01 rlsss

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Slide1: 

Restless Legs Syndrome: Classification, Diagnosis and Approaches to Treatment Part 1 of 3

Restless Legs Syndrome (RLS): 

Restless Legs Syndrome (RLS) Characterized by... Desire to move in association with paresthesias/dysesthesias of the limbs Motor restlessness www.wemove.org

Restless Legs Syndrome, cont’d: 

Restless Legs Syndrome, cont’d Characterized by... Provocative factor of rest Improved by movement Evening and nighttime accentuation www.wemove.org

RLS Diagnosis: Minimal Criteria: 

RLS Diagnosis: Minimal Criteria www.wemove.org

ICSD Criteria: RLS: 

ICSD Criteria: RLS Unpleasant sensations in legs at night Sensations of “creeping” in the calves Relief with movement PSG shows limb movement No medical or psychiatric disorder Other sleep disorder may be present www.wemove.org

Sensory Abnormalities: 

Sensory Abnormalities Desire to move limbs associated with... Paresthesias Dysesthesias www.wemove.org

Motor Abnormalities: 

Motor Abnormalities Restlessness...Irresistible urge to move Relief with Movement www.wemove.org

Provocative Factor of Rest: 

Provocative Factor of Rest Symptoms worse or exclusively present at rest, such as while lying down or sitting Partial or temporary relief with motor activity www.wemove.org

Evening and Nighttime Accentuation: 

Evening and Nighttime Accentuation Worsening symptoms during the evening or night Symptoms typically peak near midnight Seem to follow a Circadian pattern www.wemove.org

RLS: Associated Findings: 

RLS: Associated Findings Periodic Limb Movements in Sleep (PLMS) Sleep disturbances Dyskinesias While Awake (see next slide) www.wemove.org

Dyskinesias While Awake: 

Dyskinesias While Awake Involuntary and occur at rest Flexion jerk of lower extremities Sporadic, aperiodic, periodic, or in clusters Higher frequency than PLMS Perhaps a “waking counterpart” of PLMS www.wemove.org

Two Forms of RLS: 

Two Forms of RLS Idiopathic or primary RLS Familial Sporadic Symptomatic or secondary RLS Renal failure – Iron deficiency Neuropathy – Radiculopathy Diabetes – Pregnancy Rheumatoid arthritis www.wemove.org

Positive Family History: 

Positive Family History In idiopathic RLS... Fifty to 60% report a close relative or relatives with RLS-associated symptoms www.wemove.org

Disease Course: 

Disease Course Idiopathic RLS: variable age of onset Symptoms may present during late adulthood Symptoms tend to increase with age Some patients experience remissions www.wemove.org

Clinical Characteristics: 

Clinical Characteristics Mean age of onset is 27 years Unilateral onset in 42% Arm involvement in 25% to 50% www.wemove.org

Clinical Features of RLS: 

Clinical Features of RLS Affects females more than males Sleep disturbance in about 94% Sleep latency insomnia Fragmented or nonrestorative sleep Excessive daytime sleepiness in 22% www.wemove.org