Restless Legs Syndrome Severity Research Articles

Perceptions of exercise and restless legs syndrome: Results from a nationwide survey.

Restless legs syndrome is a prevalent, sensorimotor sleep disorder temporarily relieved by movement, with evidence of symptomatic improvement with regular exercise. The present study describes perceptions of the effects of exercise on symptoms of restless legs syndrome. Participants (N = 528) completed a mixed-methods (i.e. numerical and narrative), nationwide survey including items assessing personal experiences with exercise and restless legs syndrome (both positive and negative), as well as restless legs syndrome diagnosis, restless legs syndrome severity, and demographic and clinical characteristics. Responses varied widely on specific experiences with exercise, but a higher percentage of participants indicated positive experiences with exercise than those who reported negative experiences (72%-40%, respectively) with exercise. Further, 54% of respondents reported that exercise only improves restless legs syndrome, while 24% reported exercise only worsens symptoms. Participants described that any abrupt change in exercise routine would almost always elicit restless legs syndrome symptoms (e.g. hiking for a long time, stopping an exercise routine), and that a consistent pattern of exercise improved restless legs syndrome symptoms with an overall beneficial effect on the frequency of symptomatic bouts. Participants further described time of day as impactful for their exercise experience, with > 50% indicating morning exercise improves symptoms and evening exercise worsens symptoms. Participants described several questions that they wanted answered regarding the evidence for exercise in restless legs syndrome and specific exercise prescription recommendations. The present study describes information crucial to the creation of stakeholder-informed health promotion programs for individuals with restless legs syndrome to optimize personalized treatment plans that could prevent and manage symptoms.

Evaluation of Restless Leg Syndrome in Patients with Type 2 Diabetes Mellitus

Objective: To evaluate restless leg syndrome (RLS) in type 2 Diabetes Mellitus (T2DM) in Lahore.
 Materials and Methods: A cross-sectional study design was recruited for this study. Non-probability purposive sampling technique was used to select the patients in the study. The data was collected from the Pakistan Society for the Rehabilitation of Disabled (PSRD) Hospital and Hameed Latif Hospital Lahore. Patients diagnosed with T2DM with a maximum of 10 years, ages between 35 to 65 years, and patients who suffer from minor complications of diabetes mellitus were in cluded in the study. The RLS rating scale was used to assess the severity of restlessness in participants.
 Results: Out of 144 subjects, the frequency of the RLS was 71.5% and the majority was more in females as compared to male subjects. The female subjects have moderate severity of RLS while male subjects have mild severity of RLS.
 Conclusion: The frequency of RLS was high in patients with T2DM and females were more prone to RLS as compared to male subjects.

The effects of greater occipital nerve blockage with lidocaine on sleep characteristics in chronic migraine patients

PurposeThe aim of our study was to determine the effects of greater occipital nerve block (GONB) with lidocaine on sleep characteristics in patients with chronic migraine. Materials and methodsTwenty female patients who underwent GONB with lidocaine were included in the study. The Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Pre-Sleep Arousal Scale (PSAS), Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), Restless Legs Syndrome Severity Scale (RLSSS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and headache diary results before and after the treatment of the patients were compared. ResultsWe included 20 patients (all females) in our study. The mean age was 35.80 ± 8.82 years (range 24–50). After GON blockade, the number of days with pain (p < 0.001), duration of pain (p < 0.001), and Visual Analog Scale (VAS) score (p < 0.001) were significantly lower than before. After GONB, BDI (p = 0.007), BAI (p = 0.022), ISI (p = 0.009), and PSQI (p = 0.026) scores were significantly lower than before. After GONB, sleep quality was better than before (p = 0.035). ConclusionThis study showed that GONB with lidocaine can improve sleep quality, insomnia, and symptoms of depression and anxiety while reducing migraine headache.

Change of iron content in brain regions after intravenous iron therapy in restless legs syndrome: quantitative susceptibility mapping study.

