International Restless Legs Syndrome Study Group Research Articles

Short-term effects of massage with olive oil on the severity of uremic restless legs syndrome: A double-blind placebo-controlled trial

BackgroundAlthough the efficacy of olive oil massage has been established for different disorders, no studies have yet focused on the effect of olive oil massage on restless legs syndrome (RLS). In this study, we aimed to evaluate the short-term effects of massage with olive oil in reducing the severity of uremic RLS. MethodsThis double-blind placebo-controlled trial was conducted on 60 patients with uremic RLS (mean age: 51.96 ± 10.15), who were randomly divided into olive oil and placebo groups. The olive oil group received massage with olive oil, while the placebo group received massage with liquid paraffin twice a week during hemodialysis sessions for three weeks. For each leg, 10 mL of the olive oil or placebo was applied and then massaged for five min from the plantar surface of the foot to the area below the knee. The severity of RLS was rated on the first day and one week after the final massage therapy session by using the International Restless Legs Syndrome Study Group (IRLSSG) Rating Scale. ResultsIn terms of different categories of RLS severity, a significant decline was observed only in the olive oil group from the pre- to post-intervention stages (P = 0.003). After the intervention, the decline in the total RLS severity was more significant in the olive oil group (P < 0.001), compared to the placebo group (P = 0.019). Moreover, a significant difference in the total RLS severity (P < 0.001) and different categories of RLS severity (P = 0.002) was observed after the intervention between the groups in favor of olive oil massage. However, no significant difference was found between groups in pre-intervention stage in this regard (P = 0.363 and P = 0.955, respectively). ConclusionApplication of short-term massage with olive oil as a complementary method seems to be effective in reducing the severity of uremic RLS. Further studies are suggested to identify the sustainability of the findings.

Genetic Association Study of Restless Legs Syndrome in Chinese Population

Backgrounds: Several recent case-control studies have suggested some candidate genes being responsible for causing the restless legs syndrome (RLS). However, the association between those genes and the risk for RLS among the Asian population has not been well investigated. Objectives: The aim of the study was to investigate the genetic risk factors of RLS among the Chinese Population. Methods: A total of 158 RLS patients and 229 controls were recruited and the diagnosis of RLS was based on the criteria of International RLS Study Group. Polymer chain reaction and sequencing were used to detect 14 single nucleotide polymorphisms (SNPs) in 9 genetic loci (heme oxygenase 1 [HMOX1], HMOX2, vitamin D3 [1, 25-dihydroxyvitamin D3] receptor gene [VDR], interleukin 17A [IL17A], IL1B, NOS1, alcohol-dehydrogenase [ADH1B], gamma-aminobutyrate acid receptors[GABRR3] and GABRA4). Results: Among 14 selected SNPs, the frequency of IL1B rs1143634C allelic variant was lower in RLS patients than that in controls. Moreover, after adjustment for age and sex, rs731236 of VDR were found associated with increased risk of RLS in the dominant model. However, none of those results survived Bonferroni correction. The effects of HMOX1 and HMOX2 gene on developing RLS were not seen after the inclusion of RLS patients with a low ferritin level. Conclusions: Our study failed to replicate the association between 9 candidate genetic loci (HMOX1, HMOX2, VDR, IL17A, IL1B, NOS1, ADH1B, GABRR3 and GABRA4) and RLS in the Chinese population.

Restless legs syndrome and quality of life in pregnant women.

In this study, we aimed to determine the extent of restless legs syndrome (RLS) in pregnant women and evaluate the relationship between the syndrome and quality of life. This is a cross-sectional descriptive study. A questionnaire developed by the researcher, the Short Form 36 (SF-36) Questionnaire to measure the quality of life, the International Restless Legs Syndrome Study Group (IRLSSG) Diagnostic Criteria for RLS and the Restless Legs Syndrome Rating Scale were applied to the women to collect the data. A total of 250 pregnant women were included in the study. The mean age of the women was 28.11 ± 5.59 years and the mean gestational time was 26.26 ± 10.72 weeks. Symptoms of RLS were seen in 46.4 % of the women. The mean for the RLS Violence Rating Score was 20.82 ± 6.61 for the women with RLS. RLS was found to be mild in 5.2 % of the women, moderate in 45.7 %, severe in 40.5 % and very severe in 8.6 %. A statistically significant effect of RLS survival on quality of life was observed. These results indicate that almost half of the pregnant women in this study experienced RLS, and about half of those with RLS experienced severe or very severe RLS. There is a significant relationship between RLS and six domains of SF-36 (physical, role limitations, pain, general health perception, energy/vitality, and mental health).

