Restless Legs Syndrome Scores Research Articles

Association of anxiety, sleepiness, and sexual dysfunction with restless legs syndrome in hemodialysis patients

Restless legs syndrome (RLS) is characterized by unpleasant sensations, pain in the legs along with irresistible urges to move the legs when at rest. It is often accompanied by sleep disturbance. The purpose of this study was to assess the association of anxiety and sleepiness with sexual function in hemodialysis patients with and without RLS. Sociodemographic parameters, laboratory data of hemodialysis patients from three dialysis centers were collected prospectively. Anxiety, sleepiness, sexual function, and presence of RLS symptoms were assessed with standardized questionnaires as the RLS Diagnosis and Scale, Hamilton Anxiety Rating Scale, Epworth Sleepiness Scale (ESS), Arizona Sex Experiences Scale (ASEX). Univariate, regression tree method were used for statistical analysis. RLS was observed in 45.9% (n = 113) of hemodialysis patients (n = 246). The mean age of patients and duration of hemodialysis were 59.7 ± 14.0 and 4.9 ± 4.2 years, respectively. The correlation between Arizona Sexual Experiences Scale (ASEX) and sociodemographic features was significant (P < 0.0001). Patients with RLS had higher scores for anxiety (9.4 ± 7.8 with RLS and 6.8 ± 6.0 without), higher ESS (ESS, 6.6 ± 5.2 with RLS and 4.6 ± 4.0 without), and higher ASEX (24.6 ± 5.7 with RLS and 22.5 ± 6.8 without) than did those without RLS. The presence of RLS symptoms in hemodialysis patients was associated with sleepiness, anxiety, and sexual dysfunction. A regression tree method, which is a different statistical method, can help physicians estimate patients ASEX, RLS, ESS, and anxiety scores.

Ropinirole in Patients With Restless Legs Syndrome and Baseline IRLS Total Scores ≥24: Efficacy and Tolerability in a 26-Week, Double-Blind, Parallel-Group, Placebo-Controlled Study Followed by a 40-Week Open-Label Extension

BackgroundAs with studies of other dopamine agonists, previously reported studies of ropinirole in restless legs syndrome (RLS) recruited patients with baseline International Restless Legs Scale (IRLS) total scores ≥15. The reported pooled analyses of clinical trials data suggest benefits of ropinirole in patients with IRLS total scores ≥24, but the effects of ropinirole have not been prospectively evaluated in this patient population. ObjectiveThe goal of this study was to evaluate the efficacy and tolerability of ropinirole in patients with RLS and baseline IRLS total scores ≥24. This study was conducted in part to fulfill a postlicensing commitment between the maker of ropinirole and the European Union’s Committee for Medicinal Products for Human Use. MethodsThe protocol for this study comprised a randomized, double-blind, placebo-controlled, parallel-group, 26-week phase during which adults with baseline IRLS total scores ≥24 received a ropinirole dose from 0.25 to 4 mg (n = 197) or placebo (n = 207) followed by a 40-week, open-label phase during which all patients (n = 269) received ropinirole. The primary efficacy end point was the change from baseline in the IRLS total score at week 12. Tolerability measures included the incidence of adverse events, augmentation, and early morning rebound. Due to the possibility of a treatment-by–center group interaction (P = 0.04) in the IRLS analysis, further efficacy exploratory analyses were performed to assess the impact of the interaction on the overall assessment of efficacy. ResultsDemographic characteristics were comparable between groups (mean [SD] age: placebo, 56.1 [11.38] years; ropinirole, 56.5 [11.92] years; 63% female in both groups). All of the patients in the ropinirole group were white; 99% of the placebo group was white. Ropinirole was significantly better than placebo for change from baseline in the IRLS total score during both short- and long-term treatment, with mean treatment differences of –2.1 (P = 0.039) and –2.5 (P = 0.023) for weeks 12 and 26, respectively. A statistically significant treatment by center group interaction was observed (P = 0.040) for the change from baseline in IRLS total score, indicating variation of treatment effects among center groups; however, all center groups showed an improvement from baseline at both week 12 and week 26 for the ropinirole immediate-release group and the placebo group. The incidences of augmentation and early morning rebound were ≤4% for ropinirole. The adverse event profile of ropinirole was consistent with that reported in previous clinical trials. ConclusionsIn this subset of patients with RLS and a baseline IRLS total score ≥24, ropinirole was effective and well tolerated compared with placebo. The incidence of augmentation and early morning rebound in this study was low. Clinicaltrials.gov identifier: NCT00329602.

