Restless Legs Syndrome Severity Research Articles

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).

Short-interval intracortical inhibition is decreased in restless legs syndrome across a range of severity

BackgroundDecreased short-interval intracortical inhibition (SICI) to transcranial magnetic stimulation (TMS) of the primary motor cortex was described in subjects with restless legs syndrome/Willis-Ekbom disease (RLS/WED). It remained to be determined whether the magnitude of SICI decrease would be similar across levels of RLS/WED severity. Moreover, it was unknown whether, in addition to decreases in SICI, changes in cortical thickness or area could be detected in subjects with RLS/WED compared to controls. The objective of this study was to compare SICI, cortical thickness, and cortical area in subjects with idiopathic mild to moderate RLS/WED, severe to very severe RLS/WED, and controls. MethodsThe severity of RLS/WED was assessed by the International Restless Legs Syndrome Severity Scale (IRLSS). SICI and 3T magnetic resonance imaging (MRI) data of subjects with RLS/WED and controls were compared. A receiver operating characteristic curve for SICI was designed for discrimination of participants with RLS/WED from controls. Cortical thickness and area were assessed by automated surface-based analysis. ResultsSICI was significantly reduced in patients with mild to moderate and severe to very severe RLS/WED, compared to controls (one-way analysis of variance: F = 9.62, p < 0.001). Receiver operating characteristic curve analysis predicted RLS/WED when SICI was above 35% (area under the curve = 0.79, 95% CI 0.67–0.91, p < 0.001). Analyses of the whole brain and of regions of interest did not reveal differences in gray matter thickness or area between controls and subjects with RLS/WED. ConclusionSICI is an accurate cortical biomarker that can support the diagnosis of RLS/WED even in subjects with mild symptoms, but cortical thickness and area were not useful for discriminating subjects with this condition from controls.

Treatment of Leg Veins for Restless Leg Syndrome: A Retrospective Review.

Background: Restless leg syndrome (RLS) and chronic venous insufficiency (CVI) share similar circadian timings and epidemiological characteristics.Objective: The objective of the study was to investigate whether treating superficial venous reflux (SVR) improves the RLS severity in patients with CVI and whether there is an association of the RLS severity with the number of refluxed veins.Materials and methods: Patients with RLS and duplex ultrasound-proven SVR were identified from a database of 134 patients. All patients underwent endovenous radiofrequency ablation and ultrasound-guided foam sclerotherapy. International RLS (IRLS) rating scale questionnaires were reviewed to assess pre- and post-intervention RLS status.Results: Thirty-five patients were identified. The average baseline IRLS score was 19.83 (moderate RLS) and improved to 7.89 (mild RLS) after treatment (p < .0001), corresponding to 63% decrease in symptoms. Ten patients (29%) had a follow-up score of 0, indicating complete relief of RLS symptoms. Twenty patients (57%) had decreased IRLS scores of 10 points or more (i.e. 1 grade level of severity). Six patients had no improvement. There was no association of the RLS severity with the number of refluxed veins.Conclusion: The study found that correcting SVR improves RLS symptoms, suggesting an association between CVI and RLS. Venous ultrasound study and intervention should be considered for potential patients.

Probable RBD Associates with the Development of RLS in Parkinson's Disease: A Cross-Sectional Study.

Objectives We aimed to investigate the prevalence of restless leg syndrome (RLS) and exploring the contributing factors that affect the development of RLS in Parkinson's disease (PD) patients. Methods A cross-sectional study was conducted consisting of 178 consecutive PD patients from our hospital between October 2015 and August 2016. We divided the participants into two groups, which were PD with RLS and PD with non-RLS. Then, we recorded their demographics and clinical data to draw a comparison between PD with RLS and PD with non-RLS. Results 23 (12.92%) were diagnosed with RLS among all the enrolled PD patients. Unified Parkinson's Disease Rating Scale III (UPDRS III) and Hamilton Depression Scale (HAMD) scores, probable rapid eye movement sleep behavior disorder (PRBD), and daily levodopa equivalent dose (LED) in the PD with the RLS group were significantly different from those in the PD with the non-RLS group. Daily LED and the scores of UPDRS III and HAMD in PD patients with RLS were all higher than those in PD patients with non-RLS. PRBD, daily LED, and HAMD scores were significantly independent factors contributing to the development of RLS (OR = 4.678, 95% CI 1.372~15.944, P = 0.014; OR = 1.003, 95% CI 1.001~1.005, P = 0.019; OR = 1.094, 95% CI 1.002~1.193, P = 0.045). The severity of RLS was positively correlated with the duration of PD and daily LED (r = 0.438, P = 0.036; r = 0.637, P = 0.001). Conclusion PRBD existence, daily LED, and HAMD scores are independent factors for developing RLS in PD patients. PRBD existence is firstly proposed as an independent factor in developing RLS among PD patients. RLS severity in PD patients are positively associated with the duration of PD and daily LED.

