Restless Legs Syndrome Severity Research Articles

Aerobic Exercise in Individuals with Restless Legs Syndrome: A Case Series Study

Purpose: Exercise has been demonstrated to alleviate restless legs syndrome (RLS) symptoms in individuals with RLS, but little studies are available on the physical health of primary RLS. This case series aim to describe outcome after the training of supervised aerobic exercise training in individuals with RLS. Case Report: Five individuals with RLS were received with a supervised aerobic exercise training 2 days per week for 12 weeks. The International Restless Legs Syndrome Study Group Rating Scale (IRLS) was used to detect the severity of RLS. The Turkish version of the Pittsburgh Sleep Quality Index (PSQI) was used to measure sleep quality. The functional effect of fatigue was evaluated with Fatigue Impact Scale (FIS). The Six-Minute Walk test (6MWT) were used to determine the functional exercise capacity. All assessments took place at baseline and post-intervention. Conclusion: Following aerobic exercise, clinically meaningful changes in the severity of RLS, PSQI, and 6MWT were reported in all individuals with severe RLS. Four of 5 patients improved their FIS at post-intervention. These results suggest that 24-session supervised aerobic exercise training might help to improve RLS severity, sleep quality, fatigue, and exercise capacity in an individual with RLS.

#1839 Evaluating the severity of restless legs syndrome in chronic kidney disease patients across different renal replacement therapies

Abstract Background and Aims Restless Legs Syndrome (RLS) is increasingly recognized as a significant comorbidity in chronic kidney disease (CKD) patients. This cross-sectional study evaluates the risk and severity of RLS in CKD patients across various renal replacement therapies (RRT). Method A total of 167 CKD patients were assessed, including those on hemodialysis (HD) (39%), peritoneal dialysis (PD) (22%), with kidney transplants (19%), and those with non-dialyzed CKD stages IV-V (20%)—the International Restless Legs Syndrome Study Group (IRLS) questionnaire measured RLS severity. Severity scales were categorized into mild (0-10), moderate (11-20), severe (21-30), and very severe (31-40). PTH, P, Ca, ALP, and Mg serum concentrations, as well as vascular calcification, were measured as MBD biomarkers. The Adragaos score was applied to graphs of the hands and pelvis to evaluate vascular calcification. Statistical analyses focused on differences in RLS severity across RRT modalities and associated risk factors. Results The cohort comprised 82 males and 85 females, averaging 58 years. Primary disease etiologies included nephroangiosclerosis (24%), diabetic nephropathy (12%), chronic pyelonephritis (24%), chronic glomerulonephritis (24%), and ADPKD (7%). RLS prevalence was 53.8%, with significant differences in IRLS scores across groups (p ≤ 0.001). HD patients showed a mean IRLS score of 21.8 ± 12.3, with 55% reporting severe or severe symptoms. PD patients scored 16.06 ± 13.02; non-dialyzed CKD patients scored 6.41 ± 6.04; and transplant recipients scored 3.1 ± 4.7. No correlation was found between RLS severity and age or time on RRT. However, significant correlations were observed between RLS severity with HD modality, and the high Adragaos score. Multivariate analysis showed high serum phosphorus p=0.018 and markers of inflammation as a risk factor for RLS severity (CRP levels p=0.034; ferritin (p=0.048). Conclusion This study underscores the disproportionately higher severity of RLS in HD patients, necessitating tailored management strategies for this subgroup. The significant association between RLS severity and calcification and inflammation markers in CKD patients, particularly those on HD, suggests that RLS severity should be a key consideration in the clinical management of CKD. Addressing RLS in these patients may improve their quality of life and influence the outcomes of their renal replacement therapy.

Large muscle group movements during sleep in restless leg syndrome: neurophysiological and clinical implications.

