Abstract
Restless legs syndrome (RLS) is common in the elderly, with an estimated prevalence of 10 to 35% in individuals over 65 years of age. RLS is characterised by paraesthesias and dysaesthesias of the legs, typically occurring in the evening. The symptoms occur at rest and result in motor restlessness; movement often temporarily relieves the symptoms. Patients with poorly controlled RLS may develop related problems including insomnia (due to sleep-onset restlessness or periodic limb movements or related sleep fragmentation) and depression. RLS can be a primary disorder that develops in the young and includes familial cases. Secondary RLS occurs in association with iron-deficiency anaemia, uraemia and polyneuropathies. Typically, RLS is misdiagnosed or undiagnosed for years. In the elderly, both primary and secondary types of the disorder are common.
It is thought that RLS represents lower CNS levels of, or reduced responsiveness to, dopamine. The symptoms improve with dopaminergic therapy. Ergotamine dopamine-receptor agonists such as pergolide, and the non-ergotamine dopamine-receptor agonists pramipexole and ropinirole, are becoming more commonly used to treat RLS. The dopamine precursor levodopa, in combination with carbidopa, is another effective therapeutic agent. An advantage of levodopa is lower cost than non-ergotamine and ergotamine dopamine-receptor agonists. However, the adverse effect of symptom augmentation appears to develop more frequently with levodopa than dopamine-receptor agonists; therefore, levodopa may currently be used somewhat less often as first-line therapy. Patients with painful symptoms may respond favourably to the anticonvulsants gabapentin and carbamazepine. Opioids and hypnosedatives are helpful in selected patients; however, these agents may have troubling adverse effects in the elderly. Correction of iron deficiency improves symptoms in patients with low ferritin levels. Lifestyle modification may also be helpful. Therapy is directed at symptoms, and most symptomatic patients benefit from treatment. It is important to consider RLS in the differential diagnosis of any patient with paraesthesias of the limbs.
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References
American Sleep Disorders Association. Restless legs syndrome. International classification of sleep disorders, revised: diagnostic and coding manual. Rochester (MN): American Sleep Disorders Association, 1997: 68–71
Walters AS, Hickey K, Maltzman J, et al. A questionnaire study of 138 patients with restless legs syndrome: the nightwalkers survey. Neurology 1996; 46: 92–5
Trenkwalder C, Walters AS, Hening W. Periodic limb movements and restless legs syndrome. Neurol Clin 1996; 14: 629–50
Ekbom KA. Restless legs syndrome. Neurology 1960; 10: 868–73
Walters AS. Toward a better definition of the restless legs syndrome. Mov Disord 1995; 5: 634–42
Ondo W, Jankovic J. Restless legs syndrome: clinicoetiologic correlates. Neurology 1996; 47: 1435–41
Allen RP, Earley CJ. Restless legs syndrome: a review of clinical and pathophysiologic features. J Clin Neurophysiol 2001; 18: 128–47
Rothdach AJ, Trenkwalder C, Haberstock J, et al. Prevalence and risk factors of RLS in an elderly population. Neurology 2000; 54: 1064–8
Montplaisir J, Nicolas A, Godbout R, et al. Restless legs syndrome and periodic limb movement disorder. In: Kryger MH, Roth T, Dement WC, editors. Principles and practice of sleep medicine. 3rd ed. Philadelphia (PA): WB Saunders, 2000: 742–52
Allen RP, Earley CJ. Defining the phenotype of the restless legs syndrome using age-of-symptom-onset. Sleep Med 2000; 1: 11–9
Sun ER, Chen CA, Ho G, et al. Iron and the restless legs syndrome. Sleep 1998; 21: 371–7
