Restless Leg Syndrome
Restless Leg Syndrome. “ The most common disorder you have never heard of.”. What are Restless legs?. Neurological movement disorder Irresistible urge to move legs when at rest Difficulty sleeping Involuntary periodic leg movements
Restless Leg Syndrome
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Presentation Transcript
Restless Leg Syndrome • “The most common disorder you have never heard of.”
What are Restless legs? • Neurological movement disorder • Irresistible urge to move legs when at rest • Difficulty sleeping • Involuntary periodic leg movements • Uncomfortable sensation in limbs subjective & difficult to describe • Symptoms eased by movement
Why should we know about it? • Excess 5 million in UK are sufferers (MEMO 2000) • Estimated prevalence 2-15% • Sufferers will present to primary care • Important physical cause of sleep disturbance • Clinical diagnosis which can be made in primary care
Why should we know about it? • Unrecognised & under-diagnosed • Incorrectly labeled as stress / anxiety • Managed poorly
Wide spectrum • Affects any age group • More common in middle age + women • Mild • Minimal distress • Severe • Episodes occur >2 per week • Can be disabling
Why is it important? • Large impact on quality of life: (REST Study) • Poor sleep • Inability to get comfortable / relax • Poor concentration / fatigue • Pain • Depression • Problems in day to day functioning / employment • Implications for partner
How do we diagnosis RLS? • International Restless Legs Syndrome Study Group - 2003
Supporting Features • Positive FHx (50-92%) • Involuntary limb movements (80%) • Sleep disturbance
What investigations should we do? • Exclude secondary cause. • Vascular dx / Neuropathy / nocturnal cramp / anxiety • Examination • Neuro / vascular • Bloods • FBC, ferritin, B12, Folate, U&E, Glucose, TFT
Aetiology • Primary • No underlying cause found. • Positive FHx >50% • Earlier onset / slower progression • Secondary • Fe deficiency • Pregnancy • End stage renal disease • Peripheral neuropathy / DM / RA / Fibromyalgia • Later onset / more severe
Pathophysiology • Genetic • Susceptibility loci identified on 3 chromosomes • Positive FHx >50% • Neurochemical • Dopaminergic dysfunction - universal response to dopaminergic agents • Ferritin level - inverse relation between severity and serum ferritin
What are the treatment options? • Non Pharmacological • Preventative measures • Symptomatic control • Pharmacological • PRN treatment - mild / intermittent • Maintenance treatment - moderate / severe • Majority of treatments used ‘off license’
Non pharmacological treatment • Preventative • Avoid caffeine / alcohol / nicotine • Avoid medication which may aggravate • SSRI / antihistamine / antiemetic / CaChannel blockers • Keep active into evening • Good sleep hygiene • Symptom control • Mental alerting activities • Walking / stretching • Massage • Hot / cold bath • Relaxation / biofeedback
Mirapexin (pramipexole) • First drug treatment / ONLY treatment licensed in EU for RLS • For use in moderate / severe disease • Quick onset of symptom relief (<1/52) • Start low dose 125mcg od • Titrate up (max 750mcg od)
What should we be doing? • Have raised awareness about diagnosis • Exclude / treat secondary causes • Symptoms generally mild + reassurance & non-pharmacological measures suffice • In moderate / severe cases consider onward referral
Useful Info • Resources • www.ekbom.org.uk • www.restlesslegs.org.uk • www.restlesslegs.com • Review • DTB Nov 2003 • Bandolier 118
