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Restless legs syndrome in childhood and adolescence

Applicability of a questionnaire designed to assess disease-related symptoms

Restless-Legs-Syndrom im Kindes- und Jugendalter

Eignung eines Fragebogens zur Erfassung entsprechender Krankheitssymptome

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Abstract

Background

The prevalence of restless legs syndrome (RLS) is lower among children than adults. This could be due to RLS manifestation later in life or false diagnoses in children caused by symptom similarity to other diseases such as attention deficient hyperactivity disorder (ADHD).

Objective

The aim of this study was to test the reliability and validity of a questionnaire designed to identify RLS-related symptoms in children and adolescents.

Materials and methods

The questionnaire was designed for two age groups (6–12 and 13–18 years). It was distributed among 11 pediatric RLS patients and 22 healthy children and adolescents (control group). The control group answered the questionnaire twice (M1, M2; 14-day separation). Reliability was analyzed descriptively and with Spearman correlation coefficients, intraclass correlation coefficients (ICC), and test–retest variability (TRV). An index was calculated by transferring the 12 answers concerning RLS symptoms into a coding system, grading each answer between −2 and 2 and adding the grades to an index value. Low index values hint at the absence of RLS-related symptoms. Student’s t‑test was used to test the difference between healthy controls and pediatric patients.

Results

In the control group, 84% of answer pairs were identical between M1 and M2. Mean TRV was 8% (range: 2–16%), Spearman correlation coefficient 0.762, and ICC 0.754 (confidence interval: 0.473–0.899). Comparison between controls and pediatric RLS patients showed that RLS patients had significantly higher (p < 0.001) index values (mean ± SD: 18.8 ± 4) compared to controls (mean ± SD: −3.8 ± 7.6).

Conclusion

The questionnaire can distinguish between supposedly healthy and RLS-diagnosed children and adolescents in most cases. Nonetheless, the questionnaire cannot be used alone as a diagnostic instrument.

Zusammenfassung

Hintergrund

Die Prävalenz des Restless-Legs-Syndroms (RLS) ist im Kindes- und Jugendalter geringer als bei Erwachsenen. Der Grund hierfür könnte darin liegen, dass sich RLS erst mit fortschreitendem Alter entwickelt oder aufgrund von Symptomüberschneidungen mit anderen Krankheitsbildern wie dem Aufmerksamkeitsdefizits-Hyperaktivitäts-Syndrom (ADHS) Fehldiagnosen gestellt werden.

Ziel der Arbeit

Ziel dieser Studie ist die Überprüfung der Reliabilität und Validität eines neu entwickelten Fragebogens zur Erfassung der Symptome von RLS bei Kindern und Jugendlichen.

Material und Methoden

Es wurden 2 verschiedene Fragebogenversionen erstellt (6–12 und 13–18 Jahre). Ausgefüllt wurde der Fragebogen von 11 Kindern und Jugendlichen mit RLS-Diagnose und 22 gesunden Kindern und Jugendlichen (Kontrollgruppe). Die Kontrollgruppe füllte ihn nach 14 Tagen ein zweites Mal aus (M1, M2). Die Reliabilität wurde mittels deskriptiver Statistik, Korrelationskoeffizienten (Spearman), Intraklassenkorrelationskoeffizienten (ICC) und Test-Retest-Variabilität (TRV) analysiert. Es wurde aus den 12 auf RLS-Symptome bezogenen Items ein Indexwert errechnet, indem die Antworten zwischen den Werten −2 und 2 gewichtet und zu einem Score addiert wurden. Ein niedriger Score weist darauf hin, dass keine RLS-Symptome vorhanden sind. Mittels Student-t-Test wurde geprüft, ob sich die Antworten pädiatrischer Patienten von der Kontrollgruppe unterschieden.

Ergebnisse

Bei der Kontrollgruppe waren 84 % aller Antworten im Vergleich der Messzeitpunkte M1 und M2 identisch. Die TRV lag im Mittel bei 8 % (Wertebereich: 2–16 %), der Spearman-Korrelationskoeffizient bei 0,762 und der ICC bei 0,754 (Konfidenzintervall: 0,473–0,899). Im Vergleich beider Gruppen zeigte sich, dass junge RLS-Patienten signifikant höhere (p < 0,001) Scores aufwiesen (Mittelwert ± Standardabweichung, SD: 18,8 ± 4) als die Kontrollgruppe (Mittelwert ± SD: −3,8 ± 7,6).

Schlussfolgerung

Mittels Fragebogen kann größtenteils zwischen Gesunden und Patienten unterschieden werden. Trotzdem reicht er als alleiniges Instrument nicht aus, um eine Person als an RLS erkrankt einzustufen.

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Acknowledgements

We hereby thank the German Restless Legs Association, especially Lilo Habersack and Katharina Glanz, for their contribution to and financial support of this study.

Funding

The research group receives funding from the German Restless Legs Association for this study.

Author information

Authors and Affiliations

  1. Outpatient Clinic, Professorship of Sports Medicine and Sports Orthopedics, University of Potsdam, Am Neuen Palais 10 Haus 12, 14469, Potsdam, Germany

    Anne Schomöller, Katharina Weis M.A. &  Frank Mayer

  2. Department of Paediatrics, Hospital West Brandenburg Potsdam, Potsdam, Germany

    Reena von Barby &  Thomas Erler

  3. Hospital for Children and Adolescents, Chemnitz, Germany

    Axel Hübler

Authors
  1. Anne Schomöller
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  2. Katharina Weis M.A.
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  3. Reena von Barby
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  4. Axel Hübler
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  5. Frank Mayer
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  6. Thomas Erler
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Corresponding author

Correspondence to Anne Schomöller.

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Conflict of interest

A. Schomöller declares that she has no competing interests.

All procedures were in accordance with ethical standards and were approved by the ethics committee of the Medical Association of the federal state of Brandenburg. Informed consent was obtained from all included subjects and their parents.

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Schomöller, A., Weis, K., von Barby, R. et al. Restless legs syndrome in childhood and adolescence. Somnologie 23, 104–108 (2019). https://doi.org/10.1007/s11818-018-0188-y

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