Recently, criteria have been drawn up for large muscle group movements during sleep (LMM), defined as movements lasting for 3-45 seconds in adults, which are often accompanied by changes in sleep stage, arousals, and increases in heart rate. The aim of this study was to characterize LMM in restless legs syndrome (RLS) in order to better evaluate their impact on the neurophysiology of the disorder and, therefore, the possible clinical implications. Consecutive, drug-free patients diagnosed with RLS and controls, aged 18 years or more, were retrospectively enrolled. Leg movement activity-short-interval (SILMS), periodic (PLMS), and isolated (ISOLMS) leg movements during sleep-and LMM were detected and scored. In total, 100 patients and 67 controls were recruited. All movement measures were significantly higher in RLS. A significant positive correlation was found between LMM and ISOLMS index but not PLMS index in both groups. LMM index showed a significant negative correlation with total sleep time, sleep efficiency, and percentage of sleep stages N3 and R, as well as a significant positive correlation with the number of awakenings, and percentage of sleep stages N1 and N2 only in patients with RLS. No significant correlation was found between either LMM or PLMS index and RLS severity. Different types of movements, including SILMS, ISOLMS, and LMM, play somewhat distinct roles in sleep neurophysiology in RLS. Notably, LMM, a newly recognized category of movements, demonstrates associations with sleep architecture instability and fragmentation, arousals, and awakenings, suggesting potential clinical implications.

The ethos brief index-validation of a brief questionnaire to evaluate wellness based on a holistic perspective in patients with restless legs syndrome.

The aim of this study was to validate the Ethos Brief Index (EBI) in patients with Restless Legs Syndrome (RLS). A cross-sectional design, including 788 subjects with RLS (65% women, 70.8 years, SD 11.3) from the Swedish RLS Association, was used. A postal survey was sent out to collect data regarding socio demographics, comorbidities, and RLS-related treatment data. Questionnaires included were EBI, the Restless Legs Syndrome-6 Scale (RLS-6), Restless Legs Syndrome-Quality of Life questionnaire (RLSQoL), the Insomnia Severity Index (ISI), and the Epworth Sleepiness Scale (ESS). The validity and reliability of the EBI were investigated using Rasch and confirmatory factor analysis (CFA) models. Measurement invariance, unidimensionality, and differential item functioning (DIF) across age and gender groups, as well as insomnia, daytime sleepiness, RLS-related QoL and RLS severity were assessed. The results supported the unidimensionality of the EBI in the CFA (i.e., explaining 61.5% of the variance) and the Rasch model. The reliability of the EBI was confirmed using composite reliability and Cronbach's alpha. No DIF was identified for gender, age, insomnia, daytime sleepiness, RLS severity or RLS-related QoL. The EBI showed good validity and reliability and operated equivalently for male and female patients with RLS. Accordingly, healthcare professionals can use the EBI as a psychometrically sound tool to explore and identify patient-centered problems related to the whole life situation.

Compromised Dynamic Cerebral Autoregulation in Patients with Restless Legs Syndrome.

Restless legs syndrome (RLS) is a prevalent sensorimotor nervous system disorder in patients accompanied with insomnia, blood pressure fluctuation, and sympathetic dysfunction. These symptoms may disrupt cerebral hemodynamics. Dynamic cerebral autoregulation (dCA) describes the temporary response of cerebrovascular system to abrupt fluctuations in blood pressure, which keep cerebral blood flow stable and serve as a marker of cerebrovascular system ability. This research aimed to assess dCA in RLS patients. In this study, RLS patients were recruited and subsequently classified into four groups (mild, moderate, severe, and very severe) based on the International RLS Rating Scale (IRLS). Healthy controls matched for age and sex were enrolled. All participants were evaluated dCA by assessing phase difference (PD). A portion of patients with RLS was reassessed for dCA after one month of medication therapy (pramipexole [0.125 mg/day] and gabapentin [300 mg/day]). There were altogether 120 patients with RLS and 30 controls completed the polysomnography and dCA assessment. PD was lower in the moderate, severe, and very severe RLS groups than that in the controls and mild RLS groups. Periodic limb movement index (PLMI), arousal index, and IRLS all showed a linear correlation with PD in RLS patients. Additionally, PD increased in RLS patients after therapy. The dCA was compromised in moderate, severe, and very severe RLS patients and was negatively correlated with the IRLS, arousal index, and PLMI. After 1 month of therapy, dCA improved in RLS patients.