Non-motor symptoms in newly diagnosed Parkinson\u2019s disease patients

IntroductionThe non-motor symptoms (NMSs) in Parkinson’s disease (PD) patients have greater effects on their quality of life compared to the motor symptoms; however, they are under-recognized.The aimThe study aims to evaluate the prevalence and severity of NMS in newly diagnosed PD patients in Tanta University hospitals.Patients and methodsThe study included 41 newly diagnosed PD patients. All patients were screened for NMS by the non-motor symptoms questionnaire (NMS-Quest). According to the NMS-Quest response, patients were further evaluated by Sialorrhea Clinical Scale for PD (SCS-PD), Scales for Outcomes in Parkinson’s disease for Autonomic symptoms (SCOPA-AUT), Rome III Questionnaire, Nocturnal voiding and Sleep-Interruptions Questionnaire, Brief Pain Inventory, Montreal Cognitive Assessment (MoCA), Scale for Evaluation of Neuropsychiatric Disorders in Parkinson’s Disease (SEND-PD), Pittsburgh Sleep Quality Index (PSQI), and questionnaires based upon the International Restless Legs Study Group criteria.The resultsThe study included 22 female and 19 male patients; the duration of illness was 2.7 ± 2.08 years. Constipation was the most common symptoms as it was present in 73.1% in the studied patients; 61% suffered loss of sexual interest. 47.5% of patients had depressive symptoms. Sleep disturbance was present in 36.6% of the patients. Anxiety was reported by 30% of the patients.ConclusionAll newly diagnosed PD patients suffered one or more NMSs; constipation was the most frequent followed by sexual dysfunction, depressive symptoms, and sleep disturbance, while pain, sialorrhea, and restless leg were the least reported.

Restless legs syndrome in end stage renal disease patients undergoing hemodialysis

BackgroundThe prevalence of Restless legs syndrome (RLS) in End Stage Renal Disease (ESRD) patients is higher than that in the general population. However, the associations of RLS within the ESRD population are inconsistent and RLS is usually neglected in dialysis centers, although it impairs the life quality among ESRD patients. We aim to investigate the prevalence of RLS in patients with ESRD undergoing maintenance hemodialysis and evaluate the risk factors of developing RLS and the effect of RLS on quality of life among ESRD patients.MethodsESRD patients undergoing maintenance hemodialysis in Shanghai General Hospital dialysis unit from July 2016 to October 2016 were enrolled in the study. RLS was diagnosed according to the criteria of the International Restless Legs Syndrome Study Group (IRLSSG). IRLSSG Severity Scale was used to evaluate the severity of RLS. Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality, and Hospital Anxiety and Depression Scale (HADS) was used to estimate anxiety and depression. Serologic and historic variables were analyzed to determine predictors of RLS in the ESRD population.ResultsA total of 137 ESRD patients were enrolled. The prevalence of RLS among the ESRD patients was 20.44%. The risk of RLS was increased significantly in females (OR = 2.729, p = 0.032) and daily alcohol drinkers (OR = 4.716, p = 0.022). RLS increased the risks of sleep disorders (25/28, 89.3% vs 73/109, 67.0%, p = 0.02) and sedative hypnotics intake (7/28, 25.0% vs 10/109, 9.2%, p = 0.047) and impaired the sleep quality (7/109 vs 11/28, p = 0.001) according to PSQI sum scores.ConclusionA high RLS prevalence among the ESRD patients undergoing hemodialysis was confirmed. ESRD patients who are women and drinking alcohol have a higher risk of RLS. The sleep quality was significantly impaired and sleeping medication use was more common among the ESRD patients with RLS.