Restless legs syndrome and daytime sleepiness are prominent in myotonic dystrophy type 2

Although sleep disturbances are common in myotonic dystrophy type 1 (DM1), sleep disturbances in myotonic dystrophy type 2 (DM2) have not been well-characterized. We aimed to determine the frequency of sleep disturbances in DM2. We conducted a case-control study of 54 genetically confirmed DM2 subjects and 104 medical controls without DM1 or DM2, and surveyed common sleep disturbances, including symptoms of probable restless legs syndrome (RLS), excessive daytime sleepiness (EDS), sleep quality, fatigue, obstructive sleep apnea (OSA), probable REM sleep behavior disorder (pRBD), and pain. Thirty patients with DM2 and 43 controls responded to the survey. Group comparisons with parametric statistical tests and multiple linear and logistic regression analyses were conducted for the dependent variables of EDS and poor sleep quality. The mean ages of patients with DM2 and controls were 63.8 and 64.5 years, respectively. Significant sleep disturbances in patients with DM2 compared to controls included probable RLS (60.0% vs 14.0%, p < 0.0001), EDS (p < 0.001), sleep quality (p = 0.02), and fatigue (p < 0.0001). EDS and fatigue symptoms were independently associated with DM2 diagnosis (p < 0.01) after controlling for age, sex, RLS, and pain scores. There were no group differences in OSA (p = 0.87) or pRBD (p = 0.12) scores. RLS, EDS, and fatigue are frequent sleep disturbances in patients with DM2, while OSA and pRBD symptoms are not. EDS was independently associated with DM2 diagnosis, suggesting possible primary CNS hypersomnia mechanisms. Further studies utilizing objective sleep measures are needed to better characterize sleep comorbidities in DM2.

Gabapentin enacarbil in Japanese patients with restless legs syndrome: a 12-week, randomized, double-blind, placebo-controlled, parallel-group study

ObjectiveGabapentin enacarbil (GEn) was effective and well-tolerated for the treatment of restless legs syndrome (RLS) in North American studies. However, no placebo-controlled studies of GEn have been performed in Asian patients with RLS. Therefore, we investigated the efficacy and safety of GEn in Japanese patients with RLS to determine the optimal dosage.Research design and methodsOutpatients with RLS (International Restless Legs Syndrome Rating Scale (IRLS) scores ≥15) were randomized (n = 474) and treated (n = 469) in a double-blind manner with once-daily placebo (n = 116), 600 (n = 120), 900 (n = 119) or 1200 (n = 114) mg GEn for 12 weeks.Clinical trial registrationClinicalTrials.gov identifier: NCT00530530.Main outcome measureThe primary outcome was the change in IRLS score. Secondary outcomes included Investigator (ICGI)- and Patient (PCGI)-rated Clinical Global Impression and adverse events.ResultsThe mean change in IRLS score from baseline to the final observation was −8.96 for placebo versus −11.10, −10.28 and −11.38 for 600, 900 and 1200 mg GEn. Williams’ multiple comparison test showed that only 1200 mg GEn was superior to placebo (p = 0.011). However, in post hoc mixed-effects models with repeated measures, which accounted for the time-course of changes in IRLS, the placebo-adjusted changes were −2.31, −1.92 and −2.31 for 600, 900 and 1200 mg GEn. ICGI and PCGI response rates were significantly greater for all three GEn doses versus placebo (all p ≤ 0.014). Adverse events, including somnolence, dizziness and nasopharyngitis, were frequent but of mild-to-moderate severity. However, there was a tendency toward a dose-dependent increase in the incidence of adverse events.ConclusionsGEn is effective and well-tolerated for the treatment of RLS in Japanese patients. All three doses produced improvements in IRLS compared with placebo; 600 mg GEn is a suitable target dose. However, our analysis possibly introduced positive bias by assuming that symptoms improve after discontinuation.

Restless Legs Syndrome as a Cause of Sleep Disturbances in Cancer Patients Receiving Chemotherapy

ContextSleep disturbances are frequent in cancer patients during chemotherapy; the contributory role of restless legs syndrome (RLS) in this setting has never been assessed. ObjectivesThis study investigated the role of RLS in causing sleep disturbances and altering the quality of life in cancer patients during chemotherapy. MethodsEvaluation tools included the Pittsburgh Sleep Quality Index (PSQI), the RLS questionnaires, the Functional Assessment of Cancer Therapy-General, and the Hospital Anxiety and Depression Scale for quality of life and anxiety/depression assessment. The study population was 173 cancer patients. The questionnaires were administered during the third chemotherapy cycle. Patients positive for RLS were reassessed six months after the end of chemotherapy. ResultsIn all, 58.8% of patients reported experiencing sleep disturbances (PSQI≥5) and 20% screened positive for RLS. Neither sleep disturbances nor RLS was associated with anemia, neurotoxic cytotoxic drugs, or benzamide treatment. A direct relationship was found between the PSQI and RLS (P=0.007); both PSQI and RLS scores were significantly associated with poor quality of life (P=0.008 and 0.01, respectively) and anxiety (P=0.0001 and 0.01, respectively). PSQI score also was associated with depression (P=0.0001). RLS persisted in four of the 25 RLS-positive patients reassessed at six months after chemotherapy. RLS recovery was associated with a significant reduction in sleep disturbances and improvement in quality of life. ConclusionRLS can be a contributory factor in sleep disturbances in cancer patients undergoing chemotherapy. Screening for RLS could aid in tailoring a potentially more efficacious treatment of such disturbances.

Overall self-perceived health in Restless legs treated with intrathecal morphine

Restless legs syndrome (RLS) has a high prevalence in the general population. Treatment with intrathecal morphine has been shown to be successful in a small number of patients. Our aim was to quantify the effect on RLS-related symptoms, health and quality of life in three patients treated with intrathecal morphine. Three patients with medically refractory RLS received an implanted pump for delivery of intrathecal morphine. Severity of RLS and self-assessed health were rated using the International Restless Legs Syndrome Study Group (IRLSSG) rating scale and the Short Form health survey (SF-36). Assessments were made preoperatively and after 6 months of follow-up. Preoperatively two patients had very severe RLS, scoring 35 and 36 on the IRLSSG rating scale, and one patient had severe RLS (score, 26). All three patients were free of symptoms of RLS post-operatively and also at the 6-month follow-up. The daily doses of intrathecal morphine ranged from 73 to 199 µg. Results from the SF-36 health survey showed that all three patients had a better physical health compared to before surgery. Intrathecal morphine may be efficient in the treatment for medically refractory RLS. All three patients became completely free of symptoms, and there was also improvement in self-perceived overall health.