Use of Integrative Medicine Practices by Pregnant Women with Restless Legs Syndrome

Objective: To determine the use of integrative medicine practices in pregnant women with restless legs syndrome. Methods: This cross-sectional descriptive study was conducted in the perinatology service and outpatient clinic of a university hospital between 2 February-11 May 2022. The study included 148 pregnant women with restless legs syndrome who met the inclusion criteria. Data were collected using the Restless Legs Syndrome Diagnostic Criteria Questionnaire, the Restless Legs Syndrome Severity Rating Scale, a Personal Information Form, and an Integrative Medicine Use Form. Results: The pregnant women of the 61.4% were in their last trimester, and 75.7% had no information about restless legs syndrome. Symptoms started at an average of 20.29 ± 8.65 weeks of gestation and 81.1% of the pregnant women did not consult a physician. Of those who did consult a physician, 57.7% consulted a gynecologist and 81.0% were recommended vitamins/minerals as a treatment. For syndrome symptoms, 50.7% of pregnant women used integrative medicine practices. The four most commonly used methods were taking vitamins (55.9%), prayer (51.9%), brisk walking (45.2%) and massage (33.3%). There was no statistically significant difference between the use of integrative medicine practices and the severity of restless legs syndrome (P> .05). Conclusion: Restless legs syndrome is a condition that is not widely recognized by pregnant women. About half of pregnant women try to manage the condition by using integrative medical practices for syndrome. Nurses and other health professionals should provide information to pregnant women to raise awareness of the disease and provide effective treatment options.

Effect of Self-developed Ye'an Analgetic Decoction/Jiawei Shaoyao Gancao Decoction Combined with Tramadol on TCM Symptom Scores and RLS Severity of patients with Restless Legs Syndrome.

To investigate the effect of self-developed Ye'an Analgetic Decoction/Jiawei Shaoyao Gancao Decoction on Traditional Chinese Medicine (TCM) symptom scores and RLS Severity of patients with restless legs syndrome (RLS). This was a clinical comparative study. Eighty patients with RLS admitted to Baoding No.1 Central Hospital from January 2022 to December 2022 were randomly divided into observation group and control group(n=40). Patients in the control group were given basic and oral tramadol treatment, while those in the observation group were given self-developed Ye'an Analgetic Decoction/Jiawei Shaoyao Gancao Decoction based on the treatment in the control group. The differences of TCM symptom scores, RLS severity (IRLS), quality of life (QOL-RLS), sleep quality (PSQI) and clinical efficacy between the two groups were compared. Before treatment, no statistically significant differences were observed in the TCM symptom scores, IRLS scores, QOL-RLS scores and PSQI scores between the two groups (p>0.05). After treatment, the above scores decreased significantly in both groups, with a higher degree of decrease in the observation group than in the control group, indicating statistically significant differences (p<0.05). The QOL-RLS scores were significantly higher in the observation group than in the control group, with a statistically significant difference (p<0.05). The overall response rate in the observation group was 95.00%, which was higher than that in the control group (80.00%), with a statistically significant difference (p<0.05). Self-developed Ye'an Analgetic Decoction/Jiawei Shaoyao Gancao Decoction leads to numerous benefits in the treatment of RLS, such as obviously ameliorating patients' clinical symptoms, reducing RLS severity, and improving their quality of life and sleep quality.

Restless legs syndrome in patients with obstructive sleep apnea: Association between apnea severity and symptoms of depression, insomnia, and daytime sleepiness

ObjectiveTo determine if the prevalence and severity of restless legs syndrome (RLS) varies with apnea severity and analyze differences between the sexes in terms of comorbid RLS with symptoms of depression, insomnia, and daytime sleepiness in patients with obstructive sleep apnea (OSA). MethodsSymptoms of depression, insomnia, and daytime sleepiness were defined as Patient Health Questionnaire–9 score ≥10, Insomnia Severity Index score ≥15, and Epworth Sleepiness Scale score ≥11. Multivariate logistic and linear regression analyses were conducted. ResultsIn 707 adults with OSA (85.1% males), 16.1% (n = 114) had comorbid RLS. The prevalence of RLS was markedly lower in those with moderate and severe OSA than in those with mild OSA. Similarly, the odds of RLS significantly decreased with increasing apnea-hypopnea index. After controlling for age and sex, in patients with comorbid RLS, the International RLS Study Group Rating Scale scores were negatively correlated with apnea-hypopnea index and a nadir peripheral oxygen saturation during sleep. The presence of RLS was more likely to be associated with symptoms of depression, insomnia, and daytime sleepiness after controlling for confounding variables, but only in men. ConclusionsRLS is frequently noted in combination with OSA, with a female preponderance. The severities of OSA and RLS may be negatively associated. In patients with OSA, sex-related differences in terms of comorbid RLS with symptoms of depression, insomnia, and daytime sleepiness warrant further investigations.

The Melanocortin and Endorphin Neuropeptides in Patients with Restless Legs Syndrome.

Based upon similarities between the urge to move and sensory discomfort of restless legs syndrome (RLS) and properties of melanocortin hormones, including their incitement of movement and hyperalgesia, we assessed plasma and cerebrospinal fluid (CSF) α-melanocyte-stimulating hormone (α-MSH) and β-endorphin in RLS patients and controls. Forty-two untreated moderate-to-severe RLS patients and 44 matched controls underwent venipuncture at 19:00, 20:30, and 22:00; 37 RLS and 36 controls had lumbar puncture at 21:30. CSF and plasma were analyzed for pro-opiomelanocortin (POMC), adrenocorticotropin hormone (ACTH), α-MSH, β-MSH, and β-endorphin by immunoassay. RLS severity was assessed by International RLS Study Group Severity Scale. RLS participants were 52.7 ± 12.0 years old, 61.9% were women, 21.4% had painful RLS, and RLS severity was 24.8 ± 9.0. Controls had similar age and sex. Plasma ACTH, α-MSH, and β-endorphin were similar between groups. Plasma POMC was significantly greater in RLS than controls (17.0 ± 11.5 vs 12.7 ± 6.1fmol/ml, p = 0.048). CSF ACTH was similar between groups. CSF β-MSH was significantly higher in painful than nonpainful RLS or controls (48.2 ± 24.8 vs 32.1 ± 14.8 vs 32.6 ± 15.2pg/ml, analysis of variance [ANOVA] p = 0.03). CSF α-MSH was higher in RLS than controls (34.2 ± 40.9 vs 20.3 ± 11.0pg/ml, p = 0.062). CSF β-EDP was lowest in painful RLS, intermediate in nonpainful RLS, and highest in controls (8.0 ± 3.4 vs 10.8 ± 3.1 vs 12.3 ± 5.0pg/ml, ANOVA p = 0.049). The ratio of the sum of CSF α- and β-MSH to CSF β-endorphin was highest, intermediate, and lowest in painful RLS, nonpainful RLS, and controls (p = 0.007). CSF β-MSH is increased and CSF β-endorphin decreased in RLS patients with painful symptoms. ANN NEUROL 2024;95:688-699.

Non-invasive vagus nerve stimulation therapy for severe pharmacoresistant restless legs syndrome: efficacy and tolerance at 6 months

Non-invasive vagus nerve stimulation therapy for severe pharmacoresistant restless legs syndrome: efficacy and tolerance at 6 months

Restless leg syndrome as a complication of primary hyperparathyroidism: insights from a retrospective study.