Investigation of inflammation with neutrophil/lymphocyte ratio in restless legs syndrome

Aim: Restless Legs Syndrome (RLS) is a chronic, progressive, sensorimotor disorder characterized by the urge to move legs and abnormal sensations in the limbs. The pathophysiology of RLS is not clear. In recent years, many studies have used different serum biomarkers to discuss pathophysiology or to follow up the diagnosis and treatment. There are not enough studies that entirely investigating the relationship between RLS and serum neutrophil/lymphocytes (N/L). Therefore, in this study it was aimed to examine the relationship between idiopathic RLS and serum N/L.Methods: A case control study was planned. After sample size analysis, 93 patients with diagnosed RLS (study group) and age- and gender matching 50 healthy volunteers (control group) were included in the study. N/L ratio were compared between two groups.Results: The median of N/L ratio was 2.58 in the RLS group and 2.72 in the control group. There was no statistically significant difference between the groups (p=0.891). The mean duration of disease was 3.2±1.37 years in patients’ group. Sleep disorders were found in 81.7% (n=76) of the patients, and similar complaints were observed on the upper extremities in 34.4% (n=32) of the patients. Severity scale of disease was determined according to the International Restless Legs Syndrome Study Group (IRLSSG). It was observed to be low severity of the symptom in 6.3%, middle severity of the symptom in 15.2%, severe severity of the symptom in 64.8%, high severity of the symptom in 13.7% of the patients. There was no correlation neither between duration of disease and N/L ratio (r:-0.117, p=0.281) nor between severity of the symptoms and N/L (r:0.68, p=0.413). Conclusion: In this study, it was investigated the role of inflammation in the pathophysiology of RLS was evaluated with N/L ratio and it was not observed statistically significance on behalf of patients group.

Increased frequency of the restless legs syndrome in adults with cystic fibrosis.

Patients with cystic fibrosis (CF) may suffer from iron deficiency which is a known risk factor for the restless legs syndrome (RLS), however, its prevalence has not yet been investigated in these subjects. Adult out-patients with CF (n = 39) and healthy volunteers (n = 32) were recruited for this study. A diagnosis of RLS was made based on the diagnostic criteria established by the International Restless Legs Syndrome Study Group (IRLSSG). The IRLSSG rating scale was used to assess the severity of the disease. Furthermore, in the CF group, parameters of iron metabolism were measured in peripheral venous blood samples. The RLS occurred more frequently in the CF patients than the controls (n = 13/33,3% vs. n = 2/6,3%; p < 0,05). In the CF patients suffering from RLS, the mean score of the IRLSSG rating scale was 17,2 ± 9,4 indicating moderate disease severity. Iron deficiency was present in the majority of the CF patients investigated (n = 33/84,6%), however, serum iron, ferritin and transferrin levels as well as transferrin saturation were similar in those with vs. without RLS. The frequency of the RLS is increased in adult patients with CF. On an average, its severity is moderate and it is not related to iron deficiency as evaluated by serum parameters of iron metabolism.

Restless leg syndrome a common undiagnosed comorbidity of clinical significance in cirrhosis.

Our aim was to study the prevalence and association of restless leg syndrome (RLS) in liver cirrhosis subjects. Sleep disturbances are common in cirrhosis. RLS is a chronic sensorimotor sleep disorder with an irresistible urge to move limbs. Two hundred consecutive cirrhosis patients, presenting at Mahatma Gandhi Medical College & Hospital, Jaipur were evaluated. 157 subjects meeting the inclusion criteria were selected for further evaluation. Revised International Restless Legs Syndrome Study Group (IRLSSG) criteria 2012, was used for diagnosed of RLS. Severity of RLS was evaluated by a validated Hindi translation of International RLS severity (IRLS) scoring system. Of studied 157 cirrhotic, the mean age was 46.4 ± 10 years, 109 (69.43%) males and 48 (30.57%) females. 41 (26.11%) cirrhotic subjects had RLS. Child Turcotte Pugh (CTP) Class (A 9/55, B 15/68, C 17/34; p 0.043) and alcohol as etiology for liver dysfunction (p 0.03) were significantly associated with RLS. RLS is common comorbidity in cirrhosis, especially in alcohol related cirrhosis. RLS has a clinical correlation with prognosis & severity of cirrhosis.

