Restless Legs Syndrome and Painful Legs/Moving Toes
Restless legs syndrome (RLS), which has been recently renamed Willis–Ekbom disease (WED), is a neurological disorder characterized by unpleasant sensations in the legs, with an urge to move. Symptoms mainly occur at rest in the evening or at night, and th
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Luigi Ferini-Strambi, Sara Marelli, and Romina Combi
List of Abbreviations
36.1 Restless Legs Syndrome
CSF Cerebrospinal fluid EMG Electromyography ICSD-3 International classification of sleep disorders, 3rd edition PLMS Periodic limb movements in sleep PLMTS Painful legs and moving toes syndrome PLMW Periodic limb movements in wakefulness RLS Restless legs syndrome SIT Suggested Immobilization Test WED Willis–Ekbom disease
Restless legs syndrome (RLS), recently renamed Willis–Ekbom disease (WED), is a neurological disorder characterized by paresthesia in the legs, with an urge to move. The most common adult RLS descriptors are “restless,” “uncomfortable,” “twitchy,” “need to stretch,” “urge to move,” and “legs want to move on their own,” and about half of patients express their RLS sensations as painful. The symptoms begin or worsen during periods of rest or inactivity such as lying down or sitting, while the activity may typically relieve the urge to move and the unpleasant leg sensations. Symptoms may also involve arms and other body parts (20 % of patients) [1]. Another important characteristic of RLS is the worsening of symptoms in the evening or during the night. The circadian pattern in the occurrence of RLS symptoms has been investigated by using a method called the “Suggested Immobilization Test” (SIT), administered every 2–4 h during 24–28 h [2]. These studies showed that the severity of leg discomfort followed a circadian rhythm with a maximum occurring after midnight. Moreover, the peak intensity of symptoms occurred on the falling limb of the core body temperature rhythm. Interestingly, it has been reported that changes in melatonin secretion precede the increase in sensory or motor symptoms of RLS [3].
L. Ferini-Strambi, MD, PhD (*) Department of Clinical Neurosciences, San Raffaele Scientific Institute, Sleep Disorders Center, Milan, Italy Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy Sleep Disorders Center, Università Vita-Salute San Raffaele, Milan, Italy e-mail: [email protected] S. Marelli, PhD Department of Clinical Neurosciences, San Raffaele Scientific Institute, Sleep Disorders Center, Milan, Italy e-mail: [email protected] R. Combi, PhD Department of Surgery and Traslational Medicine, Università of Milano-Bicocca, Milan, Italy e-mail: [email protected]
© Springer-Verlag Wien 2017 C. Falup-Pecurariu et al. (eds.), Movement Disorders Curricula, DOI 10.1007/978-3-7091-1628-9_36
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The majority of RLS patient complain of poor sleep [4]: most patients report difficulty falling asleep, but some patients fall asleep rapidly and wake up shortly after with unpleasant legs sensations that force them to get up and walk around. The clinical spectrum of RLS is very wide. Some patients may report symptoms during only short periods in their lives, while the severely affected cases have daily symptoms. Interestingly, the age of RLS onset appears to be the only characteristic item qualifying as an endophenotype [5]. Specifically, two different R
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