The pathomechanism of restless legs syndrome (RLS) is related to brain iron deficiency and iron therapy is effective for RLS; however, the effect of iron therapy on human brain iron state has never been studied with magnetic resonance imaging. This study aimed to investigate the change of brain iron concentrations in patients with RLS after intravenous iron therapy using quantitative susceptibility mapping (QSM). We enrolled 31 RLS patients and 20 healthy controls. All participants underwent initial baseline (t0) assessment using brain magnetic resonance imaging, serum iron status, and sleep questionnaires including international RLS Study Group rating scale (IRLS). RLS patients underwent follow-up tests at 6 and 24 weeks (t1 and t2) after receiving 1000 mg ferric carboxymaltose. Iron content of region-of-interest on QSM images was measured for 13 neural substrates using the fixed-shaped method. RLS symptoms evaluated using IRLS were significantly improved after iron treatment (t0: 29.7 ± 6.5, t1: 19.5 ± 8.5, t2: 21.3 ± 10.1; p < .001). There was no significant difference in susceptibility values between the controls and RLS patients at t0. In the caudate nucleus, putamen, and pulvinar thalamus of RLS patients, the QSM values differed significantly for three timepoints (p = .035, .048, and .032, respectively). The post-hoc analysis revealed that the QSM values increased at t1 in the caudate nucleus (66.8 ± 18.0 vs 76.4 ± 16.6, p = .037) and decreased from t1 to t2 in the putamen (69.4 ± 16.3 vs 62.5 ± 13.6, p = .025). Changes in the QSM values for the pulvinar and caudate nuclei at t1 were positively and negatively correlated with symptomatic improvement, respectively (r = 0.361 and -0.466, respectively). Intravenous iron treatment results in changes in brain iron content which correlate to reductions in RLS severity. This suggests a connection between symptom improvement and the associated specific brain regions constituting the sensorimotor network.

Evaluation of emotional dysregulation in patients with restless legs syndrome.

The aim of this study is to examine patients with restless legs syndrome (RLS) in terms of difficulty in emotion regulation and insomnia. A total of 52 patients with RLS and 57 healthy volunteers were enrolled. Difficulties in Emotion Regulation Scale Short Form (DERS-16), Insomnia Severity Index (ISI), Hospital Anxiety and Depression Scale (HADS), and International Restless Legs Syndrome rating scale were applied to participants. The mean age was 34.00 ± 8.27years in patients and 31.70 ± 9.12years in control. The scores of DERS-16, ISI, HADS-A, and HADS-D were significantly higher in the patients than the controls (p = 0.000). The DERS-16 total score showed a significant correlation with age (r = 0.404, p = 0.003), ISI (r = 0.281, p = 0.043), IRLS score (r = 0.422, p = 0.002), HADS-A (r = 0.409, p = 0.003), and HADS-D (r = 0.416, p = 0.002). The factors (age, gender, ferritin, ISI, and IRLS scores) that may be associated with the DERS-16 total scores were assessed with stepwise regression analysis. It was seen that the IRLSs variable had the most ability and could predict 45% (β = 0.625, p < 0.001, ∆R2 = 0.450) of difficulty in emotion regulation. In addition, the variable of insomnia could predict difficulty in emotion regulation by 17% (β = 0.097, p = 0.001, ∆R2 = 0.170). Patients with RLS may experience more emotion regulation difficulties than healthy controls. RLS severity and insomnia may be factors affecting emotion regulation difficulties in patients with RLS. According to our knowledge and our literature review, this finding seems to be the first report in the literature.

0699 Longitudinal Assessment of Buprenorphine Effectiveness for Severe Restless Legs Syndrome and Dopaminergic Augmentation

