High false-positive rate of questionnaire-based restless legs syndrome diagnosis in multiple sclerosis

Mery, Victoria; Kimoff, R. John; Suárez, I.; Benedetti, Andrea; Kamińska, Marta; Robinson, Ann; Lapierre, Yves; Bar‐Or, Amit; Trojan, Daria A.

doi:10.1016/j.sleep.2015.02.529

Cited by 21 publications

(5 citation statements)

References 33 publications

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“…For example, a high false-positive rate of RLS diagnosis was found in MS patients because of the MSrelated sensorimotor symptoms. It seems that greater severity of symptoms in MS than in controls may reflect not RLS but some of these other symptoms [25]. Second, the diagnostic threshold of RLS frequency applied in these studies was different.…”

Section: Discussionmentioning

confidence: 86%

Restless leg syndrome and multiple sclerosis: a case-control study in China

et al. 2015

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Section: Discussionmentioning

confidence: 86%

Restless leg syndrome and multiple sclerosis: a case-control study in China

et al. 2015

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“…[ 13 14 ] These conditions need to be carefully ruled out as while making the diagnosis of RLS as they may be source of false positive diagnosis of RLS. [ 13 14 15 39 ] However, RLS and RLS mimics are not mutually exclusive conditions. RLS mimics may occur along with RLS.…”

Section: Discussionmentioning

confidence: 99%

Modification and Validation of a Diagnostic Questionnaire for Restless Legs Syndrome: Modified-Restless Legs Syndrome Diagnostic Questionnaire (m-RLS-DQ)

Kumar

Krishnan

Das

et al. 2023

Annals of Indian Academy of Neurology

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Background: Diagnostic questionnaire that are available for restless legs syndrome does not include items related to RLS mimics and, hence, increases chances of false positive cases. This study aimed at modification and validation of RLS-diagnostic Questionnaire. Methods: During modification, additional items were identified, developed, and subjected to evaluation by experts. Experts were requested to validate the content of each item. Based on their responses, content validity indices (average and universal agreement) were calculated. It was then translated to Hindi and validated in a clinical population that included patients with RLS, somatic symptoms disorder, anxiety, other RLS mimics, and osteoarthritis. In addition, a group of healthy controls was also included. Face, concurrent, and discriminant validities were calculated. Results: Among 209 subjects, nearly 40 subjects had clinical diagnosis of RLS, osteoarthritis, somatic-symptoms-disorder, and anxiety disorder, each. In addition, 16 patients had other RLS mimics (akathisia, varicose veins, BFS, leg-cramps, chronic insomnia) and 30 were healthy controls. After multiple revisions, content validity indices achieved a score of 1 for m-RLS-DQ. Sensitivity and specificity of m-RLS-DQ v. 1.4 for the diagnosis of RLS were 94.9% and 94.1%, respectively. For the diagnosis of RLS, PPV was 78.7%, and NPV was 98.7% with an accuracy of 94.3%. Less than one fourth of participants having chronic insomnia, somatic symptoms disorder, anxiety disorder, and knee osteoarthritis were found to be false positive on m-RLS-DQ; however, none of the healthy controls were found positive on m-RLS-DQ. Concurrent validity with clinical diagnosis of RLS was 0.83 (P < 0.001). Discriminant validity with somatic symptoms disorder was −0.14 (P = 0.03) and with osteoarthritis −0.24 (P < 0.001). Conclusion: m-RLS-DQ is a valid instrument with acceptable psychometric properties, which can be used for the screening as well as diagnosis of RLS in clinical practice and research studies.

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“…Caution needs to be exercised when instruments that are not validated for specific neurologic diseases are used by patients with MS, an example being a high false-positive rate of restless legs syndrome (RLS) when using the International Restless Legs Syndrome Study Group diagnostic questionnaire. 11 A recent review of sleep disorders in MS and their relationship to fatigue similarly recognised that generic scales may be confounded in MS and recommended the creation of instruments that would be specific to sleep disorders in the context of MS-related fatigue. 12 …”

Section: Introductionmentioning

confidence: 99%

The Neurological Sleep Index: A suite of new sleep scales for multiple sclerosis

Mills

Tennant

Young

2016

Multiple Sclerosis Journal - Experimental, Translational and Cl

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ObjectiveThe objective of this study was to develop patient-reported outcome measures for sleep dysfunction and sleepiness in multiple sclerosis (MS), since there are currently no MS-specific measurement tools for these clinically important entities.MethodsItems were generated from semi-structured interviews followed by cognitive debrief. A 42-item pool was administered to patients with MS at three neuroscience centres in the UK. Comparator scales were co-administered. Constructs were validated by Rasch analysis, guided by initial exploratory factor analysis.ResultsThere were two supraordinate qualitative themes of diurnal sleepiness and non-restorative nocturnal sleep. Rasch analysis on 722 records produced three scales, which corresponded to diurnal sleepiness, non-restorative nocturnal sleep and fragmented nocturnal sleep. All had excellent fit parameters, were unidimensional and were free from differential item functioning. A summed raw score cut-point of 31/48 in the Diurnal Sleepiness Scale equated to the standard cut-point of 10 on the Epworth Sleepiness Scale (ESS).ConclusionThree high-quality measurement scales were developed, and together they compose the Neurological Sleep Index for MS (NSI-MS). The Diurnal Sleepiness Scale might provide an alternative to the ESS. The Non-Restorative Nocturnal Sleep Scale and the Fragmented Nocturnal Sleep Scale appear to be the only such measures for use in MS.

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High false-positive rate of questionnaire-based restless legs syndrome diagnosis in multiple sclerosis

Cited by 21 publications

References 33 publications

Restless leg syndrome and multiple sclerosis: a case-control study in China

Restless leg syndrome and multiple sclerosis: a case-control study in China

Modification and Validation of a Diagnostic Questionnaire for Restless Legs Syndrome: Modified-Restless Legs Syndrome Diagnostic Questionnaire (m-RLS-DQ)

The Neurological Sleep Index: A suite of new sleep scales for multiple sclerosis

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