Frequency of cardiovascular diseases in the patients with restless legs syndrome

Background: Restless Legs Syndrome (RLS) is a sensory-motor neurological disease characterized by discomfort, unpleasant sensations, an urge to move the legs. There are a lot of studies showing the association between Restless Legs Syndrome (RLS), Cardiovascular Diseases (CVD), Hypertension (HT) and Body Mass Index (BMI). The potential underlying mechanism of an increased risk of CVD in RLS is not clear but may involve hypertension, as Periodic Limb Movements during Sleep (PLMS) were shown to be related to blood pressure increases. These studies were inconsistent. The aim of this case control study was to show the prevalence of CVD in the patients with RLS compared with a control group.Methods: A total of 37 newly diagnosed patients with RLS (group 1) who were applied to neurology polyclinic of Sakarya University Hospital between March 2016 and May 2017 and 37 control subjects (group 2) were included in this case control study. RLS was diagnosed using the criteria of the International RLS Study Group. Both groups were screened for HT, dyslipidemia, coronary artery diseases, atrial fibrillation. 24hour Ambulatory Blood Pressure Monitoring (ABPM) were enrolled for both groups. Interventricular septum was measured with echocardiography by cardiologist for diagnosis of left ventricular hypertrophy.Results: There were no significant differences in sex (p:0.11) and age (p:0.33) between the two groups. Hypertension (p:0.001) and non-dipper hypertension (p:0.004), BMI (p:0.004), left ventricular hypertrophy (p:0,002) were found statistically significantly higher than the control group. There were no differences in atrial fibrillation (p:1) and hyperlipidemia (p:0.69) between two groups.Conclusions: Patients with RLS should be followed closely for cardiovascular diseases.

Comparative Efficacy and Safety of Clonazepam versus Nortriptyline in Restless Leg Syndrome among Forty Plus Women: A Prospective, Open-Label Randomized Study.

Aims and Objectives:The aim of this study is to compare the effect of clonazepam and nortriptyline on rate, frequency, and severity of restless leg syndrome (RLS) in above 40 years women suffering from RLS.Materials and Methods:A prospective, randomized, open-label comparative study was conducted at a tertiary care teaching hospital for 1 year. Restless legs syndrome (RLS) diagnosis was based on four essential clinical criteria established by the International RLS Study Group in 2003. Patients were randomized into two groups. Group 1 received tablet clonazepam 0.5 mg bedtime orally daily. Group 2 received tablet nortriptyline 25 mg bedtime orally daily. The primary efficacy endpoints by the International Restless leg Syndrome Scale (IRLS) were evaluated at 0, 4, and 8 weeks. Adverse drug events and safety assessment for vital signs such as blood pressure, pulse, heart rate, waist circumference, and body mass index were compared between two groups.Results:Effect on mean IRLSS was statistically more in clonazepam group in comparison to nortriptyline group with comparable results at 8 weeks (P < 0.001), but at 4 weeks, nortriptyline showed less improvement (P < 0.01) versus P < 0.001 in nortriptyline group. Thus, nortriptyline reported relatively more improvement on IRLSS numerically in comparison to clonazepam. Nortriptyline proved to be statistically better in improving the frequency of RLS with comparison to clonazepam, whereas the results were comparable with regard to rate and the severity of RLS. Both the groups were relatively safe and did not produce any change in biochemical parameters and were free from any serious or severe adverse events and overall, both the treatments were well tolerated.Conclusion:Both the drugs provided clinically and statistical significant effect on RLS when compared with their respective baselines. However, nortriptyline proved to be statistically better in improving the frequency of RLS in comparison to clonazepam, whereas the results were comparable with regard to rate and the severity of RLS on intergroup comparison. Both the drugs were well tolerated.

Aumento de los depósitos cerebrales de hierro en una familia de donantes de sangre con síndrome de piernas inquietas

The pathophysiology of restless legs syndrome (RLS) is complex. Secondary RLS with iron deficiency -which suggests disturbed iron homeostasis- remains to be elucidated. We report the findings from a unique blood donor family with RLS. Three blood donors family members were diagnosed with RLS defined by the International RLS Study Group and without history of neurologic diseases and RLS symptoms in the last 3-5 years (range of blood donation: 10-40 years). The neurological examination and electromyographies were normal. A polisomnography showed disturbed nocturnal sleep with a reduction in sleep efficiency and an increased periodic limbs movement index. The cranial MRI showed brain iron deposits in basal ganglia, substantia nigra, red nuclei and dentate nuclei. Phenotypic and genotypic studies rule out genetic haemochromatosis or iron overload. The abnormal iron accumulation in the basal ganglia indicated a complex iron metabolism disorder of the central nervous system. Further studies are warranted to confirm our findings and its role in the pathophysiology of RLS.