Abstract Introduction Opioids are a consensus second-line treatment for moderate-to-severe restless legs syndrome (RLS). Due to its partial mu-opioid receptor agonist mechanism, buprenorphine (bup) has lower risk of respiratory depression, euphoria, and dependence than full-agonist opioids. We hypothesize that with long-term administration for severe RLS, bup is both effective and well-tolerated and can facilitate successful weaning off dopamine agonists (DA) for patients with augmentation. Methods We conducted a longitudinal examination of a retrospective cohort of patients prescribed bup over a 21-month period by a tertiary RLS specialist. Patient-reported outcomes were administered through patient-completed electronic health record-based questionnaires or by clinician interview: International RLS Study Group(IRLS-SG,primary outcome), Clinical Global Impressions of Improvement(CGI-I), Epworth Sleepiness Scale(ESS), Insomnia Severity Index(ISI), Patient Health Questionnaire(PHQ-9), and Patient-Reported Outcomes Measurement Information System-Sleep Disturbance domain(PROMIS-SD). A linear mixed model assuming compound symmetry correlation structure was used (least square means,95%CI) to test the change from baseline to 6-week, 3-month, 6-month, and 1-year intervals, and the final visit, irrespective of time from baseline, with adjustment of age, sex, other RLS meds at final visit, and administration of iron infusion. Results 55 patients (56.4% female, 64.9±12.1 years) started bup for RLS, and 42(76.3%) remained on bup at the final visit. IRLS-SG was 27.8(25.3,30.3) at baseline and was significantly reduced at every interval (p of trend &amp;lt; 0.001), including 11.4(7.4,15.4) at 1 year. Of the 39(70.9%) patients that were on a DA with augmentation at baseline, 32(82.1%) had discontinued DAs with 5(12.8%) on a reduced dose at the final visit. Of those remaining on bup at the final visit, 93.8% were CGI-I responders, There was a statistically significant longitudinal trend in 1-year improvement in ESS:9.9(8.0,11.8) to 6.9(4.5,9.4),p=0.003, ISI:18.0(15.9,20.1) to 15.0(11.6,18.3),p=0.048, PHQ-9:10.4(8.2,12.5) to 6.1(3.6,8.6),p&amp;lt; 0.001, and PROMIS-SD:63.0(60.2,65.7) to 53.8(49.8,57.8),p&amp;lt; 0.001. 13(23.6%) discontinued bup with nausea, cognitive complaints, and dizziness as the most common side effects. Conclusion In this largest cohort to date to examine buprenorphine in severe RLS, our findings show buprenorphine markedly reduced RLS symptoms, effectively enabled the elimination of dopamine agonists in patients with augmentation, improved sleep and other health quality measures, and was tolerated comparably to other RLS medications. Support (if any)

(040) A Case Report of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia Secondary to Lumbar Facet Cyst-Induced Sacral Radiculopathy Treated by Lumbar Endoscopic Spine Surgery

Abstract Introduction Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD), characterized by distressing, abnormal genito-pelvic sensations, especially unwanted genital arousal, may be triggered by pathology in Region 3, the cauda equina. Sacral radiculopathy is an inflammatory irritation of the S2-S3 nerve roots in the cauda equina, formed by convergence of pelvic, pudendal, and sciatic nerves and clinical symptoms that involve the sensory fields of these nerves. In a subgroup of patients, both cauda equina Tarlov cyst-induced sacral radiculopathy and lumbosacral annular tear-induced sacral radiculopathy have been reported to trigger PGAD/GPD, and in both conditions, endoscopic spine surgery has been shown safe and effective. Lumbar facet cysts, most common at the L4-L5 level, arise from lumbar zygapophyseal joints and can cause sacral radiculopathy. Thus, it is possible that lumbar facet cyst-induced sacral radiculopathy may be a trigger for PGAD/GPD. Objective To report one case of PGAD/GPD secondary to lumbar facet cyst-induced sacral radiculopathy, successfully treated with lumbar endoscopic spine surgery (LESS). Methods A 55-year old woman with a long history of PGAD/GPD presented to our spine-sexual medicine program for biopsychosocial assessment and treatment using our multidisciplinary management algorithm: Step A) detailed psychosocial and medical history; Step B) non-invasive assessments for sacral radiculopathy; Step C) targeted diagnostic transforaminal epidural spinal injection (TFESI) resulting in temporary clinically significant reduction of PGAD/GPD symptoms; Step D) surgical intervention with LESS and post-operative multidisciplinary follow-up. The patient was diagnosed with PGAD/GPD from lumbar facet cyst-induced sacral radiculopathy and underwent LESS for an L4-5 facet cyst. Results This 55 year old cisgendered woman had multiple painful spontaneous orgasms, shooting sharp pains that felt “like a bruise” going up the inside of her vagina, hypersensitivity of her vulva, clitoris, vagina, urethra and anus, along with constant symptoms of arousal and urinary urgency. These began in 2008 after her second childbirth. Her PGAD symptoms worsened over the last 2 years. She experienced sensations of pins and needles in her right buttocks, front of her left thigh, and down both legs into feet and toes. She also had severe constipation and restless leg syndrome. Neurogenital testing, including quantitative sensory testing, sacral dermatome testing and bulbocavernosus reflex latency testing, were all abnormal consistent with sacral radiculopathy. Region 1 anesthesia testing for vestibular pain showed persistent PGAD/GPD symptoms despite numbness on vestibular cotton swab testing. Pudendal nerve testing was negative. It was thus hypothesized that her PGAD/GPD trigger was closer to the central nervous system. Her MRI showed an L4-5 facet cyst. A TFESI with anesthetic was positive with temporary symptom reduction. She underwent LESS to excise the facet cyst and was discharged the same day. At early post-operative follow-up, she is PGAD-free. She no longer has irritative bladder symptoms, sciatica, restless leg syndrome, or pins and needles, and her constipation symptoms have improved. Conclusions Of the many recognized triggers for PGAD/GPD, we report for the first time a patient diagnosed with lumbar facet cyst-induced sacral radiculopathy after a multidisciplinary step-care management algorithm evaluation. She experienced marked improvement with lumbar endoscopic spine surgery. Disclosure No

