Restless Legs Syndrome
Restless legs syndrome (RLS) is an under-recognized neurologic sensorimotor disorder, affecting approximately 2% of male and female adolescents. It is characterized by an urge to move the legs, usually associated with leg discomfort. The symptoms occur at
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Restless Legs Syndrome Mandana Mahmoudi and Sanjeev V. Kothare
Abbreviations CKD FDA RLS SSRI
Chronic Kidney Disease Food and Drug Administration Restless Legs Syndrome Serotonin-Specific Reuptake Inhibitor
Case 1 Stephanie is a 14-year-old young woman who presents to clinic with her parents due to concerns that she has been increasingly irritable during the daytime, and her school performance has been declining over the past year. Her parents report that Stephanie has been complaining of leg pains since the age of 9. They saw different specialists in this regard, and she was told to have “growing pains.”
M. Mahmoudi, M.D. Pulmonary, Critical Care, and Sleep Medicine, New York University Langone Medical Center, New York, NY, USA e-mail: [email protected] S.V. Kothare, M.D. (*) Department of Neurology, NYU Langone Medical Center and NYU School of Medicine, 223 East 34th Street, New York, NY, USA e-mail: [email protected]
© Springer International Publishing Switzerland 2017 S.V. Kothare, R. Quattrucci Scott (eds.), Sleep Disorders in Adolescents, DOI 10.1007/978-3-319-41742-4_3
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M. Mahmoudi and S.V. Kothare
Stephanie states that she has trouble falling asleep at night, as her legs ache and occasionally cramp when lying in bed. She sometimes gets up and walks around, but that relieves her leg discomfort only temporarily. Her parents describe her sleep as “restless,” and she “tosses and turns” at least for an hour until she falls asleep. Until 1 year ago, she would not awaken during the night, but now she awakens 3–4 times at night, unless exhausted. Her symptoms are worse when she is very tired, and occur at least 2–3 times a week. The only other change is that she started menstruating about 18 months ago, at age 13. She has a normal developmental history, as well as a normal general and neurologic examination. Her family history is notable for RLS in her maternal aunt and cousin. Biochemical investigations reveal a normal thyroid function, vitamin B12 and folic acid levels, transferrin saturation, and complete blood count. Her serum ferritin level was 22 ng/ml. Polysomnography revealed delayed sleep onset due to leg movements, as well as 8 PLMS per hour of sleep, most of which occurred in stage 2 sleep, with 72% being associated with arousals from sleep. RLS was confirmed, likely in the setting of relative iron deficiency, and Stephanie was started on a trial of oral iron combined with vitamin C to enhance absorption. At 3-month follow-up, her ferritin level was 97 ng/ml, and her symptoms of leg discomfort, restlessness, and daytime irritability resolved almost entirely.
Discussion Stephanie was likely misdiagnosed with growing pains during childhood. Her symptoms and polysomnographic findings are consistent with RLS, and have likely been worsening over the past year due to relative iron deficiency in the setting of growth, blood loss with menses, and an underlying genetic predisposition for RLS. RLS in adolescents is a common yet frequently undiagnosed neurologic sensorimotor disorder, af
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