Definite Restless Legs Syndrome Research Articles

Sleep disorders in Parkinson’s disease, an early and multiple problem

In Parkinson’s disease (PD), it remains unclear whether sleep disorders including insomnia, REM sleep behavior disorder (RBD), excessive daytime sleepiness (EDS), restless legs syndrome (RLS) and sleep-disordered breathing (SDB), are isolated or combined, interact with each other and are associated with clinical factors. We sought to determine the prevalence and combinations of the main sleep disorders, and their clinical and polysomnographic associations in early stage PD. Sleep disorders were systematically diagnosed after medical interview and video-polysomnography in 162 participants with early stage PD and 58 healthy controls from the baseline of the longitudinal ICEBERG cohort. Demographic, clinical (motor, cognitive, autonomic, psychological and sensory tests), therapeutic and polysomnographic associations of sleep disorders were investigated. Sleep disorders were frequent (71%) and combined in half of the patients. The number of sleep disorders increased with disease duration and dysautonomia. Insomnia was the most common (41%), followed by definite RBD (25%), EDS (25%), and RLS (16%). These disorders were more frequent than in controls whereas SDB was rare, moderate and similar in both groups. In patients, insomnia (mainly difficulties maintaining sleep) was associated with female gender, shorter sleep time and RLS, but not with motor or psychological symptoms. RBD was associated with dysautonomia and advanced age, but not with motor and cognitive measures. EDS was associated with psychiatric and motor symptoms as well as the sedative effects of dopamine agonists but not with other sleep disturbances. Sleep disturbances are frequent and combined in early patients with PD. Their determinants and markers are more organic than psychological.

Prevalence and correlates of restless legs syndrome in men living with HIV.

Data on the prevalence and correlates of restless legs syndrome (RLS) in people with HIV are limited. This study sought to determine the prevalence of RLS, associated clinical correlates, and characterize sleep-related differences in men with and without HIV. Sleep-related data were collected in men who have sex with men participating in the Multicenter AIDS Cohort Study (MACS). Demographic, health behaviors, HIV status, comorbidities, and serological data were obtained from the MACS visit coinciding with sleep assessments. Participants completed questionnaires, home polysomnography, and wrist actigraphy. RLS status was determined with the Cambridge-Hopkins RLS questionnaire. RLS prevalence was compared in men with and without HIV. Multinomial logistic regression was used to examine correlates of RLS among all participants and men with HIV alone. Sleep-related differences were examined in men with and without HIV by RLS status. The sample consisted of 942 men (56% HIV+; mean age 57 years; 69% white). The prevalence of definite RLS was comparable in men with and without HIV (9.1% vs 8.7%). In multinomial regression, HIV status was not associated with RLS prevalence. However, white race, anemia, depression, and antidepressant use were each independently associated with RLS. HIV disease duration was also associated with RLS. Men with HIV and RLS reported poorer sleep quality, greater sleepiness, and had worse objective sleep efficiency/fragmentation than men without HIV/RLS. The prevalence of RLS in men with and without HIV was similar. Screening for RLS may be considered among people with HIV with insomnia and with long-standing disease.

Restless legs syndrome is increased in postural orthostatic tachycardia syndrome.

Postural orthostatic tachycardia syndrome (POTS) and restless legs syndrome (RLS) are both characterized by sleep disturbance along with autoimmune/inflammatory features and autonomic dysfunction. However, to our knowledge, there has been no direct study looking at the prevalence of RLS in patients with POTS patients compared with healthy participants (controls). Ninety-six physician-diagnosed patients with POTS (89 female and 7 male) and 130 controls (99 female and 31 male) were administered the Cambridge Hopkins questionnaire. Participants who were diagnosed with probable or definite RLS on the Cambridge Hopkins questionnaire were then contacted to determine the severity of RLS with the International Restless Legs Scale. More patients with POTS (15 of 96; 15.6%) than controls (6 of 130; 4.6%) were diagnosed with probable or definite RLS on the Cambridge Hopkins questionnaire (P = .0048). A sensitivity analysis with only female respondents yielded similar results. RLS severity was in the moderate range (12.23 ± 9.22). There is a higher prevalence of RLS in patients with POTS patients compared with controls. This association may have to do with shared increased inflammatory/autoimmune load and autonomic dysfunction.

