Clinician s Manual on Restless Legs Syndrome

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1 Clinician s Manual on Restless Legs Syndrome

2

3 Mark J. Buchfuhrer Clinician s Manual on Restless Legs Syndrome Second Edition

4 Mark J. Buchfuhrer PIH Health Hospital - Downey Downey, CA USA ISBN ISBN (ebook) DOI / Library of Congress Control Number: Springer International Publishing Switzerland 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Adis imprint is published by Springer Nature The registered company is Springer International Publishing AG Switzerland

5 To my wife, Dr Laurie Buchfuhrer, who has supported me and my work on RLS for the past three decades which has facilitated the development of my skills and expertise treating RLS patients and performing research and publishing in the field of RLS. I also thank her for very helpful efforts and insights aiding me with editing this manual. To Dr Wayne Henning, my coauthor of the first edition of this publication who has been missed by the RLS community since his untimely death. He was one of my original mentors, and as a teacher and clinician, he was a major influence in advancing the knowledge and awareness of RLS at a time when RLS was a little-known disease with limited therapeutic options.

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7 Preface For many years perhaps many centuries restless legs syndrome (RLS) has been something of a stealthy sensorimotor disorder. The current RLS Foundation ( had its origin as a small newsletter group brought together by the National Organization for Rare Disorders. However, RLS was not and is not rare. In fact, it is relatively common and, in some settings, more than 10 % of adults can merit a diagnosis of RLS. In the last years, a series of studies within different populations in the primary care setting have shown that RLS can present in every medical setting. RLS can be seen by internists, family doctors, pediatricians, sleep specialists, rheumatologists, endocrinologists, gynecologists, obstetricians, nephrologists, neurologists, and sleep specialists, to name just a few. Thus, the intention of this clinician s manual is to provide a short, accessible introduction to understanding and managing RLS that is useful to all medical professionals. First, what is a sensorimotor disorder? Such a condition involves abnormalities of both sensation and movement. Indeed, RLS is a condition of both abnormal sensation and excessive movement. The primary symptom of RLS is an urge or need to move one s legs or other affected body parts (technically an akathisia) that typically occurs at first in the evening or at night when a person tries to rest or relax. This urge or need to move is often so compelling that RLS sufferers may have to walk, shake their legs, ride a bicycle, massage their legs, or stretch to alleviate their discomfort. It is usually associated with unpleasant or uncomfortable sensations. Patients with RLS may also suffer from involuntary movements at rest, known as periodic limb movement (PLM), that vii

8 viii Preface can occur both when awake and asleep. Due to this abnormal movement, patients with RLS are often seen by movement disorder specialists. Because their symptoms usually occur in the evening and at night, patients may have sleep difficulties, such as trouble falling asleep, disrupted sleep, and the daytime consequences of inadequate sleep. Sleep problems are a most prominent complaint and a common reason why patients with RLS request medical attention. As a result, physicians specializing in sleep medicine (i.e., neurologists, pulmonologists, psychiatrists) were the first to become familiar with RLS. Second, where did the term restless legs syndrome originate? Legs refers to the initial site of the disorder, but, in severely affected individuals, similar symptoms can be experienced in the arms and, less frequently, in other parts of the body; however, in almost every patient, the legs are first and most severely involved. Because the term is so evocative, although criticized as insufficiently serious, RLS has proven to be useful in increasing awareness of the condition. A few years ago, RLS received an additional name: Willis-Ekbom Disease (WED), named after Sir Thomas Willis who first described the disease in 1685 and Karl Ekbom who rediscovered the disease and named it restless legs syndrome in Although both names are currently being used, most patients and clinicians use the more common and descriptive term, RLS. Mark J. Buchfuhrer Downey, CA, USA

9 Contents 1 Epidemiology of Restless Legs Syndrome References Clinical Presentation of Restless Legs Syndrome References Establishing a Diagnosis of Restless Legs Syndrome Diagnostic Interview and Clinical Assessment Differential Diagnosis References Comorbidities of Restless Legs Syndrome and Periodic Limb Movement Disorder References Management of Restless Legs Syndrome Introduction Lifestyle Adjustments Medications That Worsen Restless Legs Syndrome Iron Replacement Therapy Vibration Pad Pharmacologic Treatment Problems with the Long-Term Therapy Treatment of Special Populations Summary of Treatment References ix

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11 Author Biography Mark J. Buchfuhrer, MD, is a consulting assistant professor at Stanford University School of Medicine, Stanford, CA, where he teaches the sleep fellows in the Restless Legs Syndrome (RLS)/Sleep Medicine Clinic. He is also in private practice in Downey, CA, USA, in the fields of pulmonary and sleep medicine. Dr Buchfuhrer graduated with a BSc from McGill University, Canada, before attending medical school at the University of Ottawa. He completed his internship and residency training in internal medicine at the University of Toronto in 1980, followed by fellowship training in pulmonary medicine at Harbor University of California Los Angeles Medical Center in Torrance, California, in Dr Buchfuhrer has authored and contributed to many publications on RLS, including clinical books for physicians and a book for patients with RLS. He has been involved in several professional RLS organizations and manages an RLS website ( org). He is the medical director of SleepMed Sleep Disorders Center in Cypress, California, and the Good Samaritan Hospital Sleep Disorders Center in Los Angeles, California. xi

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