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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

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restless leg syndrome

Restless Leg Syndrome

  • “The most common disorder you have never heard of.”
what are restless legs
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
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 it4
Why should we know about it?
  • Unrecognised & under-diagnosed
  • Incorrectly labeled as stress / anxiety
  • Managed poorly
wide spectrum
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
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
How do we diagnosis RLS?
  • International Restless Legs Syndrome Study Group - 2003
supporting features
Supporting Features
  • Positive FHx (50-92%)
  • Involuntary limb movements (80%)
  • Sleep disturbance
what investigations should we do
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
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
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
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
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
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
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
Useful Info
  • Resources
    • www.ekbom.org.uk
    • www.restlesslegs.org.uk
    • www.restlesslegs.com
  • Review
    • DTB Nov 2003
    • Bandolier 118