Restless Legs Syndrome, and symptoms of Restless Syndrome in patients with Graves' disease: a cross-sectional survey

OBJECTIVES:Restless legs syndrome (RLS) is a frequent comorbid condition associated with distinct unrelated diseases. While the incidence of RLS has not been definitively confirmed, RLS-like symptoms have been reported in a section of Asian population who also had hyperthyroidism. The prevalence of RLS is generally low in Asian populations. Under these circumstances, we hypothesized that in a population where RLS is common, such as in Brazil, RLS could manifest as a comorbid ailment alongside Graves’ disease, a common hyperthyroid condition.METHODS:In a cross-sectional survey, 108 patients who presented with Graves' disease were analyzed for restless legs or associated symptoms.RESULTS:Twelve patients (11.1%) displayed symptoms of RLS prior to the incidence of Graves’ disease. These patients experienced worsening of the symptoms during their hyperthyroid state. Six patients (5.6%) developed RLS, consequent upon the incidence of Graves’ disease as per the consensus of the panel of the experts. Fifteen patients (13.9%) also presented with RLS-like symptoms without any discernible circadian feature of the syndrome.CONCLUSION:Our findings confirm that Graves’ disease might trigger restless legs-like symptoms, while the condition of hyperthyroidism could also be complicated by definite RLS.

Acute-onset Restless legs syndrome in acute neurological conditions-a prospective study on patients with the Guillain-Barre syndrome and acute stroke.

While the Restless legs syndrome (RLS) is usually recognized as a chronic condition, it has often been diagnosed among patients with acute neurological illnesses, in which limb discomfort is reported. This study was conducted to determine how many among these, actually have acute-onset RLS, and also to evaluate characteristics of this subgroup of patients with Guillain-Barre syndrome (GBS) and stroke developing acute-onset RLS. Consecutive patients diagnosed with GBS and eligible stroke patients, admitted to our Neurology services over a 1-year period, were enrolled. They were evaluated for symptoms of RLS based on IRLSSG consensus criteria and the AIIMS RLS Questionnaire for Indian patients (ARQIP). Forty adults with GBS and 58 with stroke were included. A total of 10 of the 40 (25%) patients with GBS developed definite acute RLS, which was mostly monophasic. Seven (70%) of these had demyelinating type of GBS, a significant association with acute RLS (P=.024). Six of the 58 stroke patients (10%) developed definite acute-onset, often persistent RLS. Subcortical location showed significant association with increased risk of developing acute RLS (P<.001). All patients diagnosed with acute-onset RLS had an immediate and good response to dopamine agonists. This is the first study showing that acute-onset RLS is common, affecting nearly 25% of patients with GBS and 10% patients with acute stroke. Recognizing and treating it can majorly contribute toward symptom relief and early improvement in the quality of life for this population.

An epidemiologic study of restless legs syndrome among Chinese children and adolescents.

To determine the prevalence of restless legs syndrome (RLS) in Chinese children and adolescents as well as the impact of the disorder on 8-11 and 12-17 years old. This population-based study was conducted in five primary schools and seven high schools, which were randomly selected in Henan province, China. A total of 6792 students aged 8-17 years old were given a questionnaire that included the adult diagnostic criteria of RLS proposed by the International Restless Legs Study Group. Subjects who answered "yes" to all four questions were selected for a face-to-face interview to confirm RLS diagnosis. Individuals with definite RLS were then administered another questionnaire to survey RLS symptoms and perceived consequences. The prevalence of definite RLS in Chinese children and adolescents was 2.2 % (141/6437), with a prevalence of 1.8 % in the 8-11 years old age group and 2.4 % in the 12-17 years old age group. RLS was found to be more prevalent in females (2.7 %) than in males (1.7 %) (P = 0.008), and the prevalence of RLS was determined to increase with age. Sleep disturbance was the most common symptom of RLS in children and adolescents. Various consequences were attributed to RLS, with participants reporting that they dreaded the arrival of evening/night most frequently, followed by the description that RLS had a negative impact on mood. These data suggest that RLS is prevalent in Chinese children and adolescents, and that those affected by this disorder suffer from disruptions to sleep and daytime function.

