RESTLESS LEG SYNDROME DR ANDREW G VEALEFRACP NZ
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RESTLESS LEG SYNDROME DR ANDREW G VEALEFRACP NZ RESPIRATORY & SLEEP INSTITUTE
WHAT IS IT? • A common disorder affecting 2% to 5% of the populaton • More common in women • Common in pregnancy • Can begin at any age • Positive family history in those with early onset • Usually intermittent • Cause uncertain
DIAGNOSIS • History!!! • A strong and often overwhelming need or urge to move the legs. Often associated with abnormal, unpleasant, or uncomfortable sensations. Deep aching, throbbing pulling, itching, crawling, creeping, burning) • • • The urge to move the legs starts or gets worse during rest or inactivity. The urge to move is relieved by movment The urge to move gets worse in the evening or nights
INVESTIGATIONS • Blood Tests • FBC, Iron studies, Renal Function. • Polysomnography • • 80% to 90% will have PLMS; but most patients with PLMS don’t have RLS. Excludes other sleep disorders
TREATMENT 1 • Often not required if intermittent and not associated with distress • Lifestyle • • • Reassurance and empathic support Avoid alcohol and nicotine Structured evening exercise Warm baths Massage Stretches
TREATMENT 2 • If Ferritin is in the lower third (lower half) of the normal range • Iron supplements (Oral, but constipation; IV, but expensive) • Medical compression devices
TREATMENT 3 • Gabapentin Pregabalin as effective as Dopaminergic agents. • Dopamine (Levo. Dopa with Carbidopa) • but augmentation & impulsive, OCD • Dopaminergic agents (Ropinerol, pramipexole, rotigotine) • but augmentation & impulsive, OCD • Opiates (methadone, codeine, oxycodone) • Benzodiazepines
ITS MORE ABOUT HOW YOU USE THE DRUGS! • Escalating doses • Augmentation • Drug holidays • “Ring the changes”