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.

Characterization of painful Restless Legs Syndrome sensations in an English-speaking South African population.

Background and aims Restless Legs Syndrome (RLS) is characterised by unusual sensations in the legs which can be described as painful in up to 60% of RLS patients. The purpose of this study was to characterise and examine whether the presence of pain influenced the words used to describe the sensations of RLS in an English speaking population. Methods RLS participants (n=55) were divided according to whether or not painful RLS sensations were reported upon questioning. They completed the McGill Pain Questionnaire (MPQ), the International Restless Legs Syndrome Severity Scale (IRLS) and selected descriptors from a list of previously published RLS terms. Results Thirty-five percent of the RLS patients had painful sensations. The participants with painful RLS had higher Pain Rating Index (PRI) scores [median (interquartile range) 21 (17-28) vs. 14 (7.5-21) p=0.0008] and IRLS scores [23 (17-28) vs. 18 (11.5-22.5) p=0.0175] than the participants with non-painful RLS. Patients with painful RLS symptoms selected more pain-related literature terms, chose significantly different words in eight of the MPQ subclasses (both sensory and affective) and selected more intense descriptors from certain MPQ subclasses than the non-painful RLS group. The terms that characterised painful RLS were "aching", "painful", "cramping" and "unbearable". Conclusions Descriptors of RLS sensations are changed by the presence of pain, which may indicate an aetiological difference in the patients who have painful RLS. Clinically, patients complaining of cramping and painful sensations may be diagnosed with a condition that mimics RLS. Thus, it is important that the most accurate set of descriptors for RLS are used to enable recognition of RLS and optimised treatment according to the RLS phenotype. Implications The diagnosis of RLS may be improved by overcoming language and cultural barriers and obtaining differential diagnostic terms for painful conditions mimicking RLS.

Acceptability and feasibility of a 12-week yoga vs. educational film program for the management of restless legs syndrome (RLS): study protocol for a randomized controlled trial

BackgroundRestless legs syndrome (RLS) is a common and burdensome sleep disorder associated with profound impairment of health, well-being, and quality of life. Unfortunately, the medications used for RLS management carry risk of serious side effects, including augmentation of symptoms. Yoga, an ancient mind-body discipline designed to promote physical, emotional, and mental well-being, may offer a viable, low-risk new treatment. The primary objectives of this pilot, parallel-arm, randomized controlled trial (RCT) are to assess the acceptability and feasibility of a 12-week yoga vs. educational film program for the management of RLS.MethodsForty-four adults with confirmed moderate to severe RLS will be recruited and randomized to a 12-week yoga (n = 22) or standardized educational film program (N = 22). Yoga group participants will attend two 75-min Iyengar yoga classes per week for the first 4 weeks, then one 75-min class per week for the remaining 8 weeks, and will complete a 30-min homework routine on non-class days. Educational film group participants will attend one 75-min class per week for 12 weeks and complete a daily RLS treatment log; classes will include information on: RLS management, including sleep hygiene practices; other sleep disorders; and complementary therapies likely to be of interest to those participating in a yoga and sleep education study.Yoga and treatment logs will be collected weekly. Feasibility outcomes will include recruitment, enrollment, and randomization rates, retention, adherence, and program satisfaction. Program evaluation and yoga-dosing questionnaires will be collected at week 12; data on exploratory outcomes (e.g., RLS symptom severity (IRLS), sleep quality (PSQI), mood (POMS, PSS), and health-related quality of life (SF-36)) will be gathered at baseline and week 12.DiscussionThis study will lay the essential groundwork for a planned larger RCT to determine the efficacy of a yoga program for reducing symptoms and associated burden of RLS. If the findings of the current trial and the subsequent larger RCTs are positive, this study will also help support a new approach to clinical treatment of this challenging disorder, help foster improved understanding of RLS etiology, and ultimately contribute to reducing the individual, societal, and economic burden associated with this condition.Trial registrationClinicalTrials.gov, ID: NCT03570515. Retrospectively registered on 1 February 2017.