Perbandingan Efektivitas Latihan Intradialisis dan Profiling Suhu dalam Meningkatkan Mutu Layanan Hemodialisis

This study aims to describe the effectiveness of intradialytic exercises and HD temperature profiling in improving the quality of HD services. The literature search method is based on the compilation of PICO through online database searches on Clinicalkey, Clinicalkey Nursing, ScienceDirect, EBSCO, ProQuest, and Scopus. Journal search results obtained 20,106 articles; after the selection stage, nine reports were obtained for analysis, consisting of 5 RCT articles, one systematic review article, two quasi-experimental articles, and one meta-analysis article. The results showed that HD patients who were routinely given intradialytic exercises would show an increase in HD adequacy achievements, suppress inflammatory reactions, increase albumin and hemoglobin values, reduce the erythropoietin resistance index, increase phosphate clearance, improve the quality of life of HD patients and minimize the risk of both acute and chronic complications. Chronic disease caused by HD. Meanwhile, temperature profiling can reduce the incidence of intradialytic hypotension, pruritus, and fatigue and reduce the severity of Restless Leg Syndrome (RLS) without interfering with the achievement of HD adequacy. This study concludes that intradialytic training and temperature profiling effectively improve the quality of HD services.&#x0D; &#x0D; Keywords: HD Quality, HD Patient Quality of Life, Intradialysis Exercise, Temperature Profiling

0702 Suicidality in Patients Using Opioid Medications to Treat Severe, Refractory Restless Legs Syndrome: Prevalence and Associations

Abstract Introduction Prior investigations demonstrate a high prevalence of suicidal ideation and behavior in Restless Legs Syndrome (RLS) patients, particularly those with depression and severe RLS symptoms. The present study examines the prevalence of, and associations with, active suicidal ideation (ASI) and passive suicidal ideation (PSI) in patients using prescribed opioids for severe refractory RLS. Methods The National RLS Opioid Registry is an observational longitudinal study consisting of individuals taking a prescribed opioid for diagnosed RLS, nearly all with previously augmented symptoms. Information on opioid dosages, side effects, past and current concomitant RLS treatments, RLS severity, psychiatric symptoms, and opioid abuse risk factors were collected at baseline and every 6 months thereafter by REDCap surveys. Two years following enrollment, the C-SSRS was utilized to assess both PSI and ASI in the previous year, whereas the last question on the PHQ-9 assessed PSI in the past two weeks. Results At baseline, participants reported a reduction in previous suicidality following initiation of opioids: ASI from 22.0% to 7.0%, and PSI from 36.7% to 13.4%. At the 2-year PHQ-9 survey, 10.1% of registry participants reported PSI within the two previous weeks. At that same 2-year assessment, on the C-SSRS, 7.8% of participants reported both PSI and ASI in the past year. Overall, suicidality was associated with depression, anxiety, female sex, and perceived opioid stigma. PSI was less likely to be present in those taking methadone. Serial mediation analysis found that both RLS severity and depression severity moderated the relationship between methadone use and PSI. Specifically, methadone use was associated with decreased RLS severity, which was associated with decreased depression severity, and then further, less PSI. Conclusion Maximal treatment of RLS symptoms and approaches which mitigate the other clinical features associated with ASI and PSI in this population (anxiety, depression, stigma) are worthy of independent therapeutic attention. Similarly, this data may be useful for prescribers when assessing the appropriateness of opioid treatment for individual patients. Support (if any) The National RLS Opioid Registry has received support from the RLS Foundation, the Baszucki Brain Research Fund, Florence Petrlik Family Foundation, Diane and Richard Brainerd, and the Blakeley Foundation.

