Article

Modeling the causal relationships between symptoms associated with restless legs syndrome and the patient-reported impact of RLS

Stanford University Center of Excellence for Sleep Disorders, Stanford Sleep Disorders Clinic, 401 Quarry Road, Suite 3301, Stanford, CA 94305-5730, USA.
Sleep Medicine (Impact Factor: 3.1). 10/2004; 5(5):485-8. DOI: 10.1016/j.sleep.2004.04.004
Source: PubMed

ABSTRACT The objective of this study is to examine the causal relationships between the symptoms of restless legs syndrome (RLS) and specific clinical and subjective health-related, quality of life consequences. Structural equation modeling was applied to data from a questionnaire-based observational study. The RLS morbidities of decreased functional alertness and emotional distress in our sample of patients appear to be mostly secondary to the sleep disturbance associated with RLS. There was no clear indication of any other feature of RLS affecting these two aspects of RLS morbidity. A primary treatment goal should be the reduction of the sleep disturbance of RLS, both to decrease the RLS-related nocturnal distress and to improve daytime functioning.

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    • "The lifetime prevalence of comorbid depression and anxiety disorders is elevated by odds ratios of 2.1 to 5.3 in RLS compared to the community at large [4-6]. Sleep problems, leg dysaesthesias, and the psychological sequelae of the disorder are all particularly implicated in contributing to impaired daily functioning [7,8]. RLS is considered to be a chronic disorder as causative treatments do not exist except of a few secondary forms such as iron deficiency. "
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    ABSTRACT: Restless legs syndrome (RLS) is a chronic disorder with substantial impact on quality of life similar to that seen in diabetes mellitus or osteoarthritis. Little is known about the psychological characteristics of RLS patients although psychological factors may contribute to unfavourable treatment outcome. In an observational cross-sectional design, we evaluated the psychological features of 166 consecutive RLS patients from three outpatient clinics, by means of the Symptom Checklist 90-R (SCL-90-R) questionnaire. Additionally, the Beck Depression Inventory-II (BDI-II) and the International RLS Severity Scale (IRLS) were measured. Both treated and untreated patients were included, all patients sought treatment. Untreated patients (n = 69) had elevated but normal scores on the SCL-90-R Global Severity Index (GSI; p = 0.002) and on the sub-scales somatisation (p < 0.001), compulsivity (p = 0.003), depression (p = 0.02), and anxiety (p = 0.004) compared with a German representative sample. In the treated group, particularly in those patients who were dissatisfied with their actual treatment (n = 62), psychological distress was higher than in the untreated group with elevated scores for the GSI (p = 0.03) and the sub-scales compulsivity (p = 0.006), depression (p = 0.012), anxiety (p = 0.031), hostility (p = 0.013), phobic anxiety (p = 0.024), and paranoid ideation (p = 0.012). Augmentation, the most serious side effect of dopaminergic, i.e. first-line treatment of RLS, and loss of efficacy were accompanied with the highest psychological distress, as seen particularly in the normative values of the sub-scales compulsivity and anxiety. Generally, higher RLS severity was correlated with higher psychological impairment (p < 0.001). Severely affected RLS patients show psychological impairment in multiple psychological domains which has to be taken into account in the treatment regimen.
    Health and Quality of Life Outcomes 09/2011; 9:73. DOI:10.1186/1477-7525-9-73 · 2.10 Impact Factor
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    • "EKD is one of the most prevalent neurological disorders in Europe and North-America, affecting about 10% of the population, with women being afflicted almost twice as often as men.3,4 The usual presentation of this condition is characterized by a strong urge to move, accompanied or caused by uncomfortable, or even distressing paresthesia of the legs, described as a “creeping, tugging, pulling” feeling.1 The symptoms often become worse as the day progresses, leading to sleep disturbances or sleep deprivation, which further result in impairment of alertness and daytime functions.5 "
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    ABSTRACT: Ekbom disease (EKD), formerly known as restless legs syndrome (RLS) has affected and bothered many people over the centuries. It is one of the most prevalent neurological disorders in Europe and North-America, affecting about 10% of the population. The main characteristics are the strong urge to move, accompanied or caused by uncomfortable, sometimes even distressing, paresthesia of the legs, described as a "creeping, tugging, pulling" feeling. The symptoms often become worse as the day progresses, leading to sleep disturbances or sleep deprivation, which leads to decreased alertness and daytime functions. Numerous studies have been conducted assessing the efficacy of dopaminergic drugs, opioids, and other pharmacologic agents in alleviating EKD symptoms. However, there is also a growing body of evidence demonstrating the effectiveness of nonpharmacologic treatments including life style changes, physical activity programs, pneumatic compression, massage, near-infrared light therapy, and complementary therapies. The working mechanisms behind these alternatives are diverse. Some increase blood flow to the legs, therefore reducing tissue hypoxia; some introduce an afferent counter stimulus to the cortex and with that "close the gate" for aberrant nerve stimulations; some increase dopamine and nitric oxide and therefore augment bio-available neurotransmitters; and some generate endorphins producing an analgesic effect. The advantages of these treatments compared with pharmacologic agents include less or no side effects, no danger of augmentation, and less cost.
    Neuropsychiatric Disease and Treatment 05/2011; 7(1):251-7. DOI:10.2147/NDT.S19177 · 2.15 Impact Factor
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    • "Restless legs syndrome (RLS) is a chronic sensorimotor disorder, characterized by a strong urge to move, accompanied or caused by uncomfortable or even distressing paresthesia of the legs, described as a creeping, tugging, "pulling" feeling. The symptoms often become worse throughout the day, leading to sleep disturbances or deprivation and, consequently, to impairment of alertness and daytime functions [1]. The symptoms are usually lessened by movement [2]. "
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    ABSTRACT: We describe a potential new treatment option for patients suffering from restless legs syndrome. Contemporary treatment for restless legs syndrome consists mostly of dopaminergic drugs that leave some patients feeling nauseated and dizzy. A non-invasive, drug-free option would open new doors for patients suffering from restless legs syndrome. A 69-year-old Caucasian woman met International Restless Legs Syndrome Study Group criteria for the diagnosis of restless legs syndrome. She had been afflicted with restless legs syndrome for over 30 years and tried many of the available pharmaceutical remedies without success. For this study she received 30-minute treatment sessions with near-infrared light, three times a week for four weeks. The restless legs syndrome rating scale was used to track symptom changes; at baseline she scored "27" on the 0 to 40 point scale, which is considered to be "severe". Our patient was almost symptom free at week two, indicated by a score of "2" on the rating scale. By week four she was completely symptom free. The symptoms slowly returned during week three post treatment. The findings suggest that near-infrared light may be a feasible method for treating patients suffering from restless legs syndrome. Undesirable side-effects from medication are non-existent. This study might revive the neglected vascular mechanism theory behind restless legs syndrome and encourage further research into this area.
    Journal of Medical Case Reports 08/2010; 4:286. DOI:10.1186/1752-1947-4-286
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