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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 lung transplant recipients
From CHEST, 10/1/05 by Jose C. Yataco

PURPOSE: Restless legs syndrome (RLS) is a neurologic disorder with a prevalence between 2.5 and 15% in the general population. Among solid organ transplant recipients, RLS was found in 45% of patients after heart transplantation in a cross-sectional study. In a prospective study, RLS eases disappeared after kidney transplantation in a group of patients on hemodialysis. The goal of this study is to determine the prevalence, severity and risk factors of RLS in a population of lung transplant recipients.

METHODS: This is a cross-sectional, observational study that recruited consecutive patients in the transplant clinic. For the diagnosis and severity assesment of RLS, we used previously validated questionnaires published by the international RLS study group (IRLSSG). Demographic data and possible risk factors were obtained from medical records.

RESULTS: RLS had a prevalence of 47.6% in 42 lung transplant recipients recruited. Among the RLS patients, 80% had a moderate to severe disorder based on the IRLSSG. The mean age in RLS patients (46.4 years [+ or -] 15.5) was similar to the mean age in patients without RLS (46.8 years [+ or -] 15.6) but there were more women in the RLS group (75%) compared to the non-RLS group (40.9%). Diabetes mellitus had a prevalence of 45.2% in the overall group but the frequency of diabetes did not reach statistical difference between the two groups (p>0.05). Chronic renal failure (defined as creatinine clearance < 50cc/hr), was found in 42.8% in the overall group but had similar distribution in the RLS and non-RLS groups (p>0.05).

CONCLUSION: RLS has a high prevalence in lung transplant recipients. Diabetes mellitus and chronic renal failure were frequent in lung transplant recipients but had similar distribution in the patients with or without RLS.

CLINICAL IMPLICATIONS: RLS is common and may have profound negative effects in the quality of life of transplant recipients causing insomnia, fatigue, reduced concentration, decreased motivation, depression and anxiety. Careful selection of therapy is necessary due to the potential interactions with the numerous medications taken by lung transplant recipients.

DISCLOSURE: Jose Yataco, None.

Jose C. Yataco MD * Joseph Golish MD Marie Budev DO Omar Minai MD Cleveland Clinic Foundation, Beachwood, OH

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group

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