The effects of restless legs syndrome on sleep and quality of life during pregnancy: a comparative descriptive study

Objective: The study aimed to identify the effects of restless legs syndrome (RLS) on sleep quality and quality of life in pregnant women.Methods: This comparative and descriptive study was conducted with 109 pregnant women between the 24 and 39 weeks of gestation. The presence and severity of RLS were investigated using the International Restless Legs Syndrome Study Group’s Diagnostic Criteria Scale and Severity Rating Scale, and the effects of the syndrome on sleep and quality of life were evaluated. Results: The prevalence of RLS in pregnant women was found to be 47.7%. In the RLS group, 22.0% of the pregnant women had severe RLS symptoms and 20.2% had moderate RLS symptoms. The mean score for Restless Legs Syndrome Severity Rating Scale was determined 20.75±6.38. The mean score for quality of life scale was determined 17.75±3.73 in RLS group and 26.46±2.67 in non-RLS group. Conclusion: The difference between the mean scores for Pittsburgh Sleep Quality Index of the pregnant women with RLS and those without the syndrome was found to be statistically significant. While the mean score for Quality of Life Scale in pregnant women with RLS was lower in general health, physical health and psychological health sub-dimensions, no statistically significant difference was found in social relations and environment sub-dimensions. It is recommended that nurses investigate RLS complaints of pregnant women and include non-pharmacological methods in their nursing practices.

The relationship between iron deficiency anemia with restless leg syndrome and sleep quality in workers working in a textile factory in Iran: a cross-sectional study

BackgroundThe aim of this study is to investigate the relationship between iron deficiency anemia with restless leg syndrome (RLS) and sleep quality in workers working in a textile factory in Iran. This cross-sectional study was conducted on 216 workers working in a textile factory in Iran. In addition to demographic and occupational variables, Pittsburgh Sleep Quality Index (PSQI) and RLS questionnaires were used for the data collection. To investigate iron deficiency anemia, 2 CC of blood was taken from the brachial artery with the help of a 10-CC syringe with a blue or pink tip. Then, relevant data were entered into SPSS26 and analyzed.ResultsThe mean (S. D.) age of the workers was 32.23 (6.14) and 60.6% of them were women. The prevalence of iron deficiency anemia was 21.2 and 69.5% in men and women, respectively. Most of the workers were in moderate condition in terms of RLS severity, and 78.2% had sleep disorders. There was an inverse and significant correlation between age (β= −0.200), work experience (β= −0.160), hemoglobin (β= −0.149), and ferritin (β= −0.186) with global PSQI score (P value<0.05). Also, an inverse and significant correlation was observed between age (β= −0.164), hemoglobin (β= −0.548), and ferritin (β= −0.410) with RLS score (P value<0.05). However, there was a direct and significant correlation between TIBC level and RLS score (β= 0.227) and global PSQI score (β= 0.395) (P value<0.05).ConclusionsIntervention programs to reduce iron deficiency anemia and periodic screening programs to identify sleep disorders and RLS in textile factory workers seem necessary.

The relationship of the prevalence and severity of restless legs syndrome in primary Sjögren syndrome with insomnia status, anxiety, depression, and neuropathic pain