Restless Legs Syndrome in Multiple Sclerosis.

The co-existence of Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WED/WED) and multiple sclerosis (MS) is a common condition. For this reason, we aimed to evaluate the effects of RLS/WED and its relationship with MS. We evaluated the clinical features of 102 patients diagnosed with MS who were in follow-up between 2010 and 2015 in outpatient clinic. All the patients were evaluated for RLS/WED according to the revised International Restless Legs Syndrome Study Group (IRLSSG) diagnostic criteria. The Expanded Disability Status Scale (EDSS), Beck Depression Inventory, Beck Anxiety Inventory and Fatigue Severity Scale scores of all the patients were recorded. The IRLSSG 2003 severity scale was used to determine the degree of RLS/WED. RLS/WED was detected in 30.4% (n=31) of the patients (MS-RLS/WED+), but not in 69.6% (n=71) (MS-RLS/WED-). The mean EDSS score of the MS-RLS/WED+ patients were 3.2±2.1 while the MS-RLS/WED-patients were 2.0±1.6. The incidences of depression, moderate or severe anxiety, fatigue and intestinal and bladder dysfunction in the MS-RLS/WED+ patients were significantly higher. Regarding to RLS/WED complaints, 32.2% were mild, 35.4% were moderate, 19.3% were severe and 12.9% were very severe. When the MS subgroups were evaluated the highest RLS/WED severity score was found in the secondary progressive MS group. In the patients with pyramidal symptoms and intestinal and bladder dysfunction, the mean RLS/WED severity was significantly higher. The mean RLS/WED severity score was also significantly higher in those with depression and anxiety. The RLS/WED severity was significantly correlated with the number of pyramidal attacks and the EDSS score. Restless legs syndrome is a cause of depression, anxiety and fatigue and has negative effects on MS patients. Therefore, after the diagnosis of MS, the RLS/WED symptoms and signs should be determined, as soon as possible, in addition to the other MS symptoms. The treatment of this condition should be started early.

Association between Restless Legs Syndrome Symptoms and Self-Reported Hypertension: a Nationwide Questionnaire Study in Korea.

BackgroundThe association between restless legs syndrome (RLS) and hypertension remains controversial. We investigated the relationship between RLS and hypertension in a nationwide sample of the Korean adult population.MethodsThis was a cross-sectional questionnaire-based study including 2,740 adults aged 19 years or more. Subjects who met the four essential International RLS Study Group criteria and reported symptoms occurring at least once a week were defined as the RLS group. The presence of hypertension was defined as a self-reported history of physician-diagnosed hypertension. We conducted multiple logistic regression analysis to determine the independent association between RLS symptoms and self-reported hypertension after adjusting for potential confounding factors.ResultsAmong the 2,740 subjects, 68 (2.5%; 95% confidence interval [CI], 1.9%–3.1%) were found to have RLS with a symptom frequency of at least once a week. The prevalence of self-reported hypertension was 30.9% (95% CI, 20.5%–42.0%) in the RLS group, which was significantly higher than that in controls (12.4%; 95% CI, 11.2%–13.6%; P < 0.001). Multiple logistic regression analysis showed that the adjusted odds ratio for self-reported hypertension in the RLS group was 2.10 (95% CI, 1.12–3.93) compared to controls. In addition to RLS symptoms, old age, being overweight, low education level, diabetes mellitus, and short sleep duration were significantly associated with self-reported hypertension.ConclusionRLS symptoms occurring at least once a week is independently associated with a higher prevalence of self-reported hypertension in the adult Korean population. Further research will confirm the clinical implication of the present results and the causal relationship between RLS and hypertension.

Prevalence of restless legs syndrome in functional movement disorders: a case–control study from the Czech Republic

ObjectivesThe prevalence of restless legs syndrome (RLS) in functional movement disorders (FMD) is not known. Patients with FMD often present with multiple motor and sensory symptoms. Some of these symptoms...

Restless Legs Syndrome in Pregnant Thai Women: Prevalence, Predictive Factors, and Natural Course.

