All articles in RLS/PLMD

Adult ferritin treatment threshold too high for kids with restless sleep

By: DEBRA L. BECK, Family Practice News Digital Network

 JUNE 2, 2014


VITALSKey clinical point: For children with restless sleep, consider iron supplementation at a serum ferritin level of 20 mcg/L.Major finding: A serum ferritin threshold of 20 mcg/L is a better predictor of sleep restlessness in children than is the adult threshold of 50 mcg/L.

Data source: Review of 537 children (1-18 yrs) referred to the University of Michigan pediatric sleep clinic.

Disclosures: The study was supported by a grant from the Charles Woodson Fund for Clinical Research.

 MINNEAPOLIS – Using the adult treatment threshold for serum ferritin to guide treatment in children with restless sleep may lead to inappropriate iron supplementation.

In both adults and children, iron deficiency has been linked to the presence and severity of restless legs syndrome (RLS) and periodic limb movements of sleep (PLMS). For adults, a serum ferritin less than 50 mcg/L is the threshold commonly used to guide iron supplementation for patients with RLS or PLMS.

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Restless leg syndrome effectively treated with pregabalin, which also reduces risk of symptom worsening

A report in the New England Journal of Medicine confirms previous studies suggesting that long-term treatment with the type of drugs commonly prescribed to treat restless leg syndrome (RLS) can cause a serious worsening of the condition in some patients. The year-long study from a multi-institutional research team found that pregabalin – which is FDA-approved to treat nerve pain, seizures, and other conditions – was effective in reducing RLS symptoms and was much less likely to cause symptom worsening thanpramipexole, one of several drugs that activate the dopamine neurotransmission system and are FDA approved for treatment of RLS.

“Our key finding is that dopaminergic drugs, while very effective for many people with RLS, can worsen symptoms in some patients over time, while non-dopaminergic pregabalin is not associated with this disturbing side effect,” says John Winkelman, MD, PhD, of the Massachusetts General Hospital Department of Psychiatry, senior author of the study.

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RLS Foundation Mission and Resources

Restless Legs Syndrome causes creepy-crawly sensations in the limbs, primarily in the legs (but occasionally in the arms and trunk). The sensations have the following features:

  • Occur during periods of inactivity
  • Become more severe at night
  • Are tied to an overwhelming urge to move the limb
  • Are relieved by movement of the limb
  • Often cause difficulty staying or falling asleep, which lead to feelings of daytime tiredness or fatigue
  • May cause involuntarily jerking of the limbs during sleep and sometimes during wakefulness

RLS Foundation is concentrating efforts on raising awareness of RLS. You have the potential to change the lives of people with RLS who may not even know that their torture has a name. Help increase awareness by doing the following:

  1. Consider becoming a member of the RLS Foundation. Your support helps the RLS Foundation provide information about RLS to those who need it. Among the benefits you will receive is our RLS newsletter “NightWalkers”.
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Ropinirole Appears Effective Against Restless Legs Syndrome

Emory University neurologists have found that the drug ropinirole is a safe and effective treatment for restless legs syndrome (RLS), a common but often undiagnosed neurologic disorder. An open-label study at Emory found that low doses of ropinirole resulted in moderate to large improvement in symptoms in two-thirds of patients.

Emory neurologist Alan Freeman, M.D., the study’s lead author, presented the findings at the American Academy of Neurology’s 52nd Annual Meeting in San Diego in May 2000. “This study suggests that low-dose ropinirole is an effective and well-tolerated treatment for RLS,” Dr. Freeman said. “This is important because RLS is a common condition that may affect five to 15 percent of the population. It’s a nuisance, and can seriously disrupt one’s life.”

The hallmark of the syndrome is an involuntary urge to move the legs and other extremities, often accompanied by a tingling or crawling sensation in the legs. Symptoms typically worsen during the evening, especially when lying down or attempting to fall asleep.

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Restless Legs: It’s No Laughing Matter

Restless Legs Syndrome (RLS): a funny-sounding name for a not-so-funny medical condition. Sufferers of this disease describe their sensations as pulling, creepy-crawly, electric, prickly, and, occasionally, painful. These sensations, which typically occur in the legs but can also affect the arms, are accompanied by an overwhelming urge to move the affected limbs. As one sufferer notes, “It feels like my bones itch. I just want to peel back the skin and scratch my shinbones, but of course I can’t do that. Instead, I get up and walk around, sometimes for hours on end, until I’m on the verge of collapse.”

Because the sensations and resultant urge to move are worse in the evening and at night, the disorder has a profound impact on people’s ability to sleep. According to Dr. William Dement, often called the grandfather of sleep and author of The Promise of Sleep, “RLS sufferers are among the most sleep-deprived patients that we see in our practice.”

Although RLS was long thought to affect only adults, researchers have recently determined that it can severely disrupt the lives of children and adolescents as well.

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Restless Legs Syndrome Information

From the National Institute of Neurological Disorders and Stroke (NINDS)

What is Restless Legs Syndrome?

Restless legs syndrome is a sensori-motor (movement) disorder characterized by uncomfortable sensations in the legs, which are worse during periods of inactivity or rest or while sitting or lying down. There is often a positive family history of the disorder. Individuals affected with the disorder describe the sensations as pulling, drawing, crawling, wormy, boring, tingling, pins and needles, prickly, and sometimes painful sensations that are usually accompanied by an overwhelming urge to move the legs. Sudden muscle jerks may also occur. Movement provides temporary relief from the discomfort. In rare cases, the arms may also be affected. Symptoms may interfere with sleep onset (sleep onset insomnia). Research suggests that restless legs syndrome is related to periodic limb movement disorder (PLMD), another more common motor disorder, which causes interrupted sleep. The symptoms often exhibit circadian rhythmicity in their peak occurrence during awakening hours.

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Facts About Restless Legs Syndrome (RLS)

Frequently Asked Questions

What Is Restless Legs Syndrome?

Restless legs syndrome (RLS) is a sleep disorder in which a person experiences unpleasant sensations in the legs described as creeping, crawling, tingling, pulling, or painful. These sensations usually occur in the calf area but may be felt anywhere from the thigh to the ankle. One or both legs may be affected; for some people, the sensations are also felt in the arms. These sensations occur when the person with RLS lies down or sits for prolonged periods of time, such as at a desk, riding in a car, or watching a movie. People with RLS describe an irresistible urge to move the legs when the sensations occur. Usually, moving the legs, walking, rubbing or massaging the legs, or doing knee bends can bring relief, at least briefly.

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An Introduction To Periodic Limb Movement Disorder (PLMD)

A sleep disorder is a physical and psychological condition or disturbance of sleep and wakefulness caused by abnormalities that occur during sleep or by abnormalities of specific sleep mechanisms. Although the sleep disorder exists during sleep, recognizable symptoms manifest themselves during the day. Accurate diagnosis requires a polysomnogram, widely known as a “sleep test.”

It is estimated that some 40 million Americans suffer from chronic, long-term sleep disorders. Another 20 to 30 million Americans suffer from some kind of sleep disorder on an irregular basis. The annual costs in productivity, health care, and safety have been estimated in the billions of dollars.

What Is Periodic Limb Movement Disorder?

Periodic Limb Movement Disorder (PLMD), formerly known as nocturnal myoclonus, is a condition in which a person’s legs or arms twitch or move involuntarily and periodically during sleep.

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