Racial Differences in the Prevalence of Restless Legs Syndrome in a Primary Care Setting

Study Objective: To assess the prevalence of restless legs syndrome (RLS) in a primary care clinic and in African American (AA) and non—African American (NAA) racial groups. Methods: We examined the prevalence of RLS using 1-on-1 interviews in general medicine clinics. Subjects were interviewed using John Hopkins Telephone Diagnostic Interview. All interviews were conducted by trained physicians. Results: A total of 190 patients were interviewed: 103 AA (58.3% were female) and 87 NAA (59.8% were female). The overall prevalence of definite RLS was 22.6%. The average age was 53 years (standard deviation, 15) in AA and 50 years (standard deviation, 13) in NAA. Among AA, the diagnosis of RLS was definite in 11.65%, probable in 3.88%, negative in 83.5%, and unknown in 0.97%. Among NAA, patients were either identified as definite RLS (35.63%) or not RLS (64.37%); no patients were diagnosed as probable RLS or unknown. Logistic regression analysis was done to determine whether age, race, and sex were statistically significant predictors of an RLS diagnosis. When accounting for the other variables, the association between NAA and RLS prevalence was statistically significant (P = 0.002). Conclusion: Restless legs syndrome is common among primary care clinic patients. Its prevalence in the NAA population is approximately 3 times higher than in the AA group. We found the association between NAA race and RLS prevalence to be statistically significant. Larger studies are needed to further examine the relation between race and RLS prevalence.

Survey of restless legs syndrome in a pulmonary hypertension population

The prevalence of restless legs syndrome (RLS) varies from 5% to 24% in the general population and is associated with a variety of medical disorders. However, the association between RLS and pulmonary hypertension (PH) is unknown. To determine the prevalence of RLS in PH patients. A cross-sectional questionnaire was given to patients with PH who attended the Pulmonary Hypertension Association conference. We used the RLS Diagnostic Index questionnaire. Demographic data included age, gender, height, weight, body mass index (BMI), medication list, PH World Health Organization (WHO) diagnosis group and current WHO functional class. The study included 128 PH patients. Most were females (86.8%) with a mean age of 49.68 years [standard deviation (SD) 14.24]. The mean BMI was 31.3 (SD 20.46). One hundred and twenty-one patients (93.75%) were classified as WHO group 1 (pulmonary arterial hypertension). Three patients were identified in WHO group 3 (hypoxemic states), four patients in group 4 (chronic thromboemboli) and one patient in group 5 (2.3%, 3.1% and 0.8%, respectively). Definite RLS was found in 16 of 128 patients with PH resulting in a prevalence of 12.5%, possible RLS in 39 of 128 patients (30.46%) and no RLS in 73 (57.03%) patients. The prevalence of RLS is not increased in PH. There is a high prevalence of possible RLS in our study. The overall prevalence of combined definite and possible RLS is significant. Future research is needed to assess more patients with PH and the association or correlation with RLS.

Prevalence of restless legs syndrome and sleep problems in Korean children and adolescents with attention deficit hyperactivity disorder: a single institution study.

PurposeAttention deficit hyperactivity disorder (ADHD) is a common disorder in school-aged children. Patients with restless legs syndrome (RLS) often present with ADHD symptoms and vice versa. This study was the first to attempt to identify the prevalence of RLS and sleep problems in children with ADHD in Korea.MethodsPatients diagnosed with ADHD were asked to complete a sleep questionnaire. The sleep questionnaire included items to help identify the presence of four typical symptoms that are used as diagnostic criteria for RLS.ResultsA total of 56 patients, including 51 boys and 5 girls (mean age, 10.7 years old) participated. Of these, 24 complained of pain, discomfort, or an unpleasant sensation in the legs. Based on the RLS diagnostic criteria, 2 patients were diagnosed with definite RLS and 4 with probable RLS. There were no significant differences in age, medication dosage, or neuropsychological test scores between the patients with and without RLS symptoms.ConclusionApproximately 42.9% of patients with ADHD presented with RLS symptoms and 7.1% of these were diagnosed with RLS. Patients with ADHD also experienced various other sleep disorders. Thus, appropriate assessment and treatment for sleep disorders in patients with ADHD is essential.