Background and aimsIn this study, we aimed to compare the prevalence of restless legs syndrome (RLS) between primary Sjögren syndrome (PSS) patients and the healthy population and investigate the relationships between RLS and insomnia status, anxiety, depression, neuropathic pain, and lower extremity pain. Our case-control study, included 55 patients aged 18–65 who were diagnosed with PSS based on the 2016 ACR/EULAR criteria and 60 healthy controls aged 18–65. The pain levels of the participants were evaluated using the pain DETECT Questionnaire, the lower-extremity visual analog scale, and an algometer, all participants were screened for fibromyalgia syndrome, and their psychiatric parameters were evaluated with the Beck Depression Inventory and the Beck Anxiety Inventory. Insomnia status was assessed using the Insomnia Severity Index. The cases in the PSS group with and without restless legs syndrome were compared.ResultsWhile the rate of RLS in the PSS group was 26.7%, that in the control group was found as 9%, and the difference between the two groups was significant (p < 0.05). The severity of RLS in the PSS group was found to be significantly higher in comparison to that in the control group (p < 0.05). The PSS group had significantly higher lower-extremity pain, fibromyalgia, insomnia, depression, anxiety, and pain scores, as well as a significantly higher mean number of painful points, than the control group (p > 0.05). In the results of the multivariate regression analysis, depression and insomnia scores were identified as independent predictors for the presence of RLS in PSS cases (p < 0.05).ConclusionsWe found the prevalence and severity of restless legs syndrome higher in the primary Sjögren syndrome patients compared to the healthy participants in the control group. We identified depression and insomnia as independent predictors of the presence of restless legs syndrome in primary Sjögren syndrome cases.

Restless legs syndrome in end-stage renal disease patients on maintenance hemodialysis: Quality of life and sleep analysis

Vitamin D insufficiency, calcium/phosphate imbalance, iron deficiency, anemia, pregnancy, and end-stage renal disease (ESRD) are all thought to be involved in the pathogenesis of restless leg syndrome (RLS). The prevalence of RLS ranging from 6.6% to 83% has been reported in another study. It is one of the illnesses that affect the quality of life of ESRD patients on maintenance hemodialysis. Unfortunately, RLS has not received enough recognition and attention, and the underdiagnosed and undertreated rate can reach more than 10%. This study aimed to look at the sleep quality and quality of life of people with RLS who were on maintenance hemodialysis. The present study included 286 individuals on chronic dialysis. The International Restless Legs Syndrome Study Group Diagnostic Criteria and the International RLS Rating Scale were used as recommendations to diagnose and assess the severity of RLS. The Pittsburgh sleep quality index (PSQI) and the Short Form-36 Health Survey (SF-36) were employed to evaluate sleep quality and quality of life. All patients’ biochemical and demographic data were reviewed, and statistical analyses were carried out. In conclusion, there were no statistically significant variations in demographic information or clinical and laboratory characteristics between RLS patients and those who did not have RLS. Specifically, among dialysis patients, those with RLS had higher PSQI and SF-36 ratings.

Opioids and restless legs syndrome: a double-edged sword.

Opioids and restless legs syndrome: a double-edged sword.

Long-Term Effects of Positive Airway Pressure Treatment on Restless Legs Syndrome Severity in Obstructive Sleep Apnea Syndrome

To research how long-term positive airway pressure (PAP) therapy affects the severity of restless legs syndrome in patients with obstructive sleep apnea syndrome (OSASThe study included 320 individuals that were diagnosed with moderate and severe OSAS using polysomnography (PSG) and under PAP treatment. Among these patients, the demographic data of 72 patients who met the diagnostic criteria of restless legs syndrome (RLS) were analyzed. The patients were evaluated with the International RLS Study Group rating scale (IRLS) before and at the 12th month after PAP in the treatment of OSAS. The mean body mass index of the 72 patients with OSAS and RLS was 31.2 (±5.8), and their mean apnea-hypopnea index was 44.9±27.7. The prevalence of RLS in moderate and severe OSAS was 24%. There was a negative correlation between the IRLS score and mean oxygen saturation all night (r: -0.075), minimum oxygen saturation all night (r: -0.125), time spent below &amp;lt;90% saturation (r: -0.172), and sleep efficiency (r: 0.087) on PSG performed before PAP treatment, as well as a negative correlation between the IRLS score and weekly PAP use hours at the 12th month after PAP treatment (r: -0.316; p&amp;lt;0.001). The data obtained from this study suggest that the coexistence of OSAS and RLS is common and should not be overlooked in the diagnosis of comorbid diseases. Long-term PAP treatment is effective in reducing RLS symptoms. Further studies are needed on this subject.