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.

Iron for the treatment of restless legs syndrome.

Iron for the treatment of restless legs syndrome.

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.

The Effect of the Cool Dialysate on the Restless Leg Syndrome in Hemodialysis Patients: Randomized Triple-Blind Clinical Trial.

Background:Restless leg syndrome (RLS) is a common symptom of some diseases specially observed during hemodialysis. Cooling the dialysate is a safe and nonpharmacological method. The aim of this study was to assess the effect of cool dialysate on RLS in hemodialysis patients.Materials and Methods:A total of 79 patients were selected for screening based on the four main criteria set by the RLS International Association. Finally, in line with the inclusion and exclusion criteria, 63 hemodialysis patients were recruited and participated in this clinical trial. The patients were randomly assigned to the intervention group (n = 32) and the control group (n = 31). The intervention group received 35.5°C dialysate and the control group received 37°C dialysate three times a week for a period of 1 month. The severity of RLS was measured in both groups using a standardized RLS questionnaire. Using R software version 3.3.1, the data were analyzed using the Student's t-test, and Wilcoxon test, at 95% confidence interval.Results:In terms of RLS severity, there was no significant difference between intervention and control groups before the intervention (t = -2.11, p > 0.05). After the intervention, the mean (SD) of RLS severity in the control group was 28.77 (5.45) and in the intervention group was 11.66 (4.69), in which t test showed a significant difference between two groups (t = 14.03, p= 0.001).Conclusions:Using cool dialysate as a nonpharmacological treatment may reduce the severity of RLS in patients on hemodialysis. Therefore, using this method to improve RLS in hemodialysis patients is recommended.

Liver disease severity is poorly related to the presence of restless leg syndrome in patients with cirrhosis.

Restless leg syndrome (RLS) has been reported to be common in patients with cirrhosis. The relation of RLS with severity of liver disease is, however, unclear. We studied the association between occurrence of RLS and severity of cirrhosis. Single centre, prospective, observational study. Adult patients with cirrhosis and relatively stable clinical condition and no associated neurological condition were prospectively studied. Severity of liver disease was graded as Child-Turcotte-Pugh (CTP) class A, B or C; using Model for End-Stage Liver Disease (MELD) score; and as a binary variable (compensated or decompensated disease). Each subject underwent an initial screening for RLS, followed by a re-evaluation by an independent neurologist to confirm the diagnosis, using the International RLS Diagnostic Criteria. In patients with RLS, its severity was assessed using a validated Hindi translation of the International RLS severity (IRLS) scoring system. Data for categorical variables were expressed as proportions and compared using chi-squared test, and those for numerical variables were expressed as median and range, and compared using Wilcoxon rank sum test. Among the 356 patients with cirrhosis studied (median [range] age: 48 [18-83] years; 241 [67.7%] male; CTP A/163, B/172, C/21; MELD 11 [6-41]; decompensated 51.7%), 36 (10.1%) had RLS. RLS severity was mild (1), moderate (15), severe (19) or very severe (1). Compared to those without RLS, patient with RLS had a lower MELD score (9 [6-25] versus 11 [6-41], P = 0.04), and a comparable distribution of CTP classes and frequency of decompensated liver disease. The prevalence and severity of RLS were not different between those with compensated and those with decompensated cirrhosis. In the Indian population, RLS is common in patients with cirrhosis. Its occurrence did not show any increase with the severity of liver disease.

The prevalence of restless legs syndrome and comorbid condition among patient with type 2 diabetic mellitus visiting primary healthcare.