Restless legs syndrome in attention deficit-hiperactivity disorder: What about the role of treatment? A multicenter study

In our clinical practice we find a high co-morbidity of Attention Deficit-Hyperactivity Disorder (ADHD) and Restless Legs Syndrome (RLS). Our aim is to describe the prevalence of RLS in children diagnosed of ADHD, as well as find out if ADHD treatment plays a role in RLS symptoms and prevalence. Observational descriptive cross- sectional study in children diagnosed of ADHD referred from Neuropediatrics and Child Psychiatry to Clinical Neurophysiology departments in two hospitals (in Cuenca and Valencia, Spain): n = 36, ages 5–17. These were divided in non-treated ( n = 16) and treated ( n = 20) subgroups. Measures: questionnaire based on Owen’s test for RLS and Periodic Leg Movements (PLM), answered by parents by phone or live interviews. International RLS Study Group criteria for RLS (2002) were followed. Global RLS prevalence in our ADHD patients: 36.1%. Among them, criteria of definite RLS are fulfilled in 30.8%, probable RLS in 46.1% and possible RLS in 23.1%. RLS prevalence in non-treated group: 50.0%. Definite RLS in 12.5%, probable in 62.5% and possible in 25.0% of them. RLS prevalence in treated group: 25.0%. Definite RLS in 60.0%, probable in 20.0% and possible in 20.0%. The prevalence of RLS symptoms in children with ADHD is higher than in normal population, according to the reviewed literature. In treated ADHD, overall RLS prevalence is only 50% of that in non-treated group, while “Definite RLS” prevalence is 4.8 times higher. These findings suggest: The symptoms of ADHD and RLS may be overlapping and lead to misdiagnosis of both disorders. In the same way, a lower prevalence of RLS in treated ADHD could be explained by an improvement in ADHD or in RLS symptoms. Further studies are needed to better understand these findings, as well as the specific role of the different drugs commonly used in ADHD. This study has been supported by a grant given by FISCAM. Special thanks also to our colleagues Dr. García-Bellón, M. and Dr. De las Heras- Martínez, E.

Is a diagnosis of ancillary restless legs syndrome reproducible over time? Experience with the Wayne Hening telephone diagnostic interview

The Hening telephone diagnostic interview (HTDI) is a validated structured diagnostic instrument for restless legs syndrome (RLS). A diagnosis of ancillary RLS is defined as RLS with non bothering or only sporadic occurrence of RLS symptoms. The aim of our study was to test the reproducibility of a previously received diagnosis of ancillary RLS with the HTDI in a telephone follow-up examination. Patients with a diagnosis of ancillary RLS underwent a telephone follow-up after an interval of 6 or more months from their entry into the RLS database. The interview included the HTDI, the International RLS Study Group severity rating scale (IRLS) and questions on current RLS medication. Sixty patients with ancillary RLS were eligible for this study, 50 participated. Thirty-six patients were assigned to definite RLS, 11 to probable RLS, one to possible RLS, and two patients were rated as not RLS. Median IRLS score of those with RLS was 10 (0-30). This is the first study to report results of the German version of the HTDI. We demonstrate a high reproducibility of a diagnosis of ancillary RLS over time and that the HTDI is an excellent diagnostic tool for RLS even in ancillary cases.

Psychiatric Comorbidity in Children and Adolescents with Restless Legs Syndrome: A Retrospective Study

Children and adolescents with restless legs syndrome (RLS) are commonly diagnosed with comorbid attention deficit hyperactivity disorder and behavioral disturbances. Uncertainty exists over the significance of other co-occurring psychiatric disorders and their pharmacologic management in children with RLS. The purpose of this study was to determine the prevalence and nature of psychiatric disorders in children with RLS and to describe the use of psychotropic medications in our study cohort. The electronic medical records of children younger than 18 years of age who had been diagnosed with RLS between January 1, 2003, and December 31, 2009, were reviewed. Only those patients whose findings were consistent with the 2003 NIH workshop diagnostic criteria for probable or definite restless legs syndrome were included in this study. The medical records were cross-referenced for encounters with a child psychiatrist or psychologist. Likewise, only psychiatric diagnoses whose medical records explicitly reflected DSM-IV diagnostic criteria for psychiatric disorder(s) were included. Demographic data, serum ferritin, psychotropic medications, and in some cases, the results of pharmacogenomic testing were included in the data analysis in an ad hoc fashion. We found 374/922 patients who met diagnostic criteria for childhood onset RLS. The mean age of the subjects was 10.6 years (range 0 to 18) and the male to female ratio was approximately 1:1. Overall, 239/374 (64%) patients with RLS had one or more comorbid psychiatric disorders. Attention deficit hyperactivity disorder was found in 94/374 (25%) patients, mood disturbances were found in 109/374 (29.1%) patients, anxiety disorders in 43/374 (11.5%) patients, and behavioral disturbances in 40/374 (10.9%) patients. Attention deficit hyperactivity disorder and disruptive behavior disorders were more common in males (OR = 1.94 for both), whereas mood disturbances and anxiety disorders were more common in females (OR = 1.6 and 1.26, respectively). Mean serum ferritin levels derived from all patients without any psychiatric disorder were compared to all patients with one or more psychiatric disorder. No differences were found. The number of new psychotropic medication trials increased significantly with increase in patient age. Stimulants and antidepressant medications were the most commonly prescribed agents. As a part of clinical care, 15 of these patients underwent pharmacogenomic testing. Metabolic abnormalities were predicted by genotyping in 12/15 (80%) patients. Comorbid psychiatric conditions occurred in two-thirds of children with RLS, underscoring the need for multidisciplinary management of this condition. An important relationship might exist between psychotropic medication, and possibly pharmacogenomic factors, in children and adolescents with symptoms of restless legs syndrome. These findings are consistent and build on those reported in the adult literature.

Prevalence and clinical correlates of restless legs syndrome among psychogeriatric patients

To evaluate the prevalence, clinical features, and comorbidities of restless legs syndrome (RLS) among psychogeriatric patients in an out-patient clinical setting. Cross-sectional study of a sample of 100 non-demented psychogeriatric outpatients that were assessed for the presence of RLS using the Revised International Restless Legs Syndrome Study Group criteria and other support criteria. Medical and psychiatric illnesses, drug treatments, and other risk factors for RLS were documented. Prevalence of definite RLS in our sample was 11.11% with an additional prevalence of 10.10% of possible RLS. None of these patients had received a diagnosis of RLS previously. RLS was associated with major depressive disorder and with hypertension, but not with other previously described risk factors as female gender, some medical conditions, or psychoactive drug treatments. RLS is a frequent condition in psychogeriatric patients, especially among those with depression, and is commonly underdiagnosed and undertreated. Clinicians should routinely ask for RLS symptoms when assessing their patients in their regular clinical practice.

A prevalence study of restless legs syndrome in Turkish children and adolescents

Objective To determine the prevalence of restless legs syndrome (RLS) in Turkish school children and adolescents during the past 12 months. Methods A cross-sectional population study conducted in three primary and four high schools was randomly selected in the Umraniye district of Istanbul. In the first step, a 7-item questionnaire including pediatric diagnostic criteria of RLS proposed by the International Restless Legs Study Group was given to 4346 students aged from 10 to 19 years in the classroom. Candidates for “definite RLS” or “probable RLS” were selected by a face-to-face interview done by an expert. In the second step, a 58-item questionnaire was administered to the families of the selected subjects. The questionnaire aimed to survey family history, parent’s awareness, and their behaviors for seeking treatment, as well as the differential diagnosis and comorbid disorders of RLS. Results Definite RLS was diagnosed in 119 (2.74%) of the subjects and was more prevalent in females (3.42%) compared to males (2.04%) ( p = 0.007). A family history of RLS was positive in 15.8% of the first-degree relatives of those 119 subjects. Less than half of the parents (45%) were aware of their children’s symptoms and only 10.9% of these parents consulted medical centers. The most prevalent symptoms of sleep disturbances were restless sleep (28.6%) and daytime sleepiness (21%). Growing pains were reported in 54.5% of the 119 subjects with definite RLS. Symptoms of Attention-Deficit/Hyperactivity Disorder were found in 15.3% of the 119 subjects. Conclusions RLS is prevalent in Turkish children and adolescents although family awareness of RLS is relatively low.

Prevalence and clinical profile of restless legs syndrome in Parkinson's disease

Parkinson's disease (PD) and restless legs syndrome (RLS) have a dopaminergic link. More insight in the clinical profile of RLS in patients with PD may benefit our understanding of this link. The aims of this study were to evaluate the frequency and clinical profile of RLS in a large cohort of PD patients. In 269 nondemented Caucasian PD patients, the four diagnostic criteria for RLS were administered by a RLS trained researcher. In patients with definite RLS, the severity of these symptoms was assessed. Furthermore, in all patients, relevant motor and nonmotor symptoms in PD were evaluated. Definite RLS was present in 11% of the patients. RLS patients were more often female (69% vs. 32%, P < 0.001), but no other significant differences existed between PD patients with and without RLS. Within the PD patients with RLS, severity of RLS correlated positively with PD severity, motor fluctuations, depressive symptoms, daytime sleepiness, cognitive problems, autonomic symptoms, and psychotic symptoms. This study in a large PD cohort shows that prevalence of RLS is similar to that in the general population, which might be caused by underestimation of RLS due to dopaminergic treatment. No relations were found between the presence of RLS and PD symptoms, but the severity of RLS was related to the severity of PD-related, mainly nondopaminergic, symptoms. It is hypothesized that, nondopaminergic systems, such as the noradrenergic system may play a role in the possible link between PD and RLS.