Background and PurposeRestless legs syndrome (RLS) is a common sleep-related neurological disorder that affects the quality of sleep. This study aimed to estimate the prevalence, predictive factors, and natural course of RLS, and its effect on sleep quality in pregnant Thai women.MethodsA cross-sectional study that included 214 pregnant women was performed. RLS was diagnosed according to the revised criteria of the International RLS Study Group (IRLSSG). General demographic and antenatal-care data were reviewed. Scores on the Thai versions of the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index, and the IRLSSG Rating Scale were determined.ResultsRLS was diagnosed in 24 of the pregnant women (11.2%): 4.2%, 25.0%, and 70.8% in the first, second, and third trimesters, respectively. Multiple logistic regression analysis revealed that a hemoglobin level (Hb) less than 11 g/dL [odds ratio (OR)=3.21, 95% CI=1.27–8.13] and a history of RLS (OR=16.62, 95% CI=1.52–181.32) were associated with RLS during pregnancy. Subjects with RLS significantly had higher Thai-ESS scores (p<0.01). All subjects with RLS had severe symptoms that subsided within 1 week after delivery. No immediate labor complication was associated with RLS.ConclusionsOur study has confirmed a high prevalence of RLS and its impacts on sleep in pregnant women. An Hb of less than 11 g/dL and a history of RLS are predictive factors for RLS developing during pregnancy. Pregnancy-related RLS has a benign course and usually disappears within 1 week after delivery.

Screening questions for the diagnosis of restless legs syndrome in hemodialysis.

BackgroundRestless legs syndrome (RLS) is common in end-stage renal disease and is associated with reduced health-related quality of life. Simple and accurate screening instruments are needed since RLS is underdiagnosed and treatable. We examined the operating characteristics of screening questions and a disease-specific measurement tool for the diagnosis of RLS in hemodialysis.MethodsWe conducted a cohort study of prevalent adult hemodialysis patients in Hamilton, Canada. The diagnosis of RLS was made using the 2012 Revised International Restless Legs Syndrome Study Group (IRLSSG) criteria. All participants received three screening instruments: (i) a single screening question for RLS derived from a nondialysis population; (ii) a single question from the Edmonton Symptom Assessment System (ESAS); and (iii) the IRLSSG Rating Scale (IRLS). All instruments were compared with the reference standard using logistic regression from which receiver operating characteristics curves were generated. Cutoffs associated with maximum performance were identified.ResultsWe recruited 50 participants with a mean (SD) age of 64 (12.4) years, of whom 52% were male and 92% were on three times weekly hemodialysis. Using the reference standard, 14 (28%) had a diagnosis of RLS. The single screening question for RLS had an area under the receiver operating curve (AUROC) of 0.72 with a sensitivity of 85.7% and specificity of 58.3%. An ESAS cutoff of ≥1 had the highest AUROC at 0.65 with a sensitivity of 79% and specificity of 56%. An IRLS cutoff of ≥20 had the highest AUROC at 0.75 with a sensitivity of 71% and specificity of 81%.ConclusionIRLS had better specificity than the single question or ESAS for the diagnosis of RLS.

The impact of the use of amalgam in dental treatment on the prevalence of restless legs syndrome in older people.

The link between restless legs syndrome (RLS) and the number of amalgam fillings in older people was investigated. Restless legs syndrome decreases the quality of life and impairs normal functioning. Mercury (in amalgam) may be toxic to nerve cells and may account for the incidence of RLS. The relationship between RLS and the presence of amalgam in the teeth of 104 people aged 60-97 years old was determined. By using 4 questions, together with the diagnostic criteria from the internationally used questionnaire produced by the International Restless Legs Syndrome Study Group (IRLSSG), authors assessed the extent of the symptoms and occurrence of RLS. Careful medical history and medical examination were used for ascertaining each subject's type of restorative materials (i.e., amalgam or other metal) and the number of such fillings. Subjects who answered "yes" (indicating presence of RLS) to the 4 subsequent questions had a significantly higher number of amalgam dental fillings as compared to the subjects without RLS symptoms. Presence of other metal dental restorative materials and the number of amalgam dental fillings reported in the past had no significant influence on RLS symptomatology. Authors conclude that while examining the correlates of the appearance of restless legs syndrome the use of amalgam in the dentition should be taken into account. Med Pr. 2019;70(1):9-16.

Treatment of pediatric restless legs syndrome.