Efficacy and safety of Shaoyao Gancao Tang for restless leg syndrome: A systematic review and meta-analysis

Restless leg syndrome (RLS) is a common and chronic neurological disease characterized by an irresistible and overwhelming urge to move the legs. In recent years, a growing body of clinical trials has demonstrated that -traditional Chinese herbal medicine Shaoyao Gancao Tang (SG-Tang) may improve RLS. However, a critical examination of the available evidence is warranted. This study aimed to evaluate the efficacy and safety of SG-Tang in the treatment of RLS. The protocol of this study was registered and published at International Prospective Register of Systematic Reviews (PROSPERO; CRD42020173520). Randomized clinical trials (RCTs) on the efficacy and safety of SG-Tang in the treatment of RLS were identified by searching the Cochrane Library, PubMed, EMBASE, Web of Science, the Chinese Biological Medicine Database, China National Knowledge Infrastructure, Wanfang Database, and VIP Information Database from inception to February 14, 2022. The primary outcome measurements were the total effective rate, and the secondary outcome measurements included the International Restless Legs Syndrome Study Group Rating Scale for Severity of Restless Legs Syndrome (IRLS), the Pittsburgh Sleep Quality Index (PSQI), and the incidence of adverse events. The Review Manager 5.3 software was utilized to conduct quantitative synthesis according to the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Six eligible RCTs were included in this meta-analysis. Compared to conventional medications, SG-Tang intervention showed significant improvements in the total effective rate (risk ratio [RR] = 1.22, 95% confidence interval [CI] (1.09,1.36), P = 0.004), the IRLS (mean difference [MD] = −4.74, 95% CI (−8.65, −0.83), P = 0.02), and the PSQI (MD = −2.54, 95% CI (−4.34, −0.74), P = 0.006) with less incidence of adverse events (RR = 0.21, 95% CI (0.09, 0.31), P = 0.0005). SG-Tang may be effective and safe as a complementary and alternative treatment to relieve RLS. However, the results need to be interpreted with caution because of limited data and the undesirable methodological quality of the included studies. More well-designed, large-scale, high-quality, and multi-center RCTs are required to be performed for further verification.

Prevalence and severity of restless leg syndrome in patients with spinal cord injuries.

To determine the prevalence of restless leg syndrome in patients with spinal cord injury using a consensus criterion. The cross-sectional study was conducted from November 29, 2018, to February 28, 2021 at the departments of Neurology and Orthopaedic Surgery, King Edward Medical University, Mayo Hospital, Lahore, Pakistan, and comprised patients of either gender aged 18-80 years having spinal cord injuries. All the patients were interviewed using a 10-item questionnaire, and were assessed using the five-point consensus criteria of the International Restless Leg Syndrome Study Group. Data was analysed using SPSS 20. Of the 253 patients, 128(50.6%) were males and 125(49.4%) were females. The overall mean age was 38.6±14.2 years. Restless leg syndrome was present in 116(45.8%) patients, and 64(55.2%) of them were males (p>0.05). The mean duration of the symptoms was 18.9±16.9 months. Causes of spinal cord injury included metastasis 28(11.1%) multiple sclerosis 32(12.6%), neuromyelitis optica spectrum disorders 68(26.9%), tuberculous spondylitis 85(33.6%), trauma 24(9.5%) and viral myelitis 16(6.3%). Restless leg syndrome was prevalent in less than half the patients having spinal cord injury. It was more prevalent in males compared to females, but the difference was not significant.

The relationship between the frequency and severity of restless legs syndrome and anaemia in patients with ankylosing spondylitis

Background Background The study aims to determine the frequency of restless legs syndrome (RLS) in patients with ankylosing spondylitis (AS) and the relationship between the International Restless Legs Syndrome Study Group Rating Scale (IRLSSG-RS) score and anemia.&#x0D; Material and Methods It was a case-control study that included 106 patients with AS and 106 age- and sex-matched healthy controls in the rheumatology clinic of a training and research hospital. The patients were divided into two groups according to their hemoglobin levels. A hemoglobin level lower than 12 g/dL in women and less than 13 g/dL in men was the criterion for anemia.&#x0D; Results Although the frequency of RLS was higher in AS patients than in control groups, there was no significant difference in the IRLSSG-RS score between AS patients and control groups. 23 (57.5%) of the AS patients with anemia had RLS, and the IRLSSG-RS score was 21.3±5.7. Of the AS patients without anemia, 11 (16.7%) had RLS, and the IRLSSG-RS score was 15±6. Statistically significant differences between AS patients with and without anemia regarding RLS frequency and IRLSSG-RS score were found. The IRLSSG-RS scores of AS patients were negatively correlated with serum iron and hemoglobin level.&#x0D; Conclusions Patients with AS had a higher RLS frequency than the control group; AS patients with anemia had a higher RLS and IRLSSG-RS score than AS patients without anemia. Also, a negative and significant correlation was found between the IRLSS-RS score and serum iron and hemoglobin levels in AS patients.

