RLS Slide Library Version All Contents Copyright © WE MOVE 2001 Restless Legs Syndrome: Classification, Diagnosis and Approaches to Treatment Part 2 of 3

Additional Clinical Characteristics More than 60% of patients have progressive disease Symptoms become worse with increasing age

Additional Assessment Issue Current medication regimen for potential causative agents, such as… –Antiemetics –Lithium –Neuroleptics –Antidepressants

RLS Associated with... Iron deficiency Uremia Pregnancy

Differential Diagnosis Neuroleptic-induced akathisia ADHD (in children) Anxiety Growing pains Other neurologic condition

Differential Diagnosis, cont’d Burning feet syndrome Fibromyalgia Meralgia paresthetica Arthritis Possible psychogenic disorder

Pathophysiology of RLS CNS abnormality (cerebral generators) Dopaminergic dysfunction Disinhibition of the flexor reflex during sleep Possible involvement of the endogenous opiate system

Pathophysiology of RLS, cont’d TMS: impaired motor cortex excitability in RLS Impaired flexor reflexes Dopaminergic dysfunction Blink Reflex: enhanced R2 excitability

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

Polysomnographic Findings

RLS/Peripheral Involvement Peripheral nerve involvement –RLS secondary to peripheral neuropathy clinically identical to idiopathic RLS –Subclinical evidence of neuropathy

Etiology of RLS Idiopathic or primary RLS –Sporadic – Familial Secondary or symptomatic RLS

Familial RLS In some patients… RLS appears to be inherited as an autosomal dominant genetic trait

RLS Genetics Family history in >50% Autosomal dominant Genetic anticipation

Secondary RLS Anemia Low Levels of Iron Diabetes/Amyloidosis Alcoholism Increased BMI Parkinson’s Disease Peripheral Neuropathy Depression Carcinoma Myokymia

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

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

Electrophysiology of RLS Lack of bereitschaftspotential NCV is normal Somatosensory-evoked responses are normal EMG demonstrates mild increase in polyphasic units

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

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?

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?

Clinical Assessment Questions, cont’d Difficulty staying asleep during the night, after falling asleep? Sleepiness or fogginess during the daytime?

RLS Slide Set Presented by: WE MOVE 204 West 84th Street New York, NY Phone: (800) 437-MOV2 (in U.S.) (212) (outside U.S.) Fax: (212) Web site: Executive Director: Judy Blazer, MS

Additional RLS Resource Restless Legs Syndrome Foundation 819 Second Street SW Rochester, MN US Telephone: (507) Fax: (507) Web Site: