RT Book, Section
A1 Rye, David B.
A1 Trotti, Lynn Marie
A2 Watts, Ray L.
A2 Standaert, David G.
A2 Obeso, Jose A.
SR Print(0)
ID 55804540
T1 Chapter 46. Restless Legs Syndrome and Periodic Leg Movements of Sleep
T2 Movement Disorders, 3e
YR 2012
FD 2012
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-161312-5
LK neurology.mhmedical.com/content.aspx?aid=55804540
RD 2024/04/20
AB Restless  legs  syndrome  (RLS)  is  characterized  by  a  compelling,  often  insatiable,  need  to  move  the  legs,  accompanied  by  unpleasant  sensations  located  mainly  in  the  ankles  and  calves.  Because  symptoms  are  brought  on  by  inactivity,  distress  intrudes  upon  everyday  activities  such  as  air  travel,  car  rides,  attending  school,  meetings,  or  the  theatre,  and  sleep.  The  first  comprehensive  description  of  RLS  in  1945  by  Ekbom  noted  its  key  features:  (1)  a  prevalence  of  at  least  5%;  (2)  a  diurnal  preference  for  the  evening  and  night;  (3)  a  subpopulation  with  pain;  (4)  a  proclivity  to  affect  pregnant  women;  (5)  heritability;  and  (6)  a  favorable  response  to  iron  supplementation.  A  second  advance  came  with  recognition  that  periodic  limb  movements  in  sleep  (PLMs)  are  present  in  the  anterior  tibialis  muscles  of  the  legs  in  85–95%  of  RLS  subjects.  Coincident  with  PLMs  are  elevations  of  heart  rate  and  blood  pressure,  and  peripheral  vasoconstriction  that  are  increasingly  viewed  as  causal  to  cardio-  and  cerebrovascular  morbidity.  A  third  major  advance  has  come  with  demonstration  that  pharmacologic  agents  acting  at  D2  and  D3  dopamine  receptors  relieve  both  the  sensory  (RLS)  and  motor  (PLMs)  symptoms.  A  fourth  advance  has  been  demonstration  of  brain  iron  reductions  in  a  subpopulation  of  RLS  cases.  The  fifth  seminal  advance  has  been  the  identification  of  five  genetic  loci  in  four  genes  that  account  for  a  majority  of  the  population  attributable  risk  of  RLS.