Schols L, Haan J, Riess O, et al. Sleep disturbance in spinocerebellar ataxias. Neurology 1998; 51: 1603–7
Chesson AL, Wise M, Davila D, et al. Practice parameters for the treatment of restless legs syndrome and periodic limb movement disorder. Sleep 1999; 22: 961–8
Henning W, Allen R, Earley C, et al. The treatment of restless legs syndrome and periodic limb movement disorder. Sleep 1999; 22: 970–99
Henning WA. Restless legs syndrome. Curr Treat Options Neurol 1999; 1: 309–19
Restless Legs Syndrome Foundation, Inc. Medical Bulletin (revised April 2001). Rochester (MN): The Foundation, 2001
O’Keeffe ST, Gavin K, Lavan JN. Iron status and restless legs syndrome in the elderly. Age Ageing 1994; 23: 200–3
Davis BJ, Rajput A, Rajput ML, et al. A randomized, double blind placebo controlled trial of iron in restless legs syndrome. Eur Neurol 2000; 43: 70–5
Allen RP, Earley CJ. Augmentation of the restless legs syndrome with carbidopa/levodopa. Sleep 1996; 19: 205–13
Poewe W, Hogl B. Parkinson’s disease and sleep. Curr Opin Neurol 2000; 13: 423–6
Stiasny K, Wetter TC, Winkelmann J, et al. Long-term effects of pergolide in the treatment of restless legs syndrome. Neurology 2001; 56: 1399–402
Comella CL, Tanner CM, Ristanovic RK. Polysomnographic sleep measures in Parkinson’s disease patients with treatment-induced hallucinations. Ann Neurol 1993; 34(5): 710–4
Danoff SK, Grasso ME, Terry PB, et al. Pleuropulmonary disease due to pergolide use for restless legs syndrome. Chest 2001; 120(1): 313–6
O’Keefe ST. Restless legs syndrome: a review. Arch Intern Med 1996; 156(3): 243–8
Becker PM, Jamieson AO, Brown WD. Dopaminergic agents in restless legs syndrome and periodic limb movements of sleep: response and complications of extended treatment in 49 cases. Sleep 1993; 16(8): 713–6
Montplaisir J, Nicolas A, Denesle R, et al. Restless legs syndrome improved by pramipexole. Neurology 1999; 52: 938–43
Montplaisir J, Denesle R, Petit D. Pramipexole in the treatment of restless legs syndrome: a follow-up study. Eur J Neurol 2000; 7(Suppl. 1): 27–31
Weimerskirch PR, Ernst ME. Newer dopamine agonists in the treatment of restless legs syndrome. Ann Pharmacother 2001; 35: 627–30
Frucht S, Rogers JD, Greene PE, et al. Falling asleep at the wheel: motor vehicle mishaps in persons taking pramipexole and ropinirole. Neurology 1999; 52: 1908–10
Ondo W. Ropinirole for restless lsegs syndrome. Mov Disord 1999; 14(1): 138–40
Olanow CW, Schapira AHV, Roth T. Waking up to sleep episodes in Parkinson’s disease. Mov Disord 2000; 15: 212–5
Ferreira JJ, Rascol O. Drug-related sleep disturbances and Parkinson’s disease: effect of dopaminergic antiparkinsonian drugs on sleep and wakefulness. Eur J Neurol 2000; 7Suppl. 4: 26–35
Happe S, Klosch G, Saletu B, et al. Treatment of idiopathic restless legs syndrome (RLS) with gabapentin. Neurology 2001; 57: 1717–9
Thorp ML, Morris CD, Bagby SP. A crossover study of gabapentin in treatment of restless legs syndrome among hemodialysis patients. Am J Kidney Dis 2001; 38: 104–8
Allen RP, Earley CJ. Validation of the Johns Hopkins Restless Legs Severity Scale. Sleep Med 2001; 2: 239–42
Acknowledgements
The authors thank Patricia Fortenberry for her patient assistance with the preparation of this manuscript. No sources of funding were used to assist in the preparation of this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.
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Milligan, S.A., Chesson, A.L. Restless Legs Syndrome in the Older Adult. Drugs Aging 19, 741–751 (2002). https://doi.org/10.2165/00002512-200219100-00003
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DOI: https://doi.org/10.2165/00002512-200219100-00003