Rifaximin antibiotic treatment for restless legs syndrome: a double-blind, placebo-controlled study

The purpose was to evaluate rifaximin antibiotic therapy for restless legs syndrome (RLS) patients who have small intestinal bacterial overgrowth (SIBO). Patients with RLS were recruited by advertisements and were included if they met all international RLS criteria and had an international RLS (IRLS) score >15. Patients were excluded if they had secondary RLS or disorders other than irritable bowel syndrome that are associated with SIBO. Patients and healthy controls were screened for SIBO using lactulose breath tests. Patients with SIBO were randomized to receive rifaximin 1650 mg daily (n = 20) or placebo (n = 10) for 10 days. Global RLS and IRLS scores were assessed over 25 days. In IRLS responders (i.e. patients with improvement in IRLS scores), mean IRLS score improvement on day 11 was significantly greater for rifaximin (-6.0 ± 5.0) versus placebo (1.7 ± 5.1; P = 0.017). Results on day 18 showed numerical improvement with rifaximin compared with placebo (-7.8 ±5.1 vs-0.33± 10; P = 0.058). Rifaximin improved IRLS scores for all 20 patients from baseline to days 11 (P = 0.037) and 18 (P = 0.006) compared with the placebo group, which had no significant improvement from baseline. Marked and moderate global improvement of RLS symptoms occurred in 40% and 22% of patients in the rifaximin and placebo groups, respectively. Shortterm rifaximin improved RLS symptoms; however, more aggressive SIBO therapy (as previously reported) and a higher powered study is required to further define the efficacy of antibiotic treatment of RLS.

Biotin Deficiency as a Target for Treating Restless Legs Syndrome in Chronic Dialysis Patients

Restless Legs Syndrome is a neuropathic disorder seen in end stage renal disease. Since biotin is dialyzable, we examined the relationship between biotin status and Restless Legs Syndrome in end stage renal disease (Study 1) and determined the effect of biotin supplementation on Restless Legs Syndrome symptoms (Study 2). Comparison of prevalence of biotin deficiency in those with and without Restless Legs Syndrome (Study 1) and randomized assignment, double-blinded, placebo-controlled study of biotin supplementation (Study 2) were in a medical center’s outpatient dialysis unit. In Study 1, patients received chronic dialysis and routine biotin supplementation at ≈300 μg daily (10 times the recommended dietary allowance). In the intervention Study 2, biotin was supplemented at 10,000 μg daily for 8 weeks; the placebo group received ≈300 μg of biotin daily. Outcome was measured by Restless Legs Syndrome symptom score and biotin status as indicated by activation coefficient of the biotin-dependent enzyme propionyl-CoA carboxylase in peripheral blood lymphocytes. In Study 1, patients with (n=30) were more likely than those without (n=19) Restless Legs Syndrome to be biotin deficient as judged by increased activation coefficient of propionyl-CoA carboxylase; mean (± 1SD) was 1.17 ± 0.65 vs. 0.87 ± 0.39, respectively (P=0.007). In Study 2, Restless Legs Syndrome score of the biotin group (n=16), improved from 20 ± 6 to 13 ± 11 (P=0.001). However, in the placebo group (n=15), Restless Legs Syndrome score also improved from 17 ± 8 to 12 ± 10 (P=0.01). Consequently, this change was not different between biotin and placebo. Mean activation coefficient of propionyl-CoA carboxylase of the biotin group (n=8) improved from 1.38 ± 0.76 to 0.81 ± 0.25 (P=0.01) and did not change in the placebo group (0.98 ± 0.44 vs. 1.17 ± 0.32; P=0.17). The improvement of biotin status and of Restless Legs Syndrome score with the 10,000 μg supplement suggests that large biotin supplements might be necessary to optimize biotin status in dialysis patients.

