An update on restless legs syndrome (Willis-Ekbom disease)

Garcı́a-Borreguero, Diego; Williams, Anne-Marie

doi:10.1097/wco.0000000000000117

Cited by 62 publications

(46 citation statements)

References 101 publications

(62 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Dopaminergic medication, alpha-2-delta calcium channel ligands and opioids are commonly used for treatment. 4,5 There are several reports of RLS occurring in families, which suggest an autosomal dominant mode of inheritance with variable expression and possible anticipation as there was evidence for an earlier age at onset in later generations. [6][7][8] Secondary RLS occurs as a result of certain conditions and the three major reversible causes are iron deficiency anaemia, pregnancy and end-stage renal disease.…”

Section: Key Pointsmentioning

confidence: 99%

Restless legs syndrome

2016

View full text Add to dashboard Cite

Restless legs syndrome (RLS), also known as Willis-Ekbom disease (WED), is a common movement disorder characterised by an uncontrollable urge to move because of uncomfortable, sometimes painful sensations in the legs with a diurnal variation and a release with movement. The pathophysiology is only partially known and a genetic component together with dopaminergic and brain iron dysregulation plays an important role. Secondary causes for RLS need to be excluded. Treatment depends on the severity and frequency of RLS symptoms, comprises non-pharmacological (eg lifestyle changes) and pharmacological interventions (eg dopaminergic medication, alpha-2-delta calcium channel ligands, opioids) and relieves symptoms only. Augmentation is the main complication of long-term dopaminergic treatment of RLS. This article will provide a clinically useful overview of RLS with provision of diagnostic criteria, differential diagnoses, possible investigations and different treatment strategies with their associated complications. Definition and diagnostic criteriaRestless legs syndrome (RLS), also known as Willis-Ekbom disease (WED), is a common neurological movement disorder characterised by an uncontrollable urge to move (mainly the legs).1 Diagnosis of RLS is based primarily on the patient's history and on a neurological examination to exclude differential diagnoses. The diagnosis can be made if all of the following five criteria are met (International RLS Study Group (IRLSSG) diagnostic criteria): 2 1 A need to move the legs usually accompanied or caused by uncomfortable, unpleasant sensations in the legs. 2 Symptoms are exclusively present or worsen during times of inactivity/rest. 3 Partial or total relief of symptoms by movement, such as walking or stretching, at least as long as the activity continues. 4 Symptoms are generally worse or exclusively occur in the evening or during the night. ABSTRACT Restless legs syndrome5 The occurrence of the fi rst four essential criteria must not be solely accounted for as symptoms primary to another medical or a behavioural condition.A single standard question for rapid screening of RLS has been validated by the IRLSSG, 3 which is: 'when you try to relax in the evening or sleep at night, do you ever have unpleasant, restless feelings in your legs that can be relieved by walking or movement?' This question can be used to effectively screen large patient groups as it has 100% sensitivity and 96.8% specificity for the diagnosis of RLS. However, the final diagnosis should always be confirmed by matching the patient's history and symptoms with the IRLSSG diagnostic criteria, accompanied by an exclusion of secondary conditions. Aetiology and differential diagnosesThe aetiology of RLS can be categorised as primary (idiopathic) or secondary. The majority of cases are primary Key pointsRestless legs syndrome (RLS) is a common neurological movement disorder, characterised by an uncontrollable urge to move the legs combined with an uncomfortable sensation in the legs.Diagnosis of RLS is mainly base...

show abstract

Section: Key Pointsmentioning

confidence: 99%

Restless legs syndrome

2016

View full text Add to dashboard Cite

show abstract

“…Then, the clinician can use this information to reach appropriate treatment decisions." 5 Omitting the co-occurring diagnosis of RLS/WED in these patients may have a significant effect on treatment choices.…”

Section: P Congiu ML Fantini G Milioli Et Al F-waves In Diagnosismentioning

confidence: 99%

“…Its symptoms typically appear during rest and show a circadian rhythm, occurring or worsening in the evening. [1][2][3][4][5] The diagnosis of RLS/WED is based on the criteria set in 1995, revised in 2003, 4 and recently updated in order to improve the sensitivity in the diagnosis. 3 The suggested immobilization test (SIT) 6 has been developed to assess RLS/WED symptoms, but to date no instrumental examination allows a clear-cut diagnosis of RLS/WED.…”

Section: Introductionmentioning

confidence: 99%

F-Wave Duration as a Specific and Sensitive Tool for the Diagnosis of Restless Legs Syndrome/Willis-Ekbom Disease

Congiu

Fantini

Milioli

et al. 2017

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

Study Objectives: Restless legs syndrome, also known as Willis-Ekbom disease (RLS/WED), is a frequent condition, though its pathophysiology is not completely understood. The diagnosis of RLS/WED relies on clinical criteria, and the only instrumental tool, the suggested immobilization test, may lead to equivocal results. Recently, neurophysiological parameters related to F-wave duration have been proposed as a diagnostic aid. The aim of this study is to assess and compare the diagnostic values of these parameters in diagnosis of RLS/WED. Methods: Fifteen women affected by primary RLS/WED and 17 age-and sex-matched healthy subjects. A complete electroneurographic evaluation, including nerve conduction studies (NCS), cutaneous silent period (CSP), and F-wave parameters, namely amplitude, F-wave duration (FWD), and the ratio between FWD and duration of the corresponding compound muscle action potential (FWD/CMAPD). Results:No subject showed alterations of the NCS. However, FWD and FWD/CMAPD of both upper and lower limbs were significantly longer in patients than controls. Tibial FWD/CMAPD best discriminated RLS/WED patients from controls. A cutoff of 2.06 yielded a sensitivity of 69.2%, a specificity of 94.1%, a positive predictive power of 90%, and a negative predictive power of 80% (area under the curve = 0.817; 95% confidence interval = 0.674-0.959). The combination of ulnar or tibial FWD/CMAPD increases the sensitivity (85.7%) while slightly decreasing the specificity (87.5%, positive predictive value: 85.7%, negative predictive value: 87.5%). Conclusions: Lower limb FWD/CMAPD ratio may represent a supportive diagnostic tool, especially in cases of evening lower leg discomfort of unclear interpretation.

show abstract

“…4 Restless legs syndrome (RLS) is a sensorimotor disorder characterized by an urge to move legs and other parts of the body accompanied by a marked sense of discomfort. 5 Besides an idiopathic, most probably genetically determined form, there are secondary forms that can be caused by a variety of medical conditions including iron deficiency, renal insufficiency, thyroid dysfunction, and sensory polyneuropathy. Of note, drugs (ie, selective serotonin reuptake inhibitors, neuroleptics, hormones, tricyclic antidepressants) can induce or worsen RLS.…”

Section: Introductionmentioning

confidence: 99%