Restless leg syndrome (RLS) is an invalidating neurological disorder with a complex, largely unknown pathophysiology. While RLS is observed in Parkinson's disease and in renal failure, idiopathic cases are common. Limited reports associate RLS with parathyroid hormone (PTH). This study analyzes a cohort of patients with primary hyperparathyroidism (PHPT) and chronic post-surgical hypoparathyroidism (hypo PTH), to investigate RLS prevalence, and associated risk factors. Ninety-five patients (54 PHPT, 41 hypo PTH) were consecutively enrolled at the bone metabolism outpatient clinic. The revised IRLSSG diagnostic criteria were used to diagnose RLS, with assessments conducted through face-to-face interviews and neurological examination. When RLS was confirmed, the RLS severity scale was applied. Retrospective records included calcium-phosphate metabolism-related parameters, surgery details, renal lithiasis, fragility fractures, and densitometric features (T-score). RLS was diagnosed in 22.2% PHPT patients, compared to 4.9% of patients with hypo PTH (p = 0.02). Of RLS diagnosed patients, 91.7% had a history of parathyroidectomy, compared to 47.6% of patients without RLS (p = 0.01). Most of the operated patients reported that surgery determined an improvement of symptoms; however, mean score severity of RLS at our evaluation was 15/40, defined as moderate. PTH and calcium levels were not statistically associated to the presence of RLS. Our study suggests that PHPT may be one of the etiologies of RLS. Parathyroidectomy alleviates symptoms in the vast majority of the cases but does not remove them.

Application of Repetitive Transcranial Magnetic Stimulation for the Treatment of Restless Legs Syndrome: A Pilot Study

ObjectiveTo explore effects of high frequency repetitive transcranial magnetic stimulation (rTMS) on restless legs syndrome (RLS) patients. Methods18 primary RLS patients were divided into rTMS group and sham stimulation group. rTMS treatment group received 15 Hz high-frequency rTMS to stimulate the leg motor representative area of the frontal cortex for 14 days and the sham stimulation group received 15 Hz high-frequency rTMS sham stimulation in primary motor cortex for 14 days. ResultsAfter rTMS, RLS severity scale score, Pittsburgh sleep quality index (PSQI), Hamilton anxiety scale (HAMA) as well as Hamilton depression scale (HAMD24) in rTMS treatment group are significantly lower than before treatment; 1 month and 2 months after treatment, the score remained at low level. Meanwhile, no significant changes have been observed in the above index before rTMS stimulation for the sham stimulation group after 14 days, after 1 month and 2 months. In addition, the results of correlation analysis suggested for all the 18 RLS patients, there was a positive correlation between PSQI score and HAMA as well as HAMD24 scores before and after rTMS stimulation. In addition, the RLS severity score was also positively correlated with PSQI, HAMA and HAMD24 scores. ConclusionsHigh frequency rTMS stimulation reduces the frequency and severity of RLS, improves the quality of sleep, anxiety as well as depression of the patients, and the curative effect can sustain for 2 months. High-frequency rTMS may be used as an alternative treatment option for improving the RLS patients’ quality of life.

A study of the correlation between magnesium and ferritin levels and the severity of the disease and sleep quality in restless legs syndrome

Background/Aim: Restless legs syndrome (RLS) is a chronic neurological disease that impairs sleep quality, causes emotional stress and affects daily activities. While the association between disease severity and low iron and ferritin levels is known, the magnesium (Mg) results are contradictory. This study aimed to investigate the influence of low Mg and ferritin levels on the severity of the disease and sleep quality. Methods: A case-control study included 50 RLS patients aged 18–78 years and 50 healthy control patients. Mg and ferritin levels were measured, considering values below &lt;1.8 mg/dL and 75 ng/mL as low. Both groups completed the International Restless Legs Syndrome Severity Rating Scale (IRLSSG) to assess the severity of RLS, as well as the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) to evaluate subjective sleep quality. Results: The mean age of RLS patients and the control group was 47.06 (13.35) years and 43.30 (15.43) years, respectively (P=0.196). The RLS patients had an IRLSSG score of 25.16 (6.85). The PSQI total scores, subscale scores, and ESS scores of RLS patients were significantly higher than those of the control group. However, no significant difference was observed in the IRLSSG score, PSQI, and ESS scores based on Mg and ferritin levels. Sleep latency was found to be shorter in individuals with Mg deficiency. Conclusion: Sleep disorders are prevalent among RLS patients. No correlation was found between Mg and ferritin levels and disease severity or sleep disorders. Furthermore, Mg deficiency did not appear to exacerbate the IRLSSG score or sleep disorder scores.

The Effect of Aromatherapy with Lavender on Pain of Needle Insertion and Severity of Restless Legs Syndrome in Hemodialysis Patients; a Systematic Review and Meta-analysis.

