Drug-Induced Restless Legs Syndrome

Patatanian, Edna; Claborn, Melanie K

doi:10.1177/1060028018760296

Cited by 43 publications

(36 citation statements)

References 72 publications

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“…There is considerable comorbidity of RLS with diseases that are particularly common in women [40][41][42][43][44], notably migraine, sleep disorder, depression, and anxiety [3][4][5]44]. The drugs that treat these disorders may, in fact, be the culprits [45][46][47][48][49], as is shown by the fact that RLS symptoms start within days of initiating treatment.…”

Section: Comorbiditymentioning

confidence: 99%

Why Are Women Prone to Restless Legs Syndrome?

Seeman

2020

IJERPH

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Restless legs syndrome is a relatively common neurologic disorder considerably more prevalent in women than in men. It is characterized by an inactivity-induced, mostly nocturnal, uncomfortable sensation in the legs and an urge to move them to make the disagreeable sensation disappear. Some known genes contribute to this disorder and the same genes contribute to an overlapping condition—periodic leg movements that occur during sleep and result in insomnia. Dopamine and glutamate transmission in the central nervous system are involved in the pathophysiology, and an iron deficiency has been shown in region-specific areas of the brain. A review of the literature shows that pregnant women are at particular risk and that increased parity is a predisposing factor. Paradoxically, menopause increases the prevalence and severity of symptoms. This implies a complex role for reproductive hormones. It suggests that changes rather than absolute levels of estrogen may be responsible for the initiation of symptoms. Both iron (at relatively low levels in women) and estrogen (at relatively high oscillating levels in women) influence dopamine and glutamate transmission, which may help to explain women’s vulnerability to this condition. The syndrome is comorbid with several disorders (such as migraine, depression, and anxiety) to which women are particularly prone. This implies that the comorbid condition or its treatment, or both, contribute to the much higher prevalence in women than in men of restless legs syndrome.

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Section: Comorbiditymentioning

confidence: 99%

Why Are Women Prone to Restless Legs Syndrome?

Seeman

2020

IJERPH

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“…There are at least three hypotheses for the explanation of RLS [ 79 ]. The first hypothesis would be the prolonged use of dopamine antagonists, but we discard this theory because MTZ does not directly inhibit dopamine release.…”

Section: Discussionmentioning

confidence: 99%

Mirtazapine-associated movement disorders: A literature review

Rissardo

Caprara

2020

Tzu Chi Med J

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Mirtazapine (MTZ) is an atypical antidepressant approved by the FDA, which mechanism of action involves the antagonism of alpha-2, H1, 5-HT2A, 5-HT2C, and 5-HT3 receptors. In this context, the aim of this literature review is to evaluate the clinical epidemiological profile, pathological mechanisms, and management of MTZ-associated movement disorders (MDs). Relevant reports of six databases were identified and assessed by two reviewers without language restriction. Fifty-two reports containing 179 cases from 20 countries were assessed. The mean age was 57 year (range, 17–85). The majority of the individuals were female (60%) and of European origin. The mean time from MTZ start to symptom onset was 7.54 days; the time from management to MD improvement was within one week in 82.60% of the individuals. The MDs associated with MTZ were 69 restless legs syndrome (RLS), 35 tremors, 10 akathisia (AKT), 9 periodic limb MD, 6 dystonia, 4 rapid eye movement sleep behavior disorders, 3 dyskinesia, 2 parkinsonism, and 1 tic, and in the group not clearly identified, 18 restlessness, 15 hyperkinesis, and 1 extrapyramidal symptom. In the literature, the majority of the reports lack important information about the neurological examination. The management should be the MTZ withdrawal, except in RLS that other options are possible. In AKT, the MTZ should not be rechallenge, and if available, the prescription of a benzodiazepine may reduce recovery time.

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“…Neuroleptics induced RAS in one patient and exacerbated symptoms in another 23,28. Different drugs, mainly neuroleptics, antidepressants, and anesthetics have been described to exacerbate preexisting RLS or induce secondary RLS 16,46–48. The differential diagnosis of akathisia in the patient with olanzapine-induced RAS was not considered as motor symptoms were initiated by dysesthesias with urge to move 23.…”

Section: Discussionmentioning

confidence: 99%

“…We classically use to distinguish an idiopathic or primary form with early-onset and genetic predispositions from a secondary or symptomatic form 11. The latter is commonly associated with iron deficiency,12,13 renal failure,14 or consequently to certain drugs such as neuroleptics and antidepressants (tricyclic or selective serotonin reuptake inhibitors) 15,16. According to recent publications, overlapping genetic risk factors may play a role in primary (idiopathic) and secondary (symptomatic) RLS suggesting an inappropriate causal relation of this classification 17…”

Section: Introductionmentioning

confidence: 99%

<p>Restless arms syndrome: prevalence, impact, and management strategies</p>

Ruppert

2019

NDT

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This literature review focuses on restless arms syndrome (RAS), an upper limb variant of restless legs syndrome (RLS). RLS, also known as Willis-Ekbom disease, is a frequently occurring neurological disorder characterized by an irresistible urge to move the lower limbs often accompanied by unpleasant sensations in the legs, worsened at rest and in the evening, improved by movement. Extension of leg restlessness to the upper limbs is frequently reported in typical patients who had RLS only in the legs and usually occurs later in the course of RLS, restlessness remaining most invalidating in the lower limbs. In RAS, the arms are predominantly affected with little or no involvement of the legs. Cases of restless shoulders syndrome or periodic arm movements without arm restlessness were not considered. A total of 9 articles with 10 cases were included and analyzed for the adherence to the five essential diagnostic criteria of the International RLS Study Group (IRLSSG) classification, as well as for the additional supportive features. All of the reported cases were classified as having definite RAS. The clinical history and disease evolution of two previously reported patients were completed and updated. Overall, the clinical picture of RAS does not differ from that of RLS, except for the symptoms localization on the upper limbs. Underlying mechanisms of the spread of RLS to upper limb restlessness and of RAS remain unknown. Whether RAS is a phenotypic variant of RLS or a separate entity needs further investigations. RAS likely remains underdiagnosed and according to IRLSSG diagnostic criteria RAS should be considered when RLS-like symptoms are present in one or both arms, especially when they have a circadian pattern and are improved by movement and dopaminergic therapy. Clinicians should be aware of this rare condition, especially as treatment using dopaminergic agonists proves to be very efficient.

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Drug-Induced Restless Legs Syndrome

Abstract: The prevalence of RLS is variable and ranges from 3% to 19% in the general population. There are many predisposing factors to RLS, but an emerging body of evidence suggests that there is an association between numerous drugs and RLS.

Cited by 43 publications

References 72 publications

Why Are Women Prone to Restless Legs Syndrome?

Why Are Women Prone to Restless Legs Syndrome?

Mirtazapine-associated movement disorders: A literature review

<p>Restless arms syndrome: prevalence, impact, and management strategies</p>

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