Aim:The aim of this study was to determine the prevalence of restless legs syndrome (RLS) and Pittsburgh Sleep Quality Index (PSQI) in patients with type 2 diabetes mellitus (T2DM) attending primary healthcare.Subjects and Methods:This is a cross-sectional study and participants were between 25 and 70 years old who visited the diabetes and endocrinology department of Mega Medipol University Teaching Hospital, Istanbul. The diagnosis of RLS was performed according to the International Restless Legs Syndrome Study Group consensus criteria. The RLS and PSQI instruments were conducted on 871 patients with T2DM. Good sleep quality was defined as PSQI score <5. RLS severity was assessed by the Restless Legs Syndrome-6 Scales (RLS-6). The scale development and validation was carried out using Rasch measurement model.Results:The prevalence of RLS was 22.8% including 60.3% of females and 39.7% of males. This study showed significant differences between RLS and no RLS patients with respect to their age (years), body mass index (BMI) (kg/m2), physical activity, smoking habit, sheesha smoking, income, and sleeping quality with PSQI. Also, the analysis presented that statistically significant differences between both RLS and no RLS reported sleep complaints including difficulty falling asleep, inadequate sleep, anytime fatigue, and leg discomfort. There were statistically significant differences between RLS and no RLS patients regarding hypoglycemia, numbness in legs, retinopathy, neuropathy, nephropathy high blood pressure, depression, stroke, anemia, diabetic foot, ulcer, arthritis, respiratory disease, metabolic syndrome, and coronary heart disease. Furthermore, there were statistically significant differences between RLS and no RLS concerning the number of sleeping hours, wake-up time (AM), sleeping time (PM), BMI (kg/m2), HbA1c, vitamin D, calcium, creatinine, fasting blood glucose, low-density lipoprotein, triglyceride, uric acid, and systolic and diastolic blood pressure (mmHg).Conclusion:This study confirms positive relation and high prevalence of RLS among patients with T2DM visiting primary healthcare. The results suggest that physical activity is associated with a better perception of functional capacity and pain in diabetic patients with RLS, and thus a more active lifestyle should be encouraged.

The effects of vibration and massage on severity of symptoms of restless leg syndrome and sleep quality in hemodialysis patients; a randomized cross-over clinical trial

Introduction: Restless leg syndrome (RLS) is a common sensory disturbance in hemodialysis patients causing mental disorders, sleep disturbances, and other problems. Objectives: This study compared the effects of massage and vibration on sleep quality and severity of symptoms of RLS in hemodialysis patients. Patients and Methods: This cross-over clinical trial was conducted on 80 hemodialysis patients with RLS who were assigned into two groups randomly. The first group received massage and the second group received vibration. Each group received the related intervention for one month three times per week each session lasting 10 minutes. One month after the first intervention, the interventions were changed in a cross-over design between the two groups. The severity of symptoms of RLS and sleep quality were assessed before and after interventions using the related questionnaire. Results: The means of severity of symptoms of RLS and sleep quality showed a significant improvement after both interventions of vibration and massage (P&lt;0.001). Additionally, a significant difference was observed in the means of severity of RLS and sleep quality after interventions between two groups hence vibration exerted a greater effect on improving the symptoms of RLS and sleep quality in patients compared to massage (P=0.001). Conclusion: Our findings suggested that both vibration and massage reduce the mean of severity of RLS and improve sleep quality in hemodialysis patients, with vibration exerting a greater effect compared to massage.

Efficacy of vitamin D replacement therapy in restless legs syndrome: a randomized control trial

Restless legs syndrome is a movement sleep disorder that may be linked to dopaminergic dysfunction and in which vitamin D may play a role. This 12-week randomized, placebo-controlled trial elucidated the efficacy of vitamin D supplements in decreasing restless legs syndrome symptom severity. Thirty-five subjects with restless legs syndrome, diagnosed using the International Restless Legs Syndrome Study Group criteria, were enrolled. The subjects were randomized to orally receive either vitamin D (50,000IU caplets) or a placebo. All medications were administered weekly using a direct observation technique. Clinical assessments, including those for restless legs syndrome severity, were conducted at baseline and the end of the study using the International Restless Legs Syndrome Study Group rating scale. The serum vitamin D levels and bone profiles were measured at baseline and every 4weeks. The primary endpoint was the change in the restless legs syndrome severity score from baseline to week 12. There were 17 and 18 patients in the vitamin D and placebo groups, respectively. The groups did not differ with respect to age, sex, restless legs syndrome severity, or vitamin D levels. Participants in the vitamin D group showed no significant change in the mean restless legs syndrome severity score compared with the placebo group. The results suggest that vitamin D supplementation does not improve restless legs syndrome symptoms. ClinicalTrials.gov : NCT02256215 (available from: https://clinicaltrials.gov/ct2/show/NCT02256215 ).

