Restless Legs Syndrome in Patients with Behçet’s Disease and Multiple Sclerosis: Prevalence, Associated Conditions and Clinical Features

Abstract

Introduction: To investigate the prevalence and characteristics of Restless Legs Syndrome (RLS) in patients with Behçet's Disease (BD) and Multiple Sclerosis (MS).Methods: Consecutive patients with BD and MS seen in the outpatient clinic were included in the study. As a control group, volunteer subjects without a known peripheral or central nervous system disorder were included. The BD group was divided into two sub-groups as BD with neurological involvement [Neuro-Behçet' s Disease (NBD)] and BD without any neurological involvement (other BD) for further evaluation. Data on demographic characteristics, medical history and family history were collected, and all patients underwent neurological examination. The patients were evaluated for the presence of diagnostic criteria for RLS. The features and severity of RLS were evaluated in patients with RLS using Restless Legs Syndrome Identification Form, and the International Restless Legs Syndrome Study Group (IRLSSG) Rating Scale. The clinical and radiological findings of patients with BD and MS were retrieved from their medical files. Results:The study included a total of 96 patients with BD (mean age 39.9±11.8; 51 males; 41 patients with NBD) and 97 patients with MS (mean age 34.97±4.1 years; 24 males). There were 100 healthy control subjects (mean age 36.18±11.10 years; 46 males). RLS was more prevalent in MS (22.8%) and NBD (22%) groups compared to the control group (10%; p=0.004 and 0.029, respectively) with a statistically significant difference. The prevalence of RLS was higher in MS patients with less disability. Most severe RLS symptoms were observed in the MS group. The rate of sleep disorders was also higher in MS group. Although stress appeared to be a factor worsening RLS in all groups, its prevalence was higher in the MS group (p=0.011). There was no correlation between the distribution of magnetic resonance imaging lesions and RLS in both MS and NBD groups.Conclusions: It is well established that RLS can accompany disorders involving the peripheral and central nervous systems such as all types of peripheral neuropathy, myelopathy, and Parkinson's disease. The present study showed that MS and NBD also seem to be a risk factor for RLS, being associated with more severe symptoms.

Sleep quality in Behçet’s disease: a systematic literature review

“…In the articles included in the present work, the only two specific sleep disorders taken into consideration were OSAS and RLS. OSAS is a common condition in autoimmune diseases, as previously reported in several studies [16,21]. Our review observed comparable data also in BD.…”

“…More specifically, 8 papers [1,[6][7][8][9][10][11][12] out of 15 (53%) exclusively assessed global sleep quality and sleep characteristics in BD patients, by adopting the Pittsburgh Sleep Quality Index (PSQI) questionnaire in 7 [1,[6][7][8][9][10]12] out of 8 papers (87, 5%) and the Mini Sleep Questionnaire (MSQ) in 1 [11] (12, 5%). On the other hand, 5 [5,[13][14][15][16] papers out of 15 (33%) exclusively evaluated the frequency of a specific sleep disorder in BD, that is Restless Leg Syndrome (RLS) in 2/5 papers [14,15] and Obstructive Sleep Apnea Syndrome (OSAS) in 3/5 [5,13,16] papers. The Berlin Questionnaire (BQ) [13], the Epworth Sleepiness Scale (ESS) [14], RLS identification-form and the International Restless Legs Syndrome Study Group-Rating Scale (IRLSSG-RS) [15] were performed by one paper each, respectively to identify the risk of OSAS in a BD cohort, to examine subjective sleep quality in BD patients suffering from RLS, to make RLS diagnosis and to evaluate RLS severity.…”

“…The Berlin Questionnaire (BQ) [ 13 ], the Epworth Sleepiness Scale (ESS) [ 14 ], RLS identification-form and the International Restless Legs Syndrome Study Group-Rating Scale (IRLSSG-RS) [ 15 ] were performed by one paper each, respectively to identify the risk of OSAS in a BD cohort, to examine subjective sleep quality in BD patients suffering from RLS, to make RLS diagnosis and to evaluate RLS severity. On the other hand, PSG was performed in 2 works [ 5 , 16 ] out of 5 (40%) to explore OSAS. Finally, two papers [ 3 , 17 ] (13%) investigated both the global sleep characteristics in a BD cohort along with the evaluation of the presence of RLS and OSAS, overall employing PSQI, ESS and PSG.…”

“…Our review observed comparable data also in BD. Four studies [ 3 , 5 , 16 , 17 ] reported statistically significant higher rates of OSAS in BD patients compared to HC, and this correlation was interpreted as a result of the chronic inflammatory state induced by the disease involvement of upper airways. Intriguingly, in the study by Chen et al [ 17 ] it was suggested that conversely OSAS may be a risk factor for the development of autoimmune diseases including BD.…”

Is Restless Legs Syndrome De Facto Thyroid Disease?

“…RLS also co-occurs more frequently in the course of multiple sclerosis (22–22.8% vs. 10% in control group) [ 33 , 34 ]. Research by Vávrova et al has shown that related gene polymorphisms, such as MAP2K5/SCOR1, may be a potential reason for this, and an association with HLA B51 sometimes linked to many autoimmune diseases (most notably Behçet’s disease) is also suspected [ 35 ].…”