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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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Pneumatic compression devices for treatment of restless legs syndrome
From CHEST, 10/1/05 by Arn H. Eliasson

PURPOSE: Restless legs syndrome (RLS) is a troublesome condition manifested by sensory and motor symptoms that disrupt sleep onset or sleep maintenance. RLS is common, occuring with a estimated population prevalence of 10%. There are no consistently reliable treatment alternatives and pharmacological treatments are often associated with unacceptable side effects. An effective nonpharmacological treatment would be a highly attractive option.

METHODS: A convenience sample of patients reliably diagnosed with RLS was asked to wear pneumatic compression devices for at least one hour each evening for at least 30 days. Symptoms of RLS severity and related quality of life measures were evaluated before and after treatment. RLS severity was measured using a validated 10-item questionnaire. Quality of life indices were scored using the RLS Foundaton Quality of Life Instrument. Daytime sleepiness was gauged using the Epworth Sleepiness Scale (ESS). Patients were asked to track compliance using logs.

RESULTS: Of eight patients enrolled (mean age 55 years, range 37 to 81, 6 women), one man withdrew due to inability to comply. Of the other seven patients, all improved regarding RLS severity with three patients (43%) experiencing complete resolution. Mean severity decreased from 24/40 to 7/40 (p=0.003). Social functioning improved from 87% to 98% (p=0.05), daily functioning improved from 76% to 94% (p=0.06), sleep quality improved from 30% to 54% (p=0.01), and emotional well-being improved from 61% to 88% (p=0.05). ESS did not change significantly, decreasing from 9.9 to 8.6 (p=0.14). Compliance averaged 87% of nights (range 58% to 100%). One patient was able to discontinue previously prescribed gabapentin and pramipexole while experiencing improvement in RLS symptoms.

CONCLUSION: Pneumatic compression devices worn for one hour per day over days to weeks improve RLS symptom severity and quality of life measures. A proportion of patients experience complete resolution of RLS symptoms.

CLINICAL IMPLICATIONS: Pneumatic compression devices are an effective treatment alternative for patients with RLS. This nonpharmacological therapy may preclude resorting to medications which may be ineffective or have unacceptable side effects.

DISCLOSURE: Arn Eliasson, Other Aircast Industries of New Providence NJ supplied six pneumatic compression devices for use in this study. No other financial incentive or support was received.

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group

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