Restless Leg Syndrome: a Neglected Diagnosis

Abstract

Context:Restless legs syndrome (RLS) is an irresistible urge to move legs that usually occur during inactivity and at night. This neurologic condition is associated with increased risk of nocturnal hypertension as well as cardiovascular events and affects patient’s sleep, which leads to anxiety, depression, and decreases quality of life. Presence of RLS in patients on hemodialysis is associated with higher mortality rate. Most of the times, patients have indescribable symptoms. The aim of this review was to provide physicians with information to be aware and turn their attention to the patient’s symptoms, which are the most important clue to diagnosis of RLS.Evidence Acquisition:For data extraction, we reviewed PubMed, Scopus, Google scholar, the Cochrane collaboration, and Up to Date databases with the keywords of restless legs syndrome, sleep disorders, and end-stage renal disease (ESRD). The most recent review articles, clinical trials, and cross-sectional studies with large sample sizes that had used International RLS Study Group criteria (IRLSSG) and had focused on demographic characteristics and renal function were included. This situation has described in primary and secondary forms. The former usually occurs in younger patients and seems to have genetic tendencies and the latter is due to the iron deficiency state, pregnancy, and ESRD.Results:Two major theories are developed regarding the pathophysiology of RLS. The first one concerns central nervous system dopamine imbalance and the second one concerns intracellular iron dysregulation. The most common used pharmacologic agents in treatment of RLS are dopamine agonists. Other used therapeutic agents include levodopa, Alpha-2-delta calcium channel ligands, opioids, anticonvulsants, benzodiazepines, clonidine, iron therapy in low levels of serum ferritin, and nonpharmacologic therapies.Conclusions:The most important factor in diagnosis is physician’s attention and clinical experience with this condition and using IRLSSG.

Iron deficiency–related symptoms in whole blood donors: a systematic review

“…In one of the studies, from Spencer and colleagues, it was concluded that this could be due to the fact that iron deficiency is insufficient by itself to be associated with RLS, as this disorder has a multifactorial derivation. Einollahi and Izadianmehr showed that apart from iron deficiency, old age, female sex, genetic background, and, being pregnant or having end‐stage renal disease contributed to the incidence of RLS. Another study by Didriksen and colleagues could not detect an association between reduced ferritin levels and likelihood of RLS in whole blood donors as well.…”

“…The timing of filling in the questionnaires may have caused the varied results. For example, RLS symptoms were assessed in the 7 days before donation only, resulting in donors with infrequent RLS symptoms possibly being missed; or donors were invited to fill in a questionnaire about unpleasant RLS directly after donation, possibly leading to overreporting of RLS …”

Update on Research and Practices in Major Sleep Disorders: Part II—Insomnia, Willis‐Ekbom Disease (Restless Leg Syndrome), and Narcolepsy

“…One study showed that older individuals with RLS had low sleep quality, less sleep duration during weekdays, and difficulty initiating sleep compared with those without RSL (Safak et al, ). Awakened by the sensations, patients get out of bed to walk to relieve the symptoms during the night, which disrupts their sleep (Einollahi & Izadianmehr, ). In patients on hemodialysis with RLS, daytime sleepiness, insomnia, and low sleep quality were commonly reported when compared with those without RLS (Chavoshi et al, ).…”

The Effectiveness of Foot Reflexology in the Severity of Restless Legs Syndrome in Female Patients Undergoing Dialysis: A Randomized Controlled Trial

“…Moreover, RLS may cause problems with the dialysis process (7). There are four main clinical criteria for the diagnosis of RLS according to the international restless leg syndrome study group (IRLSSG) including: 1, an urge to move legs that is usually associated with paresthesia; 2, alleviation of the symptoms by moving the legs; 3, aggravation or exacerbation of the symptoms particularly at rest or during sitting or lying down in the bed; and 4, worsening of the signs at night (8,9). The etiology of RLS is yet unknown.…”