Evaluation of restless legs syndrome and sleep disorders in patients with psoriatic arthritis.

Restless legs syndrome (RLS) is aneurological disease with achronic course that is characterised by sleep disorders and sensorimotor impairment. The aim of this study was to evaluate the prevalence and severity of RLS in psoriatic arthritis (PSA) patients and those with psoriasis(P). The study included 50patients with psoriasis (28females, 22males), 50PSA patients (33females, 17males) and 50 healthy control subjects (34females, 16males), and all 3groups were matched with respect to age, gender and body mass index (BMI). Evaluations were made using the International RLS Rating Scale, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, Insomnia Severity Index, Fatigue Severity Scale (FSS), Beck Depression Index (BDI) and the SF-36 quality of life scores. RLS was determined at ahigher rate in the PSA patients (64.0%), compared to the Pgroup (20.0%, p < 0.001) and the control group (14.0%, p < 0.001). The number of moderate and severe RLS cases was significantly higher in the PSA group (68.7%) compared to the Pgroup (30%, p < 0.001) and the control group (0%, p < 0.001). In regression analysis, an independent correlation was found between the RLS score and PSQI (beta [β] = 0.269, p = 0.002), FSS (β = 0.243, p = 0.003), SF-36 physical score (β = 0.242, p = 0.004) and BDI (β = 0.177, p = 0.036). RLS was determined in PSA patients at ahigher rate than in psoriasis patients. The presence of RLS in PSA and psoriasis patients is related to impairments in sleep and quality of life, fatigue and depression.

Restless Legs Syndrome and Other Movement Disorders of Sleep-Treatment Update.

The purpose of this review article is to summarize and discuss the recent advances in the treatment of restless legs syndrome (RLS), as well as REM sleep behavior disorder (RBD), and periodic leg movement disorder (PLMD). Traditionally, dopaminergic therapy has been considered the sole option for first-line treatment of RLS due to their impressive acute efficacy. Dopamine agonists such as oral pramipexole and ropinirole, as well as transdermal rotigotine are all effective treatment options. However, augmentation of the RLS symptoms is a major limitation of oral dopaminergic therapy. Recently, gabapentinoid agents such as gabapentin enacarbil and pregabalin have shown comparable short-term efficacy to dopaminergics with lower risk of augmentation of the RLS symptoms. Recent evidence on the efficacy of oxycodone-naloxone in treatment-resistant RLS provides an additional therapeutic avenue. The increasing understanding of the role of iron in RLS pathophysiology has led to new options in iron supplementation therapy in RLS, including treatment with ferric carboxymaltose. With emerging evidence of augmentation being a side effect specific to dopaminergic treatment, gabapentinoids are considered a safer option as initial treatment. In severe refractory RLS, oxycodone-naloxone can be used. If iron stores are low, IV iron formulations should be the initial treatment choice. New treatment options are needed to address issues with current therapies.

Validation of the self-administered version of the international Restless Legs Syndrome study group severity rating scale – The sIRLS

