Clinical Care- Restless Leg Syndrome Flashcards
what is an uncomfortable “creeping, crawling”, “pins and needles feeling” especially in the legs that tends to occur during periods of inactivity, particularly in evenings?
Restless Leg Syndrome
What are some CNS abnormalities that are associated with RLS?
reduced iron stores
alteration in dopaminergic systems
circadian physiology
NT imbalance of glutamate an GABA
PNS abnormalities associated with RLS?
static hyperalgesia (response to pinprick pain ratings were significantly elevated)
common sensations that RLS can be described as:
(a) Urge to move
(b) Crawling
(c) Tingling
(d) Restless
(e) Cramping
(f) Creeping
(g) Pulling
(h) Electric
(i) Soreness
Sensations are described as deep rather than superficial
exacerbating sx of RLS
Antihistamines (diphenhydramine or hydroxyzine)
Dopamine receptor antagonists (example: anti nausea medication like metoclopramide)
Antidepressants like SSRIs and SNRIs
DDX of RLS
Volitional movements
Akathisia: Intense desire to move
Nocturnal leg cramps
Diagnosis of RLS
Iron studies should be considered in evaluation
a) Urge to move legs usually accompanied or caused by unpleasant sensation in legs
(b) Unpleasant sensations worsen during periods of rest or inactivity such as lying or sitting
(c) Unpleasant sensations are partially or totally relieved by movement
(d) Symptoms are worse during the evening or night
(e) Symptoms are not solely accountable for other medical or behavioral condition
Pharmacological TX of RLS
Low iron: Start treatment if serum ferