Information
Restless Legs Syndrome (RLS) is a common neurological disease that is frequently unrecognized, misdiagnosed and poorly treated. It is characterized by highly uncomfortable sensations deep in the legs, arms and sometimes other parts of the body, that occur in rest situations and cause an irresistible urge to move. Symptoms are particularly troublesome in the evening and night, and sleep disturbance is as a result very common.
The diagnostic criteria based on which the diagnosis Restless Legs may be made, as developed by the International RLS Study Group (www.irlssg.org), are:
RLS occurs in 7% of the adult population worldwide. Primary or idiopathic RLS is familial in two-thirds of cases. RLS may also be secondary as the result of a number of conditions, among which iron deficiency, end-stage renal failure, neuropathy. Some 25% of pregnant women experience symptoms, mainly during the last trimester.
The exact cause of RLS is not known. Many recent studies have shown that there is impaired dopaminergic neurotransmission. Iron plays an important role.
RLS is often unrecognized or misdiagnosed. Patients usually delay seeking medical help for many years. When they finally do, an accurate diagnosis often is not made until many years thereafter. A large study done in 2004 demonstrated that only 8% of the many thousands of patients who took part in the study received the diagnosis RLS.
Many people with RLS have relatively mild symptoms which may be alleviated by changes in lifestyle. But there is a substantial group of patients with symptoms so severe that treatment is called for. The chronic insomnia that RLS patients suffer from often results in a significant impact on daytime functioning, and thus quality of life.
RLS is an important disorder because it is common, it causes significant distress to the sufferers, it may be the presenting feature of serious underlying disease, and it is treatable.
RLS IS TREATABLE
NON-PHARMACEUTICAL THERAPY
There are now a number of proven, effective therapies for RLS symptoms. However, the first issue for the doctor is whether or not drug therapy is necessary. Non-drug treatment should first be considered in all but the most severe of cases. These include:
The use of other drugs should be taken into account. Many antidepressants, antihistamines, most antinausea agents and most antipsychotics have the potential to cause or increase RLS symptoms and should be avoided if possible.
PHARMACEUTICAL THERAPY
Dopamine agonists are now the treatment of first choice for primary or idiopathic RLS. Pramipexole, ropinirole and rotigotine have all been shown to be safe and effective in treatment of RLS and are also approved by EMEA (European Medicines Agency). Studies have shown that these drugs are well tolerated. Augmentation and rebound may occur.
As there is no dopamine deficiency in RLS patients it is vital to start, and to continue, with a very low dose of dopaminergics - dopamine agonists and L-Dopa. Too high doses can quickly give side effects.
If dopamine agonists are poorly tolerated or ineffective, antiepileptics (gabapentin and pregabalin) or opioids (oxycodone, tilidin and tramadol) may be considered.
Treatment of secondary or symptomatic RLS involves treating the underlying problem in the first instance. Iron deficiency is important for these RLS sufferers, a serum ferritin level higher than 50 mcg/L is indicated.
The local RLS Patient organizations have all good educational material.
The cost per day to treat a RLS patient is often not more than 2 €.
Information on EARLS and its activities may be obtained from each of the member countries (see under “Links”) or from the EARLS central office via joke.earls@gmail.com