Pediatric restless legs syndrome and periodic limb movement disorder: Parent–child pairs

Objective Although recent publications have reported the occurrence of restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) in children and adolescents, the literature is relatively limited. The goals of this retrospective study were to (1) apply the recent International Classification of Sleep Disorders 2nd edition (ICSD-2) diagnostic criteria for RLS and PLMD in pediatric cases where periodic limb movements in sleep (PLMS) ⩾5 per hour were found; (2) review parental history of RLS; and (3) further define the clinical characteristics of RLS and PLMD in a pediatric subgroup where each child had a parent with clinically assessed RLS. Methods This was a retrospective analysis of consecutive polysomnograms (PSGs) with PLMS >5 per hour in patients ⩽19 years of age from a single pediatric sleep/neurology practice over 11 years. Excluded were cases with sleep apnea, narcolepsy, or medication that might induce or aggravate PLMS or RLS. ICSD-2 diagnostic criteria for definite RLS and PLMD were applied to the pediatric cases, and parental history for RLS was assessed. A subset of cases was included for detailed review if the child or adolescent had RLS or PLMD and a biological parent met RLS criteria and had a formal sleep evaluation. Results There were 204 cases that met the initial inclusion criteria. A positive parental history of RLS was found in 53% of pediatric RLS cases and in 52% of pediatric PLMD cases. A subset of 37 children or adolescents and 36 biological parents, from 33 different families, met full inclusion criteria and are presented in detail. Of these 37, 10 had a diagnosis of RLS and 27 a diagnosis of PLMD. Over this same period of time, PLMS >5 per hour were found in 74% of pediatric definite RLS cases assessed by PSG. Conclusions This case series adds to the growing literature describing RLS and PLMD in children and adolescents using recently revised diagnostic criteria. The similar prevalence of parental RLS in both pediatric RLS and pediatric PLMD cases suggests a close association between PLMD and RLS in some cases. This supports the emerging view that PLMS may be a marker or endophenotype for a specific, common RLS genotype.

The four diagnostic criteria for Restless Legs Syndrome are unable to exclude confounding conditions (“mimics”)

Background Epidemiological survey studies have suggested that a large fraction of the adult population, from five to more than 10%, have symptoms of Restless Legs Syndrome (RLS). Recently, however, it has become clear that the positive predictive value of many questionnaire screens for RLS may be fairly low and that many individuals who are identified by these screens have other conditions that can “mimic” the features of RLS by satisfying the four diagnostic criteria. We noted the presence of such confounders in a case-control family study and sought to develop methods to differentiate them from true RLS. Methods Family members from the case-control study were interviewed blindly by an RLS expert using the validated Hopkins telephone diagnostic interview (HTDI). Besides questions on the four key diagnostic features of RLS, the HTDI contains open-ended questions on symptom quality and relief strategies and other questions to probe the character of provocative situations and modes of relief. Based on the entire HDTI, a diagnosis of definite, probable or possible RLS or Not-RLS was made. Results Out of 1255 family members contacted, we diagnosed 1232: 402 (32.0%) had definite or probable RLS, 42 (3.3%) possible RLS, and 788 (62.8%) Not-RLS. Of the 788 family members who were determined not to have RLS, 126 could satisfy all four diagnostic criteria (16%). This finding indicates that the specificity of the four criteria was only 84%. Those with mimic conditions were found to have atypical presentations whose features could be used to assist in final diagnosis. Conclusion A variety of conditions, including cramps, positional discomfort, and local leg pathology can satisfy all four diagnostic criteria for RLS and thereby “mimic” RLS by satisfying the four diagnostic criteria. Definitive diagnosis of RLS, therefore, requires exclusion of these other conditions, which may be more common in the population than true RLS. Short of an extended clinical interview and workup, certain features of presentation help differentiate mimics from true RLS.