Effect of the antiplatelet agent cilostazol on endovascular inflammatory biochemical parameters and the clinical symptoms of peripheral artery disease and restless legs syndrome in hemodialysis patients

Peripheral artery disease (PAD) is a common complication in patients receiving hemodialysis (HD). Cilostazol is used for the treatment of ischemic symptoms in patients with PAD, based on its antiplatelet and vasodilating effects. In addition to these beneficial effects on clinical symptoms in PAD patients, cilostazol has been proposed to have additional effects on clinical symptoms in patients with restless legs syndrome (RLS) via the upregulation of dopamine. We performed an observational, prospective study to evaluate the effect of cilostazol on several clinical and biochemical parameters in HD patients with PAD and RLS. All the study patients received cilostazol treatment for 12 months. During the study period, several biochemical parameters, such as high-sensitivity CRP, von Willebrand antigen (VW-Ag), triglyceride (TG), high-density lipoprotein (HDL) and malondialdehyde-modified low-density lipoprotein, were monitored. A questionnaire on the physical status of PAD and RLS was also completed. 45 HD patients who received cilostazol were compared with a control group of 22 patients. The patients who continued cilostazol treatment exhibited a improvement in their serum inflammatory and biochemical parameters (VW-Ag, TG, HDL). Although PAD and RLS scores were not improved by multivariate analysis, several patients showed improvement of signs and symptoms which were included in the PAD or RLS scores. The treatment of HD patients with cilostazol improved some of the lipid-related and endovascular inflammatory biochemical parameters associated with PAD, and relieved the clinical symptoms and physical status of PAD in some cases.

Characterizing sleep disorders of adults with tuberous sclerosis complex: A questionnaire-based study and review

An adult cohort with tuberous sclerosis complex was investigated for the prevalence of sleep disturbances and the relationship with seizure variables, medication, and psychological functioning. Information on 35 adults was gathered using four questionnaires: Epworth Sleepiness Scale (ESS), Sleep and Epilepsy Questionnaire (SEQ), Sleep Diagnosis List (SDL), and Adult Self-Report Scale (ASR). In addition, clinical, genetic and electrophysiological data were collected. Of 35 respondents, 25 had a history of epilepsy. A subjective sleep disorder was found in 31% of the cohort. Insomnia scores showed a significant positive correlation with obstructive sleep apnea syndrome and restless legs syndrome scores. Significant correlations were found between daytime sleepiness and scores on depression, antisocial behavior, and use of mental health medication. A subgroup using antiepileptic medication showed high correlations between daytime sleepiness, attention deficits, and anxiety scores.

Treatment-resistant sensory motor symptoms in persons with SCI may be signs of restless legs syndrome

Case report on the successful treatment with pramipexole in four men with chronic spinal cord injury (SCI) suffering from refractory symptoms that were previously considered to be manifestations of a post-traumatic spastic syndrome or neuropathic pain. To raise awareness among health professionals regarding the diagnostic and therapeutic possibility of restless legs syndrome (RLS) and periodic limb movements (PLMs) in some patients with SCI responding poorly to conventional treatment for spasticity or neuropathic pain. Neurorehabilitation department of the Rehabilitation Medicine Center of Northern University Hospital, Umeå, Sweden. Medical records and clinical data were retrospectively reviewed. All cases obtained treatment with pramipexole, initially 0.09-0.72 mg day(-1). Two of the cases had RLS and PLMs, one RLS only and one PLMs only. All four reported symptoms in the lower extremities and one also in the upper extremities. Three patients with residual gait function reported RLS score with/without treatment as follows: 32/11, 37/12 and 33/12. One patient with complete paraplegia (with incomplete RLS score) reported 22/10. After a follow-up period of 16, 20, 43 and 49 months, respectively, all four still reported excellent outcomes. Two remained on initial dosage; one had increased dosage from 0.09 to 0.18 mg day(-1) and one from 0.27 to 0.80 mg day(-1) during the follow-up period. In persons with SCI suffering from infralesional involuntary movements and/or dysesthesia and with poor response to conventional antispastic or analgesic treatment, the possibility of RLS or PLMs should be considered, as these conditions seem eminently treatable.

