Restless Legs Syndrome:

Classification, Diagnosis and

Approaches to Treatment

Part 2 of 3

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RLS Slide Library Version 1.0 - All Contents Copyright © WE MOVE 2001
 Additional Clinical Characteristics

• More than 60% of patients have

progressive disease
• Symptoms become worse with
increasing age

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 Additional Assessment Issue
• Current medication regimen for potential
causative agents, such as…
– Antiemetics
– Lithium
– Neuroleptics
– Antidepressants

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 RLS Associated with...
• Iron deficiency
• Uremia
• Pregnancy

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 Differential Diagnosis
• Neuroleptic-induced akathisia
• ADHD (in children)
• Anxiety
• Growing pains
• Other neurologic condition

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 Differential Diagnosis, cont’d
• Burning feet syndrome
• Fibromyalgia
• Meralgia paresthetica
• Arthritis
• Possible psychogenic disorder

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 Pathophysiology of RLS
• CNS abnormality (cerebral generators)
• Dopaminergic dysfunction
• Disinhibition of the flexor reflex during
sleep
• Possible involvement of the endogenous
opiate system

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 Pathophysiology of RLS, cont’d
• TMS: impaired motor cortex
excitability in RLS
• Impaired flexor reflexes
• Dopaminergic dysfunction
• Blink Reflex: enhanced R2 excitability

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 Central Mechanism Suggested...
• PLMS resemble Babinski response
• Hyperactive brainstem and spinal cord
reflexes
• Observed in patients with complete spinal
cord lesions
• Circadian rhythms to RLS

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Polysomnographic Findings

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 RLS/Peripheral Involvement
• Peripheral nerve involvement
– RLS secondary to peripheral neuropathy
clinically identical to idiopathic RLS
– Subclinical evidence of neuropathy

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 Etiology of RLS
• Idiopathic or primary RLS
– Sporadic
– Familial
• Secondary or symptomatic RLS

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 Familial RLS
In some patients…
• RLS appears to be inherited as
an autosomal dominant genetic trait

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 RLS Genetics
• Family history in >50%
• Autosomal dominant
• Genetic anticipation

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 Secondary RLS
• Anemia • Parkinson’s Disease
• Low Levels of Iron • Peripheral Neuropathy
• Diabetes/Amyloidosis • Depression
• Alcoholism • Carcinoma
• Increased BMI • Myokymia

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 Secondary RLS, cont’d
• End Stage Renal • Pregnancy
Disease • Porphyria
• Folate Deficiency • Postgastrectomy
• Nonspecific Prostatitis Complication
• Low Testosterone Level • COPD
• Magnesium Deficiency
• Dermatological
• Rheumatoid Arthritis Disorders
• Caffeine Consumption

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 Epidemiology of RLS
• Prevalence of 2% to 5% in adults
• Estimated prevalence from 5% to 30%
• Up to 12 million in the U.S.
• Affects about 5% of population

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 Electrophysiology of RLS
• Lack of bereitschaftspotential
• NCV is normal
• Somatosensory-evoked responses are
normal
• EMG demonstrates mild increase in
polyphasic units

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 Subjective Clinical Assessment
Using this scale, how would you rate
the following symptoms where
0 = none
1 = mild
2 = moderate
3 = severe
4 = very severe

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 Subjective Clinical Assessment
• Uncomfortable feelings in the legs and/or
arms at rest in the evening or at night?
• Need or urge to move around for relief
when at rest in the evening or at night?
• Relief with movement?

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 Clinical Assessment Questions
• Uncontrollable jerks in your legs and/or
arms that occur when you rest in the
evening or at night?
• Difficulty in getting to sleep when
you first lie down?

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 Clinical Assessment Questions, cont’d

• Difficulty staying asleep during the night,

after falling asleep?
• Sleepiness or fogginess during the daytime?

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 RLS Slide Set Presented by:
WE MOVE
204 West 84th Street
New York, NY 10024
Phone: (800) 437-MOV2 (in U.S.)
(212) 241-8567 (outside U.S.)
Fax: (212) 875-8389
E-mail: wemove@wemove.org
Web site: www.wemove.org
Executive Director: Judy Blazer, MS

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 Additional RLS Resource
Restless Legs Syndrome Foundation
819 Second Street SW
Rochester, MN 55902 US

Telephone: (507) 287-6465

Fax: (507) 287-6312
E-mail: rlsfoundation@rls.org
Web Site: http://www.rls.org

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