Pain experienced during the insertion of a catheter into the arteriovenous fistula (AVF) and restless legs syndrome (RLS) are prevalent issues among Hemodialysis (HD) patients. The primary objective of this systematic review and meta-analysis was to consolidate the findings from randomized clinical trial (RCT) studies examining the impact of aromatherapy with lavender on the pain associated with AVF catheter insertion and RLS in HD patients. A systematic search was conducted on PubMed, Web of Science, Scopus, Cochrane, Embase, ClinicalTrials.gov, and Google Scholar search engine from inception to August 1, 2022, using keywords extracted from Medical Subject Headings, such as "Aromatherapy", "Lavender", "Arteriovenous fistula", "Pain", "Restless legs syndrome", and "Hemodialysis". Finally, eleven articles were included in this systematic review and meta-analysis. The results showed that aromatherapy reduced the average pain of catheter insertion in AVF compared to the control group (Standard Mean Difference: -1.60, 95% Confidence Interval: -2.32 to -0.87, Z=4.32, I2:90.3%, P<0.001). Also, aromatherapy massage reduced the average severity of RLS compared to the control group, which was statistically significant (Weighted Mean Difference: -13.21, 95% Confidence Interval: -17.50 to -8.91, Z=6.03, I2:93.0%, P<0.001). Also, the subgroup analysis showed that lavender in the intervention group significantly decreased the pain intensity compared to the "no intervention" group (P<0.001), yet it was not significant compared to the placebo group (P=0.12). In summary, the findings indicate a notable reduction in catheter insertion pain in AVF and relief from RLS among HD patients through the use of lavender essential oil. As a result, future research is encouraged to include a comparison of lavender's effects with those of a placebo group.

Ab. No. 105 A Scoping Review of the Effectiveness of Various Exercise Regimens on the Severity of Uremic Restless Leg Syndrome and Other Outcome Metric in Hemodialysis Subjects

Introduction: Uremic restless leg syndrome (URLS) is a condition that occurs in individuals with kidney failure or severe kidney disease;characterized by an uncontrollable urge to move the legs, often accompanied by discomfort or a crawling sensation.URLS can be prevalent in hemodialysis patients, as kidney dysfunction contributes to its development. Hemodialysis helps in removing waste products from the blood, but it may not completely alleviate URLS symptoms. The purpose of this scoping review is to outline the literature on physiotherapy in URLS, the types of physiotherapy interventions used and the outcome measures used. Methods: Scoping review in accordance with Joanna Briggs Institute guidelines. From 2005 to December 2023, databases searched included PubMed, PEDro, Research Gate and Google Scholar following MESH terminology and boolean operators in accordance to the study requirement.A narrative data summary was created to explain the current evidence on physiotherapy for URLS. Articles were considered if they were about physiotherapy interventions given to URLS subjects. A narrative synthesis was conducted. Results: Ten studies were included (eight randomised control trials, one pilot RCTs, one quasi experimental study). PEDro scale for 4 studies were ≥5 and 6 studies were ≥5.Interventions reported were aerobic,resistance and stretching exercise. A variety of outcome measures was utilised such as severity of URLS, physical performance, balance, sleep quality, depression score and quality of life domains. Conclusion: The results of this review suggest that there is insufficient information to assist physiotherapists in the treatment of subjects with URLS. Aerobic, resistance and stretching exercise were the widely studied physiotherapy therapies. A variety of outcome metrics are used. High-quality clinical trials with representative populations are needed, as are investigations on physiotherapy practice and the experiences of subjects with URLS.

Prevalence and clinical correlates of restless legs syndrome in psychiatric patients: A cross-sectional study from North India.

