Abstract
We have tested the hypothesis that restless leg syndrome (RLS) is related to quality of sleep, fatigue and clinical disability in multiple sclerosis (MS). The diagnosis of RLS used the four minimum criteria defined by the International Restless Legs Syndrome Study Group. Fatigue was assessed by the Fatigue Severity Scale (FSS >27), quality of sleep by the Pittsburgh Sleep Quality Index (PSQI >6), excessive daytime sleepiness by the Epworth Sleepiness Scale (ESS >10) and clinical disability by the Expanded Disability Status Scale (EDSS). Forty-four patients (32 women) aged 14 to 64 years (43 +/- 14) with disease from 0.4 to 23 years (6.7 +/- 5.9) were evaluated. Thirty-five were classified as relapsing-remitting, 5 as primary progressive and 4 as secondary progressive. EDSS varied from 0 to 8.0 (3.6 +/- 2.0). RLS was detected in 12 cases (27%). Patients with RLS presented greater disability (P = 0.01), poorer sleep (P = 0.02) and greater levels of fatigue (P = 0.03). Impaired sleep was present in 23 (52%) and excessive daytime sleepiness in 3 cases (6.8%). Fatigue was present in 32 subjects (73%) and was associated with clinical disability (P = 0.000) and sleep quality (P = 0.002). Age, gender, disease duration, MS pattern, excessive daytime sleepiness and the presence of upper motor neuron signs were not associated with the presence of RLS. Fatigue was best explained by clinical disability and poor sleep quality. Awareness of RLS among health care professionals may contribute to improvement in MS management.
Highlights
The clinical spectrum of multiple sclerosis (MS) has changed over the past few years due to new diseasemodifying therapies [1]
Subjects grouped according to the presence/absence of Restless leg syndrome (RLS) were found to have the relapsing-remitting (11/24), the primary progressive (1/3) and the secondary progressive (0/5) form, which was not different between groups
All patients with RLS symptoms reported that they began after the start of the MS symptoms
Summary
The clinical spectrum of multiple sclerosis (MS) has changed over the past few years due to new diseasemodifying therapies [1]. Several symptoms may have serious implications for patient disability. Fatigue and depressive symptoms are frequently described in association with impaired quality of life [2,3]. Fatigue is still one of the most common and disabling symptoms of MS patients affecting as many as 70% in some studies [4,5]. Restless leg syndrome (RLS) is an important cause of sleep disruption and disability in several clinical and neurological disorders and can be identified on the basis of clinical criteria [8]. Complaints of unpleasant sensation deep inside the legs, occurring at rest, at bedtime, accompanied by an irresistible urge to move the limbs producing a temporary relief of symptoms, are sufficient to identify RLS. The relationship between RLS and sleep quality, fatigue and clinical disability in MS patients has not been fully investigated.
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