IntroductionThe International Restless Legs Study Group (IRLSSG) has developed the IRLS (International Restless Legs Syndrome Severity Scale) and validated it as a clinician/researcher administered scale to be used when both patient and examiner are present. The IRLSSG recognized the need for a self-completing scale that can be used economically in clinical practice and in large population-based studies. In this study the validity and the reliability of the IRLS as a self-administered scale (sIRLS) is assessed. MethodsEstablished RLS patients were recruited by eight centers in four countries and consented to participate in this study. The validity of the sIRLS was assessed by patients completing the sIRLS before a clinician administered the IRLS. The reliability of the sIRLS was assessed by patients completing the sIRLS again, two weeks after the first one, provided no change had occurred. ResultsOverall, 173 patients were recruited and 164 of them were included in the analyses. The sIRLS showed satisfactory scaling assumptions and no relevant floor or ceiling effect. One factor explained 61.3% of the variance. Cronbach's alpha was 0.93 and the item homogeneity index was 0.59. Intraclass correlation coefficient between the sIRLS and the IRLS was 0.94. The sIRLS standard error of measurement was 3.61 (½ SD at baseline = 4.11). The results mostly overlapped those of the IRLS analyzed in parallel. DiscussionThe sIRLS is a reliable, valid and precise instrument that showed tight association with the IRLS. These findings support the use of the sIRLS for self-evaluation of RLS severity. The responses obtained on the sIRLS and the IRLS scale varied slightly. Therefore, we recommend that either the sIRLS or the IRLS scale be used as the only scale for serial measures over time.

Frequency of restless legs syndrome and relationship between depression, anxiety and sleep quality among medical school students

We aimed to investigate the relationship between frequency of restless legs syndrome (RLS), depression, anxiety and sleep quality among medical school students. We applied a questionnaire to medical school students. This questionnaire includes some questions about demographic features of participants, questions related with RLS diagnosis, the pittsburgh sleep quality index (PSQI), beck-depression-scale (BDS), beck-anxiety scale (BAS) to all subjects. Participants diagnosed with RLS asked to response some additional questions related with RLS severity rating scale. All results compared between RLS diagnosed and healthy subjects. A total of 402 medical school students, of whom 55.2% (n= 22) were female, were participated into this study. The ratio of subjects diagnosed as RLS was 16.9% (n= 68). The ratio of RLS diagnosed participants in female students was 18.0% (n= 40) and in male students was 15.6% (n= 28). Of 169 participants who got a poor sleep quality, 36 subjects (21.3%) was diagnosed as RLS. On the other hand, of 233 participants who got a good sleep quality, 32 subjects (13.7%) was diagnosed as RLS (p= 0.004). Score for the RLS severity ranging scale for participants who were diagnosed as RLS was positively correlated with both BDS and BAS scores (p= 0.002, r= 0.372 ve p< 0.001, r= 0.506, respectively). In this study, the rate of RLS in medical school students were higher than the rate presented in the literature. Additionaly, participants who were diagnosed as RLS in our study had worse sleep quality than healthy subjects. Moreover, RLS may be associated with some psychological mood disorders.

The variation of motor-related brain structure and its relation to abnormal motor behaviors in end-stage renal disease patients with restless legs syndrome.

Restless legs syndrome (RLS) is common in the end-stage renal disease (ESRD) population; however, their interrelationship remains largely unclear. In the current study, we aimed to investigate the brain structure variation in ESRD patients with RLS (ERSD-RLS) and its potential relation with the severity of RLS. Diffusion tensor imaging and T1-weighted imaging were obtained from 64 ERSD-RLS and 64 matched healthy controls. Voxel-based morphometry (VBM) analysis and tractography atlas-based analysis (TABS) were used to detect the alteration of gray matter (GM) volume and white matter (WM) microstructural characterization. The corticospinal tract (CST), which is a main motor-pathway, was selected as a fiber bundle of interest in the TABS analysis. The severity of RLS was evaluated by using the International RLS Study Group scale. Lastly, a correlation analysis was performed to explore the interrelationship between RLS rating scores and brain structure measurements. For the results, ERSD-RLS showed abnormal GM volume of motor-related brain regions located in the bilateral superior frontal gyri, precentral gyrus, and putamen. Significant differences in the diffusion properties were found at the posterior limb of the internal capsule. Furthermore, the severity of RLS was only significantly associated with the diffusion properties, which was not found in the motor-related regions of GM. Our results suggest that the motor-related brain structure was altered in ERSD-RLS. The abnormal WM microstructure of the CST may serve as an imaging marker correlated with the severity of motor dysfunction in ERSD-RLS, indicating that WM neuroprotection should be considered when improving motor function in ERSD-RLS.