HistoryThis section has been translated automatically.
DefinitionThis section has been translated automatically.
Seizure-like, spontaneously occurring dysesthesias and restlessness of movement of the legs, especially at night. The phenomenon plays a major practical role.
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ClassificationThis section has been translated automatically.
A distinction is made:
Idiopathic restless legs syndrome
restless legs syndrome
Occurrence/EpidemiologyThis section has been translated automatically.
Common, affecting 5-10% of the population in older age. Occurrence predominantly in nervous persons.
EtiopathogenesisThis section has been translated automatically.
Heterogeneous causes are considered. Favoring factors include gravidity (especially in the 3rd trimester), cold, anemia. Psychological factors may also trigger the syndrome.
In some cases autosomal dominant inheritance.
Predominantly idiopathic genesis, including in:
- Uremia (about 20% of all ESRD patients.
- Rheumatoid arthritis (about 25% of all patients with seropositive r.A.)
- fibromyalgia syndrome (about 30% of all patients)
- spinal damage
- gastric resection
- Iron deficiency
- Medications(suramin, cimetidine, tricyclics, mianserin, lithium); thalidomide intoxication.
No association has been demonstrated between CVI and restless legs syndrome (Fronek et al. 2017).
Clinical featuresThis section has been translated automatically.
When lying down, rarely also when sitting, usually at night when falling asleep, discomfort in the legs in the form of paresthesia, dysesthesia and pain in muscles or bones of the lower legs. As a result, the legs become restless. The discomfort can be improved by movement. Improvement can sometimes be achieved by prone position. The paroxysms occur in mild cases briefly and rarely, in severe cases with considerable impairment of night sleep and regularly. Phased exacerbation and spontaneous remissions.
DiagnosisThis section has been translated automatically.
Clinical criteria of RLS
- Abnormal sensations in the extremities, unilateral or bilateral, e.g., tingling, pulling, tearing, itching, burning, cramping, or pain
Urge to move
- Restlessness, stretching, moving the leg, walking around, turning or twisting in bed, rubbing or massaging the legs
Worsening at rest, improvement with movement
Intensification of symptoms in the evening or at night
- Sleep disturbances
- Difficulty falling asleep or staying asleep, daytime sleepiness, exhaustion
- Involuntary movements
- Unilateral or bilateral (PLM, PLMS)
- Chronic fluctuating course
- Onset/worsening due to iron deficiency, renal insufficiency, pregnancy, medications
- Positive family history (autosomal dominant inheritance)
Differential diagnosisThis section has been translated automatically.
TherapyThis section has been translated automatically.
No causal therapy possible. Collaboration with neurologists. Treatment of the underlying condition may lead to a reduction in symptoms (e.g., iron substitution for iron deficiency, renal transplantation for uremic RLS). Occasionally improvement by prone position.
The drug of choice is L-DOPA. Most patients require 10o-400mg as evening dose. In severely affected patients, the combination of L-Dopa+opioid may prove beneficial.
Alternatively: opioids can be tried, e.g. oxycodone (Oxygesic).
Alternative: gabapentin (dosage 400-1600 mg, possibly more if needed).
Alternative: Benzodiazepines (e.g. clonazepam).
Note(s)This section has been translated automatically.
Most of the time, no cause is found.
LiteratureThis section has been translated automatically.
- Boghen D, Peyronnard JM (1976) Myoclonus in familial restless legs syndrome. Arch Neurol 33: 368-370
- Ekbom KA (1945) Restless legs. Acta med scand Suppl 158: 1-123
- Ekbom KA (1960) Restless Legs Syndrome. Neurology 10: 868-873
- Fronek LF et al (2017) Nocturnal leg symptoms are not associated with specific patterns of superficialvenous
insufficiency. Int Angiol 36:565-568.
- Hornyak M et al (2003) Consensus statement from the German Sleep Society: indications for performing polysomnography in the diagnosis and treatment of restless leg syndrome. Sleep Med 3: 457-458
- Michaud M et al (2004) Circadian rhythm of restless legs syndrome: Relationship with biological markers. Ann Neurol 55: 372-380
- Montplaisir J, Lapierre O, Warnes H, Pelletier G (1992) The treatment of the restless leg syndrome with or without periodic leg movements in sleep. Sleep 15: 391-395
- Willis T (1672) De anima brutorum quæ hominis vitalis ac sensitiva est, excertitationes duæ; prior physiologica ejusdem naturam, partes, potentias et affectiones tradit; altera pathologica morbos qui ipsam, et sedem ejus primarium, nempe ceerebrum et nervosum genus atticiunt, explicat, eorumque therapeias instituit. R. Davis, London
- Wittmaak T (1861) Pathology and Therapy of Sensitivity Neuroses. In: T. Wittmaak, Textbook of Nervous Diseases, Part 1: Pathology and Therapy of Sensitive Neuroses. E. Schäfer, Leipzig
Incoming links (9)Anxietas tibiarum; Burning feet syndrome; Clonazepam; Hereditary acromelalgia; Pes dolorus; Prisoner\'s camp-foot; Restless legs; Restless legs syndrome; Wittmaack-ekbom syndrome;
Outgoing links (10)Arterial occlusive disease chronic of the extremity arteries; Burning feet syndrome; Cimetidine; Fibromyalgia syndrome, primary; Lithium; Opioids; Renal failure chronic; Rheumatoid arthritis and skin manifestations; Suramin; Thalidomide;
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