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Restless Legs Syndrome David Atkins 2-28-08 PAS 645-646.

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Presentation on theme: "Restless Legs Syndrome David Atkins 2-28-08 PAS 645-646."— Presentation transcript:

1 Restless Legs Syndrome David Atkins PAS

2 What is RLS ? Restless Legs Syndrome (RLS) is a sensorimotor movement disorder. Characterized by: – an uncontrollable urge to move the legs – symptoms typically begin in the evening or at bedtime, preventing the sufferer from falling asleep

3 Is RLS even REAL? YES.

4 HISTORY of RLS Phenomenon was described as early as 17 th century by Thomas Willis. Closely observed in 1945 by Karl-Axel Ekbom who coined the term "Restless legs" (formerly called "Ekbom-syndrome"). Diagnostic criteria outlined by International RLS Study Group (IRLSSG) in Revised in 2003.

5 Epidemiology Roughly 10% prevalence in the general population of U.S. and Western Europe. Significantly lower rates in African Americans. Higher incidence in women?

6 Etiology IDIOPATHIC Genetic Linkage: 3 separate loci have been identified, none solely responsible. Most research is aimed at dopamine and/or iron pathologies.

7 Two Forms of RLS: Primary (idiopathic): Early onset: usually manifests before 45 Familial: >60% have at least 1 primary family member with RLS. More gradual progression of Sx over time. Secondary RLS: Later age of onset No family history of RLS Rapid progression of Sx.

8 Secondary RLS Usually related to disorders that result in iron deficiency. Most common underlying causes of secondary RLS: –Pregnancy –Anemia –End-stage renal disease –ADHD

9 Diagnosing RLS

10 Treating RLS There is no cure, Tx is symptomatic only Pharmacologic vs. Non-pharmicologic Many treatments out there, but all lack sufficient research…studies are ongoing.

11 ALWAYS try non-pharm. Tx 1 st Behavioral/Lifestyle modification: Practice good sleep hygeine Regular moderate exercise, but at the right times Other anecdotal methods Avoid Sx aggravators: caffeine nicotine alcohol diphenhydramine TCA's SSRI's neuroleptics

12 NON-Pharmacologic Tx: IRON Iron supplementation: 50-65mg tid (+Vit C) IV: sodium ferric gluconate or iron sucrose Only beneficial if serum ferritin <50μg/L

13 Pharmocologic Tx DA-agonists are drugs of choice: –Levadopa (d.o.c. for intermittent RLS) –Ropinirole (Requip ® ) FDA approved for RLS in May, –Pramipexole (Mirapex ® ) FDA approved for RLS in November, Both indicated for moderate-severe RLS. No studies (yet) comparing ropinirole to pramipexole

14 Other Rx options: Opioids Benzodiazepines Anti-convulsants BZDP's: very popular before DA-agonists became first line, with good results. Both BZDP's and Opioids have low dependence and abuse potential when used for RLS

15 Pharmacologic Tx

16 As a clinician... Diagnose RLS using essential criteria. - Consider +FH, underlying cause, and assess iron status Educate patient and attempt non- pharmacologic therapies (d/c Sx aggravators) If non-pharm Tx fails, Rx a dopaminergic. If dopaminergics fail, try one of the "others". May use combo of dopaminergic + "other". Remember: all pts experience RLS and respond to Tx differently.

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18 References: Essential Dx table: Patrick L. Restless Legs Syndrome: Pathophysiology and the Role of Iron and Folate. Altern Med Rev Jun;12(2): Common Pharmacologic drugs: Hening WA. Current guidelines and standards of practice for restless legs syndrome. Am J Med Jan;120 (1 Suppl 1):S22-7. Tx Algorithm: Ryan M, Slevin JT. Restless legs syndrome. Am J Health Syst Pharm Sep;63(17):


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