S, Chaudhuri KR. Restless legs syndrome: diagnosis and review of management options. Neuropsychiatr Dis Treat 2006; 2(2): 155–64.
  2. Yoakum R. Night Walkers: Do Your Legs Seem to have a Life of Their Own? Your Torment has a Name. Modern Maturity September-October 1994;55:82–4.
  3. Panda S, Taly AB, Sinha S, Gururaj G, Girish N, Nagaraja D. Sleep-related disorders among a healthy population in South India. Neurol India 2012; 60:68–74.
  4. Gupta R, Lahan V, Goel D. Restless Legs Syndrome: a common disorder, but rarely diagnosed and barely treated— an Indian experience. Sleep Med 2012;13: 838–41.
  5. Leschziner G, Gringras P. Restless legssyndrome. BMJ 2012;344:e3056.
  6. Ohayon MM, O'Hara R, Vitiello MV.Epidemiology ofrestless legs syndrome: a synthesis of the literature. Sleep Med Rev2012;16(4):283–95.
  7. Winkelmann J, Wetter TC, Collado-Seidel V, Gasser T, Dichgans M, Yassouridis A, et al. Clinical characteristics and frequency of the hereditary restless legs syndrome in a population of 300 patients. Sleep 2000;23:597–602.
  8. Natarajan R. Review of periodic limb movement and restless leg syndrome. J Postgrad Med 2010;56:157–62.
  9. Wetter TC, Eisensehr I, Trenkwalder C. Functional neuroimaging studies in restless legs syndrome. Sleep Med2004;5:401–6.
  10. Rizzo G, Tonon C, Manners D, Testa C, Lodi R. Imaging brain functional and metabolic changes in restless legssyndrome. Curr NeurolNeurol Neurosci Rep 2013;13:372.
  11. Rizzo G, Tonon C, Testa C, Manners D, Vetrugno R, Pizza F, et al. Abnormal medial thalamic metabolism in patients with idiopathic restless legs syndrome. Brain 2012;135:3712– 20.
  12. Ku J, Cho YW, Lee YS, Moon H, Chang H, Christopher J, et al. Functional connectivity alternation of the thalamus in restless legs syndrome patients during the asymptomatic period: a resting-state connectivity study using functional magnetic resonance imaging. Sleep Med 2014; 15: 289– 94.
  13. Salminen A, Polo O. Peripheral hypoxia in patients with restless legs syndrome. Sleep Med 2013;14:e39–40
  14. Earley CJ, Connor J, Garcia-Borreguero D, Jenner P, Winkelman J, Zee PC, et al. Altered brain iron homeostasis and dopaminergic function in restless legs syndrome (Willis– Ekbomdisease). Sleep Med 2014;15: 1288–301.
  15. Walters AS. Toward a better definition of restless legs syndrome. The International Restless Legs Syndrome Study Group. Mov Disord 1995;10:634–42.
  16. Allen RP, Picchietti D, Hening WA, Trenkwalder C, Walters AS, Montplaisi J, et al. Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med 2003;4:101–19.
  17. Hening W, Allen RP, Tenzer P, Winkelman JW. Restless legs syndrome: demographics, presentation, and differential diagnosis. Geriatrics2007;62:26–9.
  18. Klingelhoefer L, Cova I, Gupta S, Chaudhuri KR. A review of current treatment strategies for restless legs syndrome (Willis–Ekbom disease). Clin Med 2014;14: 520–4.
  19. Walters AS, LeBrocq C, Dhar A, Hening W, Rosen R, Allen RP, et al. Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome. Sleep Med 2003;4: 121–32.
  20. Gupta R, Lahan V, Goel D. Translation and validation of International Restless Leg Syndrome Study Group rating scale in Hindi language. Ann Indian Acad Neurol 2011;14:257–61.
  21. Rijsman RM, de Weerd AW. Secondary periodic limb movement disorder and restless legs syndrome. Sleep Med Rev 1999;3:147–58.
  22. Iber C, Ancoli-Israel S, Jr Chesson AL, Quan SF. The AASM Manual for the Scoring of Sleep and Associate Events: Rules, Terminology and Technical Specifications. American Academy of Sleep Medicine, Westchester, IL, 2007.
  23. Garcia-Borreguero D, Stillman P, Benes H, Buschmann H, Chaudhuri KR, Gonzalez Rodríguez VM, et al. Algorithms for the diagnosis and treatment of restless legs syndrome in primary care. BMC Neurol 2011;11:28.
  24. Allen RP, Walters AS, Montplaisir J, Hening W, Myers A, Bell TJ, et al. Restless legs syndrome prevalence and impact: REST general population study. Arch Intern Med 2005;165:1286–92.