Restless legs syndrome (RLS) is a neuro-sensorimotor disorder which is scarcely researched and is commonly missed in routine psychiatry practice. To evaluate the prevalence of RLS and its correlates in patients with anxiety, depression, and somatoform disorders. A cross-sectional single-center study was undertaken in patients aged 18-65 years suffering from ICD-10 (International Statistical Classification of Diseases-10th edition) diagnosis of anxiety, depressive, and somatoform disorders. RLS was evaluated by using diagnostic criteria of International Restless Legs Syndrome Study Group (IRLSSG) and severity measured on IRLSSG scale. Depression and anxiety were rated on Hamilton Depression and Anxiety Rating Scales respectively, insomnia severity measured by Insomnia Severity Index (ISI), and quality of life measured by WHO Quality of Life-Brief version (WHO-QOL BREF) scale. Serum ferritin levels were measured for evaluating iron deficiency. The rate of RLS was 66.7%, 50%, and 48% in patients with depressive, anxiety, and somatoform disorders, respectively, with no significant inter-group difference. Nearly one-third of patients suffered from severe to very severe symptoms of RLS, and quality of life was poorest in those with depressive disorders. RLS was significantly higher in females (P = 0.019), who were married (P = 0.040), diagnosed with severe depression (P = 0.029), and abused benzodiazepines (P = 0.045). On binary logistic regression, female gender and presence of clinical insomnia predicted occurrence of RLS. The prevalence of RLS is very high in patients with common psychiatric disorders which is often missed. Clinical enquiry and examination for reversible causes such as iron deficiency may assist in its diagnosis and improve clinical outcome.

Treatment of Willis-Ekbom Disease (Restless Leg Syndrome); The Efficacy of Mulligan's Traction Straight Leg Raise among Paramedical Professionals.

Background: Restless Leg Syndrome (RLS) is a generalized neurological sensory-motor disorder characterized by intense restlessness and discomfort in the lower extremities, leading to an urge to move the legs at sleep time. Treatment protocols for RLS may include thermotherapy, stretching exercises, and Mulligan’s traction straight leg raise (SLR). Mulligan’s traction SLR is an effective method that influences peripheral and central neural pathways through mobilization, thereby alleviating RLS symptoms. Objective: The study aimed to compare the efficacy of stretching exercises and Mulligan traction straight leg raise in reducing RLS severity among paramedical staff. Methods: This randomized clinical trial included a sample size of 38 paramedical staff members diagnosed with RLS using standard criteria. Participants were allocated using the Convenient Sampling Technique and randomly assigned into Group 1 (Stretching Exercises) and Group 2 (Mulligan Traction SLR) through coin tossing. Each group consisted of 19 participants. The interventions were conducted three times per week for one month. Assessments were made using the RLS Severity Scale, Numeric Pain Rating Scale, Groningen Sleep Quality Scale, and Goniometer at baseline, and after the 2nd and 4th weeks of treatment. Results: The study indicated that both treatments were effective in treating RLS, showing a significant difference with p&lt;0.05. However, Mulligan's TSLR exhibited remarkable results in improving sleep quality, increasing SLR range of both legs, reducing pain intensity, and improving RLS symptoms, with p-values of 0.001, 0.000, 0.012, and 0.001, respectively. Data analysis was conducted using the Statistical Package for Social Sciences (SPSS) version 26. Conclusion: The study concluded that both Stretching Exercises and Mulligan's TSLR are effective treatments for RLS. However, Mulligan's TSLR showed superior effectiveness in reducing pain levels, RLS symptoms, and in improving sleep quality and SLR range among paramedical staff members.

Improvement of restless leg syndrome in maintenance hemodialysis patients with limb ischemic preconditioning: a single-center randomized controlled clinical trial

Objective This study evaluated the efficacy and safety of limb ischemic preconditioning (LIPC) in treating restless leg syndrome (RLS) in maintenance hemodialysis (MHD) patients. Methods A total number of 45 patients participated in the study. They were randomly divided into LIPC group and control group. The LIPC was performed by inflating the limb ischemic preconditioning training device in the patient’s thigh to 200 mmHg to create transient ischemia, whereas control group inflated the device to 20 mmHg. International Restless Legs Syndrome (IRLS), Clinical Global Impression Scale (CGI-S), and Medical Outputs Study Sleep Scale were employed to evaluate LIPC effectiveness. The primary endpoint was the ‘rate of clinical improvement in RLS severity’, defined as the percentage of patients who had an IRLS score decrease of ≥5 points in each group. Results After intervention, the rate of clinical improvement in RLS severity was 56.5% in the LIPC group and 13.6% in the control group (13 (56.5) vs 3 (13.6), p = 0.003). In addition, the LIPC group’s IRLS, CGI-S scores, the sleep disturbance and somnolence scores showed a significant downward trend compared to the control group (−5.5 ± 5.3 vs − 1.0 ± 3.8, p = 0.002; −1.7 ± 1.2 vs − 0.5 ± 1.4, p = 0.003; −15.5 ± 17.8 vs 3.7 ± 12.0, p < 0.001; −9.9 ± 18.8 vs − 2.4 ± 8.6, p = 0.003). During the study, there were no serious adverse event in any of the patients. Conclusions LIPC could be employed to effectively and safely alleviate the RLS symptoms in MHD patients.

Investigating the Effect of Temperature Therapy on the Severity of Restless Legs Syndrome: Systematic Review and Meta-Analysis.

Background: Restless legs syndrome (RLS) is a sensorimotor disorder leading to disturbance of resting, discomfort, stress, and impaired daytime activity in the sufferers. The present systematic review and meta-analysis was conducted to determine the effect of temperature therapy on the severity of RLS.Methods: The electronic databases of Google Scholar, ProQuest, Scopus, PubMed, Web of Science, and State Inpatient Databases (SID) were searched from inception to August 2022. The Cochrane Collaboration's Risk of Bias Tool was used to check the quality of included studies. Meta-analysis was performed by calculating standardized mean differences (SMDs), using random effects model, and running Comprehensive Meta-Analysis (CMA) software version 2.Results: The included studies (n=6) comprised 177 participants, whose mean age was 49.85 years old. The results of the meta-analysis showed temperature therapy could reduce the severity of RLS (SMD=-1.520, 95% CI: -2.122 to -0.918). Regarding the source of heterogeneity, meta-regression results indicated the efficacy of the intervention in reducing the severity of RLS enhanced significantly by increasing the duration of the intervention in each session (β=-0.039, 95% CI -0.076 to -0.002, P<0.001). The results also showed increasing the duration (β=-0.039, 95% CI -0.076 to -0.002, P<0.001) and the temperature of the intervention in each session (β=-0.016, 95% CI -0.028 to -0.003, P<0.05) significantly enhanced the efficacy of the intervention in reducing the severity of RLS. The results also indicated that, among patients with underlying clinical conditions, the effectiveness of temperature therapy was higher in hemodialysis patients (β=-2.006, 95% CI -2.736 to -1.276, P<0.05).Conclusion: The present study findings suggested temperature therapy could mildly reduce the severity of RLS symptoms. It was also found that the highest efficacy of this intervention could be achieved when the higher temperature was used in fewer treatment sessions in hemodialysis patients. Based on our findings, this intervention can be included in the care plan of patients with RLS considering the settings described to achieve the highest efficacy.

Spinal cord stimulation in severe pharmacoresistant restless legs syndrome—two case reports

Restless legs syndrome is a prevalent, sleep-related sensorimotor disorder with relevant impact on the patients’ quality of life. For patients suffering from severe, pharmacoresistant restless legs syndrome, few therapeutic options remain to alleviate symptoms. In this case series, two patients with severe, pharmacoresistant restless legs syndrome were treated with epidural spinal cord stimulation and repeatedly assessed with polysomnography, including sleep structure and periodic limb movements as objective biomarkers not subject to placebo effects, during a 6-month follow-up period. One of the patients experienced excellent short- and long-term efficacy on subjective symptom severity (International RLS Study group rating scale 1 vs. 34 points at 3 months) and objective sleep parameters such as sleep architecture and periodic limb movements during sleep, while the second patient only reported short-term benefits from spinal cord stimulation. Ultimately, both patients opted for removal of the device for inefficacy. Based on the complex pathophysiology of restless legs syndrome and presumed mechanism of action of spinal cord stimulation in chronic pain disorders, we provide a detailed hypothesis on the possible modulating effect of spinal cord stimulation on the key symptoms of restless legs syndrome. Apart from describing a new therapeutic option for pharmacoresistant restless legs syndrome, our findings might also provide further insights into the pathophysiology of the syndrome.