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Restless legs syndrome


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Restless legs syndrome (RLS, or Wittmaack-Ekbom's syndrome, which is not to be confused with Ekbom's syndrome) is a poorly understood and often misdiagnosed neurological disorder characterized by unpleasant or painful sensations in the body's extremities and an overwhelming urge to move them. Moving the limbs provides temporary relief for this chronic condition. Symptoms are often discernable in early childhood, and may become disabling in later life, particularly due to sleep deprivation.


The key symptoms of RLS are:

  • an urge to move the legs and sometimes arms, which can be irresistible when severe; this is usually associated with an abnormal sensation such as a "creepy" or "crawly" feeling, a tickle, an ache, or a discomfort that may be very difficult to put into words. These sensations generally occur inside the legs or arms (along the axis) in the calf or forearm area.
  • involuntary muscle movements (spasms or 'twitching')
  • excessive movement of the legs or arms when at rest,
  • aggravation of the discomfort during rest and at least temporary relief by movement,
  • a circadian rhythm of severity with symptoms being worse at the patient's usual bedtime.


Most sufferers think they are the only ones to be afflicted by this peculiar condition. Many people only have this problem when they try to sleep, but some people show symptoms during the day and pace or 'bounce' their legs. Some people get the symptoms on long car rides or during any long period of inactivity (like watching movies, attending dinners, etc.) The limbs may also start to twitch involuntarily, sometimes causing large limb excursions (flailing) especially during sleep. This is sometimes defined as a related syndrome, called Periodic limb movement disorder. It is not unknown for some people to be thrown out of bed by violent leg movements.

About 10 percent of adults in North America and Europe may experience RLS symptoms, according to the National Sleep Foundation, which reports that "lower prevalence has been found in India, Japan and Singapore," indicating that ethnic factors, including diet, may play a role in the prevalence of this syndrome.


There is a high incidence of familial cases, suggesting a genetic tendency. Secondary causes of RLS include antipsychotics, antidepressants, antihistamines (particularly those that cause drowsiness), serotonin reuptake inhibitors, and antinausea agents. As there seems to be a link between dopamine and RLS, drugs that interact with dopamine may also cause secondary RLS.


Common medications include dopamine agonists (dopaminergic agents) such as levodopa, ropinirole, sinemet or pergolide, opioids such as propoxyphene or oxycodone, benzodiazepines (which improve quality of sleep), or anticonvulsants (patients who report pain may benefit most) such as gabapentin. In 2005, The Food and Drug Administration approved Requip (ropinirole) to treat moderate to severe Restless Legs Syndrome (RLS). The drug was first approved for Parkinson’s disease in 1997.


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Restless legs syndrome in patients with chronic renal failure is not related to serum ferritin or serum iron levels
From CHEST, 10/1/05 by Khalil Ansarin

PURPOSE: Restless legs syndrome (RLS) is a sleep disorder thought to be related to iron stores and dopamine receptors of basal ganglia of brain. It occurs more commonly in patients with chronic renal failure (CRF), iron deficiency, and some other conditions. Its incidence in a few reports of patients with CRF from Asia varies from 1% to 60%. We studied this syndrome in patients with CRF and analyzed the effect of various parameters possibly involved in the etiology of RLS.

METHODS: We investigated 194 patients (116 males and 78 females) with CRF diagnosed in Tabriz University Hospital using a structured questionnaire evaluating details of sleep RLS, sleep apnea and other sleep disorders, and drug history. Daytime sleepiness was investigated with a modified Epworth Sleepiness Scale. Also a detailed laboratory investigation including serum, iron, ferritin, and PTH levels were performed.

RESULTS: 56 (28.9 %) patients, 27(23.1%) men and 29 (37.2%) women had symptoms compatible with RLS. (p= 0.04). There was no significant difference on the mean levels of hemoglobin (9.7 [+ or -] 0.18 versus 10.1 [+ or -] .31; p= 0.71) serum iron (72.2 [+ or -] 3.63versus 74.3 [+ or -] 6.66; p= 0.87), and serum ferrttin (684 [+ or -] 97.4 versus 519 [+ or -] 138; p= 0.65) in patients with CRF who had RLS and those did not. There was a statistically significant difference daytime sleepiness in patient with CRF who did and did not have RLS (5.92 [+ or -] 0.76 versus 2.95 [+ or -] 0.34; p=0.000l).

CONCLUSION: RLS syndrome is a common disorder in patients with CRF in Asian population of Azarbaydjan province of Iran.. Unlike general population in patients with CRF presence of RLS has no relationship with serum ferritin, serum iron level, or degree of anemia. These patients had poor quality of sleep that is at least partly related to the presence of RLS.

CLINICAL IMPLICATIONS: RLS inpatient with CRF is not related to serum ferritin or iron levels or degree of anemia and treatment on this direction is not expected to be as efficacious as patients without CRF.

DISCLOSURE: Khalil Ansarin, University grant monies Supported by a gran from Tuberculosis and Lung Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

Khalil Ansarin MD * Jafar Shabanpour MD Hasan Argani MD Hormoz Airomlou MD Tuberculosis and Lung Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group

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