  25. Happe S, Reese JP, Stiasny-Kolster K, Peglau I, Mayer G, Klotsche J, et al. Assessing health-related quality of life in patients with restless legs syndrome. Sleep Med 2009;10:295–305.
  26. Li Y, Walters AS, Chiuve SE, Rimm EB, Winkelman JW, Gao X. Prospective study of restless legs syndrome and coronary heart disease among women. Circulation 2012;126:1689–94.
  27. Innes KE, Selfe TK, Agarwal P. Restless legs syndrome and conditions associated with metabolic dysregulation, sympathoadrenal dysfunction, and cardiovascular disease risk: a systematic review. Sleep Med Rev 2012;16(4):309– 39.
  28. Winkelman JW, Redline S, Baldwin CM, Resnick HE, Newman AB, Gottlieb DJ. Polysomnographic and healthrelated quality of life correlates of restless legs syndrome in the Sleep Heart Health Study. Sleep 2009;32:772–8.
  29. Allen RP, Earley CJ. Defining the phenotype of the restless legs syndrome (RLS) using age-of-symptom-onset. Sleep Med 2000;1:11–19.
  30. Ondo W, Jankovic J. Restless legs syndrome: clinicoetiologic correlates. Neurology 1996;47(6):1435–41.
  31. Allen RP. Controversies and challenges in defining the etiology and pathophysiology of restless legs syndrome. Am J Med 2007;120(1 Suppl 1):S13–21.
  32. Lutz EG. Restless legs, anxiety and caffeinism. J Clin Psychiatry 1978;39:693–8.
  33. Aldrich MS, Shipley JE. Alcohol use and periodic limb movements of sleep. Alcohol Clin Exp Res 1993;17:192– 6.
  34. Russell M. Massage therapy and restless legs syndrome. J Bodywork Mov Ther 2007;11:146–50.
  35. Garcia-Borreguero D, Kohnen R, Silber MH, Winkelman JW, Earley CJ, Hogl B, et al. The long-term treatment of restless legs syndrome/Willis–Ekbom disease: evidencebased guidelines and clinical consensus best practice guidance: a report from the International Restless Legs Syndrome Study Group. Sleep Med 2013;14: 675–84.
  36. Lettieri CJ, Eliasson AH. Pneumatic compression devices are an effective therapy for restless legs syndrome: a prospective, randomized, double-blinded, sham-controlled trial. Chest2009;135(1):74–80.
  37. García-Borreguero D, Williams AM. Dopaminergic augmentation of restless legs syndrome. Sleep Med Rev 2010;14:339–46.
  38. Trenkwalder C, Högl B, Benes H, Kohnen R. Augmentation in restless legs syndrome is associated with low ferritin. Sleep Med 2008;9:572–4.
  39. Cornelius JR, Tippmann-Peikert M, Slocumb NL, Frerichs CF, Silber MH. Impulse control disorders with the use of dopaminergic agents in restless legs syndrome: a case control study. Sleep 2010;33:81–7.
  40. Kurlan R, Richard IH, Deeley C. Medication tolerance and augmentation in restless legs syndrome: the need for drug class rotation. J Gen Intern Med 2006; 21:C1–4.
  41. Allen RP, Chen C, Garcia-Borreguero D, Polo O, DuBrava S, Miceli J, et al. Comparison of pregabalin with pramipexole for restless legs syndrome. N Engl J Med 2014;370:621– 31.
  42. Aurora RN, Kristo DA, Bista SR, Rowley JA, Zak RS, Casey KR, et al. The treatment of restless legs syndrome and periodic limb movement disorder in adults—an update for 2012: practice parameters with an evidence-based systematic review and meta-analyses: an American Academy of Sleep Medicine Clinical Practice Guideline. Sleep 2012;35(8):1039–62.
  43. Trenkwalder C, Hening WA, Montagna P, Oertel WH, Allen P, Walters AS, et al. Treatment of restless legs syndrome: an evidence-based review and implications for clinical practice. Mov Disord 2008;23: 2267–302.
  44. Prakash S, Ahuja S, Rathod C. Dopa responsive burning mouth syndrome: restless mouth syndrome or oral variant of restless legs syndrome?J Neurol Sci 2012;320:156– 60.
  45. Aquino CC, Mestre T, Lang AE.Restless genital syndrome in Parkinson disease. JAMA Neurol2014;71(12):1559–61.
  46. Spoelstra SK, Waldinger M, Nijhuis ER, Weijmar Schultz WC. [A woman with restless genital syndrome: a difficult-totreat condition.][Article in Dutch] Ned Tijdschr Geneeskd 2013;157(16):A5805.
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