Emergence of restless legs syndrome during opioid discontinuation.

The development of restless legs syndrome (RLS) has been rarely reported during and following opioid withdrawal. We aimed to determine the presence and severity of RLS symptoms during and after supervised opioid tapering. Ninety-seven adults enrolled in the Mayo Clinic Pain Rehabilitation Center who underwent supervised prescription opioid tapering were prospectively recruited. RLS presence and severity was assessed with the Cambridge-Hopkins Questionnaire 13 and International Restless Legs Syndrome Study Group Rating Severity Scale at admission, midpoint, and dismissal from the program as well as 2 weeks, 4 weeks, and 3 months after completion. Frequency and severity of RLS symptoms were compared between admission and each time point. Average age of the cohort was 52.6 ± 13.3 years with a morphine milligram equivalent dose for the cohort of 45.6 ± 48.3 mg. Frequency of RLS symptoms increased from 28% at admission to peak frequency of 41% at 2 weeks following discharge from the Mayo Pain Rehabilitation Clinic (P = .01), returning to near baseline frequency 3 months after opioid discontinuation. International Restless Legs Syndrome Study Group Rating Severity Scale increased from baseline and then remained relatively stable at each time point following admission. Thirty-five (36.1%) participants developed de novo symptoms of RLS during their opioid taper, with those being exposed to higher morphine milligram equivalent doses having higher risk of developing RLS. Moderately severe symptoms of RLS, as assessed by survey, occur commonly in individuals undergoing opioid tapering, particularly if exposed to higher doses. In many cases, symptoms appear to be self-limited, although a minority develop persistent symptoms. Our results may have implications for successful opioid tapering, but future confirmatory studies with structured clinician interview are needed to establish that these symptoms truly represent restless legs syndrome given the potential for RLS-mimicking symptoms in individuals with chronic pain syndromes. McCarter SJ, Labott JR, Mazumder MK, etal. Emergence of restless legs syndrome during opioid discontinuation. J Clin Sleep Med. 2023;19(4):741-748.

Initial Cervical Spinal Cord Demyelinating Lesions are not Associated with Restless Legs Syndrome in Patients with Multiple Sclerosis.

This study aims to determine the prevalence and severity of restless legs syndrome (RLS) in patients with multiple sclerosis (MS) and its association with spinal cord lesions, fatigue, quality of life, and sleep disturbance. We recruited 222 consecutive MS patients admitted to MS outpatient clinic. Beck's Depression Inventory (BDI), Fatigue Severity Scale (FSS), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and MS Quality of Life-54 (MSQoL-54) questionnaire scores of all patients were measured. Initial cervical spinal cord magnetic resonance imaging (MRI) of the patients at first clinical evaluation for diagnosis was reviewed for accompanying demyelinating lesions. RLS was diagnosed in 53 (23.87%) patients. RLS was associated with poor sleep, worse quality of life, increased fatigue, and depressive mood. The sleep quality index, FSS, and MSQoL-54 physical composite scores significantly correlated with RLS severity (P < 0.001, P = 0.001, P < 0.001, respectively). Of the 200 patients, 127 (63.5%) had spinal cord lesions. 22.83% of the patients with cervical spinal cord lesions had RLS comorbidity. We found no significant difference regarding spinal cord demyelinating lesions between RLS positives and negatives. (P = 0.77). In addition, having multiple spinal cord demyelinating lesions did not differ between the two groups (P = 0.84). Besides, the severity of RLS symptoms did not differ in patients who had a single cervical spinal lesion and those who had multiple lesions (P = 0.35). We have demonstrated the negative impact of comorbid RLS on fatigue, sleep quality, mood, and quality of life in MS patients. However, initial spinal cord lesions did not correlate with RLS comorbidity. The severity of RLS symptoms is associated with poor sleep and physical health.