Restless legs syndrome in hemodialysis patients: association with depression and quality of life

The prevalence of restless legs syndrome (RLS) ranging from 6.6% to 83% has been reported in different case series. The pathophysiology of RLS in uremia is still unclear. The aim of this study was to assess the frequency of RLS in the hemodialysis patients and to explore depression and associated detrimental impact on quality of life. The diagnosis of RLS was made using the criteria of the International Restless Legs Study Group. The polyneuropathy was diagnosed according to clinical signs and symptoms. Each subject completed three questionnaires: Beck Depression Inventory, Short Form-36 Quality of Life Scale, and the Epworth Sleepiness Scale (ESS). Biochemical parameters including hemoglobin, serum ferritin, and Kt/V index were collected. The data of the patients with and without RLS or clinical polyneuropathy (PNP) were compared. There were 41 male and 40 female patients. RLS, PNP, and high ESS scores were seen in 12%, 47%, and 7% of hemodialysis patients, respectively. Beck depression inventory scores were high in patients with RLS when compared to those without (28.9 ± 9, p = 0.007). General health score in the RLS patients, physical functioning score in the PNP patients were significantly lower (GH, 20.7; p = 0.036; PF, 10.5; p < 0.005). We did not observe any association between hemoglobin, ferritin levels, and Kt/V index in the RLS patients. However, Kt/V index in the PNP patients were low. The frequency of RLS in hemodialysis patients was lower than that reported from similar studies in other countries. The presence of RLS and PNP in hemodialyzed patients negatively affects quality of life, and RLS contributes to occurrence of depression.

Association study between antipsychotic‐induced restless legs syndrome and polymorphisms of monoamine oxidase genes in schizophrenia

This study aimed to investigate whether the monoamine oxidase (MAO) A and B genes are associated with antipsychotic-induced restless legs syndrome (RLS) in schizophrenia. We assessed antipsychotic-induced RLS symptoms in 190 Korean schizophrenic patients and divided the subjects into two groups: those with RLS symptoms (n = 96) and those without RLS symptoms (n = 94). Genotyping was performed for the variable number of tandem repeat (VNTR) polymorphism of the MAOA gene and A644G polymorphism of the MAOB gene. There was no significant difference in the genotype and allele frequencies of all polymorphisms investigated between these two groups. However, the result of global haplotype analysis showed a significant difference in haplotype frequencies between male subjects with and without RLS symptoms (p = 0.013). The interaction between two polymorphisms had a significant effect on the RLS scores of both male (p = 0.047) and female (p = 0.028) patients. These data do not suggest that the MAOA gene VNTR and MAOB gene A644G polymorphisms are associated with antipsychotic-induced RLS symptoms in schizophrenia. However, we found that the haplotype frequencies differed between the male schizophrenic patients with and without RLS symptom and the interaction between the two polymorphisms had a significant influence on the RLS scores of patients with schizophrenia.

Pharmacologically Induced/Exacerbated Restless Legs Syndrome, Periodic Limb Movements of Sleep, and REM Behavior Disorder/REM Sleep Without Atonia: Literature Review, Qualitative Scoring, and Comparative Analysis

Pharmacologically induced/exacerbated restless legs syndrome (RLS), periodic limb movements in sleep (PLMS), and REM behavior disorder/REM sleep without atonia (RSWA) are increasingly recognized in clinical sleep medicine. A scoring system to evaluate the literature was created and implemented. The aim was to identify the evidence with the least amount of confound, allowing for more reliable determinations of iatrogenic etiology. Points were provided for the following criteria: manuscript type (abstract, peer-reviewed paper); population size studied (large retrospective study, small case series, case report); explicitly stated dosage timing; identification of peak symptoms related to time of medication administration (i.e., medication was ingested in the evening or at bedtime); initiation of a treatment plan; symptoms subsided or ceased with decreased dosage or drug discontinuation (for RLS articles only); negative personal history for RLS prior to use of the medication; exclusion of tobacco/alcohol/excessive caffeine use; exclusion of sleep disordered breathing by polysomnography (PSG); and PSG documentation of presence or absence of PLMS. For RLS and PLMS articles were also given points for the following criteria: each 2003 National Institutes of Health (NIH) RLS criteria met; exclusion of low serum ferritin; and exclusion of peripheral neuropathy by neurological examination. Thirty-two articles on drug-induced RLS, 6 articles on drug-induced PLMS, and 15 articles on drug-induced RBD/ RSWA were analyzed. Based on scores < or = 10 and trials of medication reduction/cessation, the strongest evidence available for drug induced RLS are for the following drugs: escitalopram; fluoxetine; L-dopa/carbidopa and pergolide; L-thyroxine; mianserin; mirtazapine; olanzapine; and tramadol. Since none of the PLMS articles assessed PLMI in trials of medication reduction/cessation, the strongest evidence based on scores > or = 10 are for the following drugs: bupropion, citalopram, fluoxetine, paroxetine, sertraline, and venlafaxine. Based on scores > or = 10 and/or trials of medication cessation, the strongest evidence for drug induced RBD/ RSWA is for the following drugs: clomipramine, selegiline, and phenelzine.

