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Restless Leg Syndrome “ The most common disorder you have never heard of.”

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Presentation on theme: "Restless Leg Syndrome “ The most common disorder you have never heard of.”"— Presentation transcript:

1 Restless Leg Syndrome “ The most common disorder you have never heard of.”

2 What are Restless legs? Neurological movement disorder Irresistible urge to move legs when at rest Difficulty sleeping Involuntary periodic leg movements Uncomfortable sensation in limbs subjective & difficult to describe Symptoms eased by movement

3 Why should we know about it? Excess 5 million in UK are sufferers (MEMO 2000) Estimated prevalence 2-15% Sufferers will present to primary care Important physical cause of sleep disturbance Clinical diagnosis which can be made in primary care

4 Why should we know about it? Unrecognised & under-diagnosed Incorrectly labeled as stress / anxiety Managed poorly

5 Wide spectrum Affects any age group More common in middle age + women Mild Minimal distress Severe Episodes occur >2 per week Can be disabling

6 Why is it important? Large impact on quality of life: (REST Study) Poor sleep Inability to get comfortable / relax Poor concentration / fatigue Pain Depression Problems in day to day functioning / employment Implications for partner

7 Common descriptive terms used by patients

8 How do we diagnosis RLS? International Restless Legs Syndrome Study Group - 2003

9 Supporting Features Positive FHx (50-92%) Involuntary limb movements (80%) Sleep disturbance

10 What investigations should we do? Exclude secondary cause. Vascular dx / Neuropathy / nocturnal cramp / anxiety Examination Neuro / vascular Bloods FBC, ferritin, B12, Folate, U&E, Glucose, TFT

11 Aetiology Primary No underlying cause found. Positive FHx >50% Earlier onset / slower progression Secondary Fe deficiency Pregnancy End stage renal disease Peripheral neuropathy / DM / RA / Fibromyalgia Later onset / more severe

12 Pathophysiology Genetic Susceptibility loci identified on 3 chromosomes Positive FHx >50% Neurochemical Dopaminergic dysfunction - universal response to dopaminergic agents Ferritin level - inverse relation between severity and serum ferritin

13 What are the treatment options? Non Pharmacological Preventative measures Symptomatic control Pharmacological PRN treatment - mild / intermittent Maintenance treatment - moderate / severe Majority of treatments used ‘off license’

14 Non pharmacological treatment Preventative Avoid caffeine / alcohol / nicotine Avoid medication which may aggravate SSRI / antihistamine / antiemetic / CaChannel blockers Keep active into evening Good sleep hygiene Symptom control Mental alerting activities Walking / stretching Massage Hot / cold bath Relaxation / biofeedback

15 Pharmacological options DrugAdvantageDisadvantage IronHelpful if serum ferritin low Slow response Dopamine agonist Pramipexole / ropinirole High efficacy (70-100%) Less augmentation Daytime sleepiness Long term effect not known Dopaminergic agent Carbidopa / levodopa Can be used PRN basis Shown to be effective Up to 80% develop augmentation

16 Pharmacological options DrugAdvantageDisadvantage Anticonvulsants Gabapentin / Carbamazepine Useful in neuropathy / associated pain Side effect profile BenzosPRN use + help sleep Cognitive impairment, dependence OpioidsPRN use / daytime use Cognitive impairment, dependence

17 Rx Flow chart - RLS:UK

18 Mirapexin (pramipexole) First drug treatment / ONLY treatment licensed in EU for RLS For use in moderate / severe disease Quick onset of symptom relief (<1/52) Start low dose 125mcg od Titrate up (max 750mcg od)

19 What should we be doing? Have raised awareness about diagnosis Exclude / treat secondary causes Symptoms generally mild + reassurance & non-pharmacological measures suffice In moderate / severe cases consider onward referral

20 Useful Info Resources Review DTB Nov 2003 Bandolier 118

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