Restless Legs Syndrome

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Annotated Information

Classification and Resources

ID 117
ICD-10 ICD10CM:G25.8;
ICD-9-CM ICD9CM:333.94;
OMIM OMIM:102300;OMIM:608830;OMIM:610438;OMIM:610439;OMIM:611185;OMIM:611242;OMIM:612853;OMIM:615197;
SNOMED-CT
Orphanet
MeSH MSH:D012148;
DO

Defination

Restless legs syndrome (RLS) also known as Willis-Ekbom disease (WED) or Wittmaack-Ekbom syndrome, is a neurological disorder characterized by an irresistible urge to move one's body to stop uncomfortable or odd sensations It most commonly affects the legs, but can affect the arms, torso, head, and even phantom limbs Moving the affected body part modulates the sensations, providing temporary relief~RLS sensations range from pain or an aching in the muscles, to an itch you can't scratch, an unpleasant tickle that won't stop, or even a crawling feeling The sensations typically begin or intensify during quiet wakefulness, such as when relaxing, reading, studying, or trying to sleep Additionally, most individuals with RLS have periodic limb movement disorder (limbs jerking during sleep), which is an objective physiologic marker of the disorder and is associated with sleep disruption It can be caused by low iron levels~Treatment is often with levodopa or a dopamine agonist such as pramipexole Some controversy surrounds the marketing of drug treatments for RLS It is a spectrum disease with some people experiencing only a minor annoyance and others having major disruption of sleep and impairments in quality of life~

Synonyms

WED  ; Willis-Ekbom disease  ; Wittmaack-Ekbom syndrome  ;

Etiology

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Diagnosis

There are no specific tests for RLS, but non-specific laboratory tests are used to rule out other causes such as vitamin deficiencies According to the National Institutes of Health's National Institute of Neurological Disorders and Stroke, four symptoms are used to confirm the diagnosis:~The symptoms are more severe at night and do not occur, or are negligible, in the morning (although in extreme cases, symptoms may occur in the daytime)~An irresistible urge to move the legs and/or arms, often associated with a sensation of pain, burning, pricking, tingling, numbness, or other unpleasant or unusual sensations~The sensations begin following relaxation or a period of staying still, and during sleep~Temporary relief from these sensations during movement of the affected legs and/or arms~NIH criteria[edit]~In , a US National Institutes of Health (NIH) panel modified their criteria to include the following:~An urge to move the limbs with or without sensations~Improvement with activity Many patients find relief when moving and the relief continues while they are moving In more severe RLS this relief of symptoms may not be complete or the symptoms may reappear when the movement ceases~Worsening at rest Patients may describe being the most affected when sitting for a long period of time, such as when traveling in a car or airplane, attending a meeting, or watching a performance An increased level of mental awareness may help reduce these symptoms~Worsening in the evening or night Patients with mild or moderate RLS show a clear circadian rhythm to their symptoms, with an increase in sensory symptoms and restlessness in the evening and into the night~

Symptoms

There are no specific tests for RLS, but non-specific laboratory tests are used to rule out other causes such as vitamin deficiencies According to the National Institutes of Health's National Institute of Neurological Disorders and Stroke, four symptoms are used to confirm the diagnosis:~The symptoms are more severe at night and do not occur, or are negligible, in the morning (although in extreme cases, symptoms may occur in the daytime)~An irresistible urge to move the legs and/or arms, often associated with a sensation of pain, burning, pricking, tingling, numbness, or other unpleasant or unusual sensations~The sensations begin following relaxation or a period of staying still, and during sleep~Temporary relief from these sensations during movement of the affected legs and/or arms~NIH criteria[edit]~In , a US National Institutes of Health (NIH) panel modified their criteria to include the following:~An urge to move the limbs with or without sensations~Improvement with activity Many patients find relief when moving and the relief continues while they are moving In more severe RLS this relief of symptoms may not be complete or the symptoms may reappear when the movement ceases~Worsening at rest Patients may describe being the most affected when sitting for a long period of time, such as when traveling in a car or airplane, attending a meeting, or watching a performance An increased level of mental awareness may help reduce these symptoms~Worsening in the evening or night Patients with mild or moderate RLS show a clear circadian rhythm to their symptoms, with an increase in sensory symptoms and restlessness in the evening and into the night~

Treatment

The sensations—and the need to move—may return immediately after ceasing movement or at a later time RLS may start at any age, including childhood, and is a progressive disease for some, while the symptoms may remit in others In a survey among members of the Restless Legs Syndrome Foundation, it was found that up to % of patients had their first symptoms before the age of years~"An urge to move, usually due to uncomfortable sensations that occur primarily in the legs, but occasionally in the arms or elsewhere"~The sensations are unusual and unlike other common sensations Those with RLS have a hard time describing them, using words like: uncomfortable, painful, 'antsy', electrical, creeping, itching, pins and needles, pulling, crawling, and numbness It is sometimes described similar to a limb 'falling asleep' or an exaggerated sense of positional awareness of the affected area The sensation and the urge can occur in any body part; the most cited location is legs, followed by arms Some people have little or no sensation, yet still have a strong urge to move~"Motor restlessness, expressed as activity, which relieves the urge to move"~Movement usually brings immediate relief, although temporary and partial Walking is most common; however, stretching, yoga, biking, or other physical activity may relieve the symptoms Continuous, fast up-and-down movements of the leg, and/or rapidly moving the legs toward then away from each other, may keep sensations at bay without having to walk Specific movements may be unique to each person~"Worsening of symptoms by relaxation"~Sitting or lying down (reading, plane ride, watching TV) can trigger the sensations and urge to move Severity depends on the severity of the person's RLS, the degree of restfulness, duration of the inactivity, etc~"Variability over the course of the day-night cycle, with symptoms worse in the evening and early in the night"~Some experience RLS only at bedtime, while others experience it throughout the day and night Most people experience the worst symptoms in the evening and the least in the morning~"Restless legs feel similar to the urge to yawn, situated in the legs or arms"~These symptoms of RLS can make sleeping difficult for many patients and a recent poll shows the presence of significant daytime difficulties resulting from this condition These problems range from being late for work to missing work or events because of drowsiness Patients with RLS who responded reported driving while drowsy more than patients without RLS These daytime difficulties can translate into safety, social and economic issues for the patient and for society~Individuals with RLS have higher rates of depression and anxiety disorders~Primary and secondary[edit]~RLS is categorized as either primary or secondary~Primary RLS is considered idiopathic or with no known cause Primary RLS usually begins slowly, before approximately – years of age and may disappear for months or even years It is often progressive and gets worse with age RLS in children is often misdiagnosed as growing pains~Secondary RLS often has a sudden onset after age , and may be daily from the beginning It is most associated with specific medical conditions or the use of certain drugs (see below)~

Labs working on this disease

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References

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