Rotigotine Transdermal System for the Treatment of Restless Legs Syndrome

Rotigotine is a nonergot D3, D2 and D1 dopamine agonist that is currently approved for use in Parkinson’s disease and is awaiting approval for restless legs syndrome (RLS) in Europe. In the USA, it is currently approved for the treatment of early-stage Parkinson’s disease, but not for RLS patients. Oral dopaminergic agents are considered first-line for the treatment of RLS, but may not benefit all patients. Transdermally administered rotigotine delivers medication continuously, which may benefit patients with more severe RLS symptoms that persist or fluctuate throughout the day. It may also benefit patients with gastrointestinal problems or difficulty swallowing. Future research may further define the benefits of minimizing pulsatile stimulation of dopamine receptors. Several studies support the efficacy and tolerability of rotigotine in RLS patients. After treatment with rotigotine, patients had improved International RLS scores compared with placebo. Side effects reported were generally not serious and included application site reaction, nausea, somnolence, dizziness, headache, vomiting and insomnia. The well-known effectiveness and tolerability of dopaminergics, combined with a new pharmaceutical form, represents a promising treatment option for patients with RLS.

Characteristics and clinical correlates of restless legs syndrome in schizophrenia

Objective The cause of restless legs syndrome (RLS) has not yet been ascertained, but one of the most promising theories involves dopaminergic deficiency. In accordance with this theory, we assumed that the prevalence of RLS would be higher among schizophrenics treated with antipsychotics than in the normal population. The purpose of this study was to establish the prevalence, characteristics, and clinical correlates of RLS in schizophrenic patients undergoing treatment with antipsychotics. Methods A total of 182 hospitalized schizophrenic patients and 108 age- and sex-matched normal controls were enrolled. The presence of RLS and its severity were assessed using the International Restless Legs Syndrome Study Group (IRLSSG) diagnostic criteria and the IRLSSG rating scale, respectively. The Athens Insomnia Scale (AIS), Brief Psychiatric Rating Scale (BPRS), and Barnes Akathisia Rating Scale (BARS) were used to evaluate insomnia, global psychiatric symptoms, and akathisia, respectively, in schizophrenic patients. Results Of the 182 schizophrenic patients, 39 (21.4%) were found to have RLS and 87 (47.8%) met at least one of the RLS diagnostic criteria. The prevalence of RLS was significantly higher in the schizophrenia group than in the control group ( p = 0.009), as were the RLS scores ( p < 0.001). The BPRS ( p = 0.001) and the AIS ( p < 0.001) scores were higher in the RLS group than in the group with no RLS symptoms. Conclusion We conclude that it is important to consider the diagnosis of RLS when schizophrenic patients complain of insomnia, and that RLS symptoms could be associated with more severe psychiatric symptoms and insomnia.

