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Restless Legs Syndrome (RLS) or Willis Ekbom Disease (WED) is a common neurological disease that is frequently unrecognized, misdiagnosed and poorly treated. It is, by patients, characterized by highly uncomfortable sensations deep in the legs, arms and sometimes other parts of the body, that occur in rest situations and cause an irresistible urge to move. Symptoms are particularly troublesome in the evening and night. Sleep disturbances as a result are very common.
The diagnostic criteria based on which the diagnosis Restless Legs may be made, as developed by the International RLS Study Group (www.irlssg.org), are:
Highly unpleasant sensations in the legs and sometimes arms and other parts of the body that are described as creepy, crawly, shock-
The sensations cause an irresistible urge to move.
Movement provides temporary relief so long as the movement continues.
The symptoms occur in situations of rest and peak during evening and night.
RLS occurs in 7 -
There are two forms of RLS:
Primary or idiopathic RLS
Secondary or symptomatic RLS
The primary or idiopathic form is familial in one-
RLS is often unrecognized or misdiagnosed. Patients usually delay seeking medical help for many years. When they finally do, an accurate diagnosis often is not made until many years thereafter. A large study done in 2004 demonstrated that only 8% of the many thousands of patients who took part in the study received the diagnosis RLS.
Many people with RLS have relatively mild symptoms which may be alleviated by changes in lifestyle and avoiding alcohol and nicotine. But there is a substantial group of patients with symptoms so severe that treatment is called for. The chronic insomnia that RLS patients suffer from often results in a significant impact on daytime functioning, and thus quality of life.
RLS is an important disease because it is common, because it causes significant distress to the sufferers, because it may be the presenting symptom of serious underlying disease, and because it is treatable.
RLS IS TREATABLE
NON-
There are now a number of proven, effective therapies for RLS symptoms. However, the first issue for the doctor is to decide whether or not drug therapy is necessary. Non-
Regular exercise
Improvement of sleep hygiene
Avoidance of alcohol, caffeine and tobacco
The use of other drugs should be taken into account. Many antidepressants, antihistamines, most antinausea agents and most antipsychotics have the potential to cause or increase RLS symptoms and should be avoided if possible.
PHARMACEUTICAL THERAPY
Dopamine agonists are now the treatment of first choice for primary or idiopathic RLS. Pramipexole, ropinirole and rotigotine have all been shown to be safe and effective in treatment of RLS and are also approved by EMEA (European Medicines Agency). Studies have shown that these drugs are well tolerated. Augmentation and rebound may occur and tend to increase with increased dose of the dopamine agonists.
As there is no dopamine deficiency, but possibly a hyper dopaminergic state, in RLS patients it is vital to start, and to continue, with a very low dose of dopaminergics -
If dopamine agonists are poorly tolerated or ineffective, antiepileptics (gabapentin and pregabalin) or opioids (oxycodone, tilidin and tramadol) may be considered.
Treatment of secondary or symptomatic RLS involves treating the underlying problem in the first instance. Iron deficiency is important for these RLS sufferers, a serum ferritin level higher than 50 mcg/L is indicated.
The local RLS Patient organizations have all good educational material.
The cost per day to treat a RLS patient is often not more than 2 €.