Restless legs syndrome (RLS) is not uncommon in children with an estimated prevalence of 2%. There is clear evidence that RLS affects quality of life, sleep, cognition and behavior in children and adults. Although the diagnosis of RLS can be challenging in young children, the International Restless Legs Study Group (IRLSSG) has published guidelines for diagnosis which include description of symptoms in the child's own words. Once the diagnosis is made, treatment options must be explored. It is commonly accepted that non-pharmacological interventions be recommended to all affected families. These include maintaining a consistent bedtime routine, establishing healthy eating habits and exercise, avoiding caffeine and other substances that can exacerbate RLS, and stretching before bedtime. Pharmacological interventions in children are challenged by the lack of solid data supporting effectiveness and long-term safety. Historically and based on pathophysiology, iron supplementation is the first line therapy in children. Recently intravenous iron supplementation has shown promising results, following studies in adults. Most studies in children on various pharmacological options follow a robust body of data previously published in adult patient with RLS, yet data in children remain scarce. This chapter will discuss both non-pharmacologic and pharmacologic treatment options for children with RLS.

Restless legs syndrome and its variants in acute ischemic stroke.

The clinical-radiological correlation between restless legs syndrome (RLS) or its variants and acute ischemic stroke remains unclear. This study prospectively included 104 consecutive patients with acute ischemic stroke, confirmed by diffusion-weighted imaging. The frequency and clinical characteristics of RLS or RLS variants were evaluated according to the International RLS Study Group criteria, as was the topography of the associated lesions. Among 104 patients with acute ischemic stroke, 6 (5.8%) and 2 patients (1.9%) had RLS and RLS variants, respectively, for a total of 8 patients (7.7%). Three (3.3%) had poststroke RLS/RLS variants: 2 (66.7%) had bilateral symptoms and 1 (33.3%) had unilateral symptoms contralateral to the lesion. RLS symptoms developed within 2days after the onset of stroke. Forty percent of prestroke RLS/RLS variant patients experienced exacerbation of their symptoms after stroke onset, and two-thirds of poststroke RLS/RLS variant patients required treatment for their RLS/RLS variants. Patients positive for RLS/RLS variants tended to have difficulty falling asleep, but there was no difference in daytime sleepiness, sleep quality, depressive symptoms, stroke subtypes, comorbid diseases, laboratory data, or modified Rankin Scale scores at admission or discharge between patients with and without RLS/RLS variants. RLS/RLS variants were most frequently observed to accompany lesions in the medulla (25%), followed by the pons (15.4%), the corona radiata (14.8%), the basal ganglia (3.8%), and the cortex (3.8%). RLS/RLS variants were found in 8% of acute ischemic stroke patients. Adequate screening and management are needed to improve patients' quality of life.

Exclusion of mimics does not influence Willis-Ekbom disease diagnosis among recent medical graduates.

In view of the diagnostic challenge posed by restless legs syndrome/Willis-Ekbom disease (RLS/WED) to health professionals and the challenge of its recognition by patients, the diagnostic criteria have been revised and updated to facilitate identification of this disease. However, in a previous study, we found that self-diagnosis of RLS/WED depends on the very name used to describe the condition. To ascertain whether the presence of the fifth diagnostic criterion of the International Restless Legs Syndrome Study Group (IRLSSG), is necessary for RLS/WED diagnosis when the term "Willis-Ekbom disease" is used. We randomly distributed 705 forms to recent medical graduates, asking them to self-assess whether they had "Willis-Ekbom disease" (WED). In one questionnaire model, we excluded the fifth criterion suggested by the IRLSSG, while in the other, all five criteria were included. No forms contained the term RLS; only WED was used throughout. Seven hundred and five recent medical graduates participated in the study. Among the 332 who received the form without the fifth criterion, 8 (2.41%) self-diagnosed as having WED (95%CI: 0.8%-4.1%). Of the 373 who received the form with all five of the 2014 IRLSSG criteria, 9 (2.41%) self-diagnosed as having WED (95%CI: 0.8%-4.0%) (p > 0.05). Our data show that presence of the fifth IRLSSG criterion did not influence self-diagnosis of WED among recent medical graduates, suggesting that the name WED reduces the odds of mimics (confounding conditions) being misinterpreted as symptoms of this disease. This finding indicates that for the diagnosis of RLS/WED only four criteria and a systematic use of the name WED are necessary.