Efficacy and tolerability of ropinirole in patients with restless legs syndrome and a baseline IRLS total score ≥ 24 points – data from the ropinirole clinical trial programme

ABSTRACTObjective: Results from one of the largest clinical trial programmes to date of a dopamine agonist in patients with primary restless legs syndrome (RLS) have demonstrated that ropinirole, 0.25– 4.0 mg once daily 1–3 hours before bedtime, is associated with significant improvements in RLS symptoms, sleep parameters and quality-of-life measures, compared with placebo. Analyses were conducted in a subpopulation of patients with a baseline score on the International Restless Legs Scale (IRLS) of at least 24 points.Research design and methods: Data was pooled from four, 12‐week, pivotal studies: RESET PLM and TREAT RLS 1, 2 and US.Main outcome measures: Covariate analysis demonstrated that the magnitude of treatment difference between ropinirole and placebo for change in IRLS total score (a measure of RLS symptom severity) increased with increasing baseline IRLS total score. Mean treatment difference was > 3 points in patients with a baseline total score ≥ 24. Among this population, ropinirole treatment was associated with significant reduction in RLS symptom severity compared with placebo, along with significant improvements in global symptoms and sleep measures. A treatment benefit was also observed for measures of quality of life. Ropinirole is well tolerated in this patient population.Conclusions: Patients with primary RLS and baseline IRLS total score ≥ 24 gain clinically meaningful benefits from ropinirole treatment. As with the overall population in the ropinirole clinical trial programme, ropinirole was associated with improvements in RLS symptoms, global symptoms, sleep and quality of life and was well tolerated in patients with a baseline IRLS total score ≥ 24.

Restless legs syndrome in Parkinson's disease patients may improve with subthalamic stimulation

We report on 6 advanced Parkinson's disease (PD) patients who underwent bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) surgery whose restless legs syndrome (RLS) improved postoperatively. Despite a mean 56% decrease in their levodopa equivalents postoperatively, their RLS scores dropped by a mean of 84% (100% in three). Our findings suggest that bilateral STN DBS surgery can improve RLS in patients with advanced PD.

Emergence of restless legs syndrome during subthalamic stimulation for Parkinson disease

The authors systematically studied the emergence of restless legs syndrome (RLS) after subthalamic nucleus (STN) deep brain stimulation (DBS) for Parkinson disease (PD). Postoperatively, 11 of 195 patients with STN DBS reported new problematic symptoms of RLS. The mean reduction in antiparkinsonian medication was 74%. The mean RLS score at diagnosis was 15 (+/-5.9) of a possible 24 points and after symptomatic drug therapy 4.3 (+/-3.1) points. Reduction of antiparkinsonian medication during STN DBS may unmask symptoms of RLS and complicate therapy of both RLS and PD.

Amantadine is beneficial in restless legs syndrome.

Twenty-one patients (mean age 70 yrs) with restless legs syndrome (RLS) were treated with amantadine in an open-label trial. Amantadine was started at 100 mg per day and was increased every 3-5 days by 100 mg (up to a maximum of 300 mg per day) until significant relief of symptoms or intolerable side effects were experienced. Patients were rated pre- and posttreatment using an RLS rating scale (0-10). Each patient also rated the degree of response in a continuous scale from 0% (no improvement) to 100% (complete improvement). Eleven of 21 (52%) had subjective benefit to amantadine, with degree of response ranging from 25%-100% (mean 69%) among responders. Six had 95%-100% improvement. The RLS score for all 21 patients dropped from a mean (+/- standard deviation) of 9.8 +/- 0.6 (range, 8-10) pretreatment to 6.6 +/- 3.8 (range, 0-10) posttreatment (p = 0.001). The duration of response was 0-13 months (mean, 3.6 +/- 4.5), with nine responders still remaining on the drug as of last follow up. The mean effective dose was 227 mg per day. The most common side effects were drowsiness (3), fatigue (2), and insomnia (2); only two stopped amantadine because of side effects. We conclude that amantadine is an effective and well-tolerated drug for RLS.