A Presentation on "Restless Leg Syndrome"

It is a presentation on "Restless Leg Syndrome" in detail.

1. Restless Leg Syndrome Presented by - Major Dr. Neamatullah Ahmed( Retd .) PBGMS,MPH,MCPS Preventive & Family Medicine Consultant DG Lab Medical Services, Mirpur-10. Bangladesh

2. History The first description of RLS is attributed to Thomas Willis in 1685. Ekbom coined the term “Restless legs”. In 1945,Ekbom gave a full description of the syndrome based on a large series of patients. This condition is sometimes referred to as Willis-Ekbom disease.

3. Definition Syndrome characterized by an unpleasant sensation ‘wanting to move’ the legs with throbbing/pulling during resting, sitting or lying.

4. Prevalence Has a strong familial tendency. 10% of adults are affected. Prevalence of male: female=1:2. Also seen in children. The prevalence of RLS increases with age and, hence, is more frequent in the elderly. Often occurs in the evenings / night time

5. Genetics 01 02 Family studies of RLS suggest an increased incidence (40%-50%) in first-degree relatives of idiopathic cases. Autosomal dominant mode of inheritence (Hening et al, 2009). Linkage analysis documented significant linkage to at least 06 different chromosomes ( 12q, 14q, 9p, 2q and 20p ). 03

6. Types of RLS Early onset: Age of onset is less than 45 years, tends to cluster in families and progresses slowly with a female to male ratio of 2:1 Late onset: Age of onset over 45, has an equal male to female ratio, more rapid progression, more severe and more frequent symptoms, no familial clustering & more commonly associated with radiculopathy, neuropathy or myelopathy.

7. Causes of RLS 1.Primary /Idiopathic : 2. Secondary RLS (PIPPUDH CARPECD ) : -Polyneuropathy - COPD -Iron deficiency Anaemia - Amyloidosis -Parkinson’s disease - RA -Pregnancy - Hypothyroidism -Uraemia - ESRD -Diabetes - Cancer -Persistent genital arousal disorder - Drugs (WAL CNN )

8. Drugs WAL CNN : -Withdrawal from sedatives / narcotics. -Antidepressants & antipsychotics. -Lithium. -Caffeine. -Narcotics. -Neuroleptics.

9. Diagnostic Criteria 01 02 The diagnosis rests entirely on clinical features and is based on the International Restless Leg Syndrome (IRLSSG) Criteria first established in 1995 ( Walters 1995 ) and modified slightly in 2003 (Allen et al, 2003). These criteria include essential, supportive and associated features. All 3 essential criteria are needed for establishing the diagnosis. 03

10. Essential Criteria 01 02 Unpleasant sensation only present during lying/sitting. Partially/totally relieved by walking or stretching. Unpleasant sensation occur /worse only in the evening /night. 03

11. Investigations 01 03 02 04 05 Urine for RME CBC with PBF study FBS, HbA1C to exclude DM. Anti CCP antibody to exclude RA. Blood Urea to exclude Uraemia / Gout

12. Investigations 06 08 07 09 Serum Creatinine to exclude ESRD. CBC with PBF study Stool for RME to exclude Helminthiasis. For female patients, Urine for Pregnancy test.

13. Treatment 01 02 Avoid foods that worsens the problem Alcohol Tea Nicotine Caffine Following underlying disease should be treated Anaemia DM Kidney Disease Parkinson’s Disease Nutritional deficiencies Varicose veins Benzodiazepines : Tab Clonazepam 0.5mg: 1 Tab at H/S, Max 4 tabs. + Tab Ropinirole 0.25mg : 1 Tab after dinner, max 4mg/d,Or, Tab Pramipexol 88mcg: 1 Tab after dinner, Max 6 Tabs. 03

14. References A Handbook of Family Medicine Review of periodic limb movement and restless leg syndrome. -R Nataranjan, JPGM 2010. Department of Pulmonary & Critical Care Medicine, University of Massachusetts, Worcester, USA.

15. Thank You Presented by Major Dr. Neamatullah Ahmed (Retd.)