Introduction: Restless legs syndrome (RLS) is a common yet undiagnosed neurological disorder characterized by a circadian variation in symptoms involving dysesthesia and paresthesia in the limbs, usually the legs, aggravating in the evening and night. The purpose of this study is to investigate the incidence of RLS in spine center and to review clinical manifestations of this syndrome and its current treatments.
Methods: From January 2012 to December 2012, 639 patients with leg discomforts had undergone lumbar spine magnetic resonance imaging (MRI) to determine whether they had a certain lumbar spine problem. Among them, 32 patients were diagnosed by four essential clinical criteria based solely on symptom. We investigate demographic data, clinical characteristics, prognosis and treatment of RLS.
Results: Over a one year period, the incidence of RLS is 5.00% (32/639) in spine center. The median age at diagnosis was 55.4 years (range, 25~93 years). Affected limbs were on bilateral legs for 29 patients and both arms and legs for 3 patients. The median duration of symptoms was 14months. The exact cause of RLS is unknown but 12 patients have noted the beginning of their symptoms weeks or months after procedures. Several degenerative change in the lumbar spine MRI have been observed in 21 patients. All of 32 patients find relief when moving and the relief continues while they are moving their affected limbs at night. For the treatment of this syndrome, Mirapex?R was used alone or with Lyrica?R and these medications can be effective to decrease unpleasant feeling in the limbs without sleep disturbance. 71% of patients stopped medications within 6months and 9 patients were still taking these medications over 6months.
Conclusions: We suggest that awareness of this syndrome can help reduce diagnostic error, thereby avoiding the morbidity and expense associated with an unnecessary studies or inappropriate treatment in RLS patients
Patient Care: To distinguish degenerative spinal disorders and restless legs syndrome.
Learning Objectives: By the conclusion of this session, participants should keep in mind the clinical manifestations of restless legs syndrome and should distinguish from leg discomfort originated from spinal disorders.
References: 1. Trenkwalder C, Paulus W. Restless legs syndrome: pathophysiology, clinical presentation and management. Nat Rev Neurol 2010;6:337-346.
3. Budhiraja P, Budhiraja R, Goodwin JL, Allen RP, Newman AB, Koo BB, Quan SF. Incidence of restless legs syndrome and its correlates. J Clin Sleep Med 2012;8:119-124.
4. Ohayon MM, O'Hara R, Vitiello MV. Epidemiology of restless legs syndrome: a synthesis of the literature. Sleep Med Rev 2012;16:283-295.
5. Lee S, Lee JW, Yeom JS, Kim KJ, Kim HJ, Chung SK, Kang HS. A practical MRI grading system for lumbar foraminal stenosis. AJR Am J Roentgenol 2010;194:1095-1098.
6. Schizas C, Theumann N, Burn A, Tansey R, Wardlaw D, Smith FW, Kulik G. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine (Phila Pa 1976) 2010;35:1919-1924.
7. Civi S, Kutlu R, Tokgoz S. Frequency, severity and risk factors for restless legs syndrome in healthcare personnel. Neurosciences (Riyadh) 2012;17:230-235.
8. Cirillo DJ, Wallace RB. Restless legs syndrome and functional limitations among American elders in the Health and Retirement Study. BMC Geriatr 2012;12:39.