Restless Legs Syndrome

#The Neurology
Question: True & False: Restless Legs Syndrome

1. Symptoms start with sleep
2. Dystonia and myoclonus
3. Symptoms aggravate with dopaminergic agonist
4. Normal Brain MRI
5. Sensory symptoms on awakening

(Source: The Neurology: Self-Assessment & Review By Dr. Sunil Kumar, www.theneurology.org)

Reference: Picchietti DL, Stevens HE. Early manifestations of restless legs syndrome in childhood and adolescence. Sleep Med. 2008;9(7):770-781.

Restless legs syndrome affects approximately 10% of the adult population.

Clinical Features

The four core symptoms required for diagnosis are as follows:

1. An urge to move the legs: usually caused or accompanied by an unpleasant sensation in the legs
2. Symptoms begin or worsen with rest
3. Partial or complete relief by movement
4. Worsening during the evening or night

Symptoms most commonly begin in the legs, but can spread to or even begin in the upper limbs. The unpleasant sensation is often described as a creepy-crawly feeling, paresthesia, or burning. In about 80% of patients, RLS is associated with periodic leg movements (PLMs) during sleep and occasionally while awake. These involuntary movements are usually brief, lasting no more than a few seconds, and recur every 5–90 seconds. The restlessness and PLMs are a major cause of sleep disturbance in patients, leading to poor-quality sleep and daytime sleepiness. Dopamine agonists relieve symptoms of restless legs syndrome.

[Answers are: 1. Symptoms start with sleep-True; 2. Dystonia and myoclonus-True; 3. Symptoms aggravate with dopaminergic agonist-False; 4. Normal Brain MRI-True; 5. Sensory symptoms on awakening-False]