Validation of an algorithm for the diagnosis of Restless Legs Syndrome: The Restless Legs Syndrome-Diagnostic Index (RLS-DI)

Background There is a need for structured methods to improve sensitivity and specificity of diagnostic decision making in Restless Legs Syndrome (RLS). We present the RLS-Diagnostic Index (RLS-DI), a diagnostic algorithm which combines essential and supportive diagnostic criteria from patient interviews, polysomnography and neurological examination in an adaptive procedure. Method The RLS-DI consists of 10 items which are related to the essential diagnostic criteria established by the International RLS Study Group (five items) as well as their supportive criteria (3 items) and features associated with RLS (2 items). Items have to be completed using three categories per item that address frequency of occurrence of symptoms or certainty of presence or absence of other diagnostic information. Negative weights were given when the clinically most relevant items were not present. The RLS-DI was administered in a telephone interview to 179 patients (86 with RLS, 93 with other sleep disorders) of the 21 month cohort of one sleep center in Germany. Results With receiver-operating characteristics, a cut-off of ⩾11 points on a scale ranging from −22 (no RLS) to 20 (definite RLS) was identified by comparing the RLS-DI total score to the diagnosis of two independent sleep experts. Sensitivity was 93.0%, specificity was 98.9%, and 96.1% of the patients could be correctly diagnosed. Specificity was higher in items related to supportive or associated diagnostic information (95.7%) than in those related to the essential diagnostic criteria (81.7%). Patients with RLS scored a higher RLS-DI than those with primary insomnia or other neurological or psychiatric disorders ( p < .001). Conclusion The RLS-DI demonstrated the ability to validly diagnose an actual and persistently present Restless Legs Syndrome in patients of a sleep lab population and to exclude those patients whose sleep disturbances have other causes.

Effectiveness of ropinirole for RLS and depressive symptoms in an 11-year-old girl

An 11-year-old girl was referred for an irresistible urge to move her legs associated with uncomfortable sensations. She was diagnosed with definite Restless Legs Syndrome (RLS) according to 2003 NIH criteria. The IRLSSG severity scale score was 31 (very severe). The girl also presented with dysthymic disorder according to DSM-IV criteria, as confirmed by the semi-structured interview Kiddie-SADS-PL. The score on the Children Depression Inventory (CDI) was in the clinical range (21). The total score on the Sleep Disturbance Scale for Children (SDSC) was 100. A standard PSG revealed a periodic limb movement index of 16.5, indicating that the child also presented with Periodic Limb Movements Disorder. The girl was treated with ropinirole (a D2/D3 dopamine agonist). After 3 months of treatment (0.50 mg/day at 8.00 PM), RLS, as well as depressive symptoms, remarkably improved, as suggested by the improvement in the IRLSSG severity and CDI scores (14 and 4, respectively). No side effects were reported. The total score on the SDSC also improved (73). The PLM index did not remarkably change. We strongly recommend double blind, randomized, controlled studies to gain insight into the effective treatment strategies for RLS and depression when they coexist in children.

Epidemiology of Restless Legs Syndrome in Korean Adults

To investigate the prevalence of restless legs syndrome (RLS) in Korea. A large population-based telephone interview method using the Korean version of the Johns Hopkins telephone diagnostic interview for the RLS. A computer aided telephone interview method. A total of 5,000 subjects (2,470 men and 2,530 women) were interviewed in depth. A representative sample aged 20 to 69 years was constituted according to a stratified, multistage random sampling method. N/A. Of the respondents, 373 respondents (7.5%) of the population (pop) met the criteria for the definite or probable RLS groups: 194 (3.9% of pop) respondents fulfilled the criteria for definite RLS and 179 (3.6% of pop) respondents fulfilled the criteria for probable RLS. The prevalence of RLS was generally higher for women than men (4.4% vs. 3.3% for definite, 8.7% vs. 6.2% for definite plus probable). About 90% of RLS individuals were experiencing symptoms at the time of the interview and this was similar for both RLS groups. Seventy-four respondents (1.48%) reported symptoms were moderately or severely distressing and were therefore classified as RLS "sufferers." Of those with a diagnosis of RLS sufferer, 24.3% reported being treated for their symptoms, compared to 12.4% of RLS not designated a "sufferer." RLS is common and underdiagnosed in Korea with nearly 1% of the population reporting disturbed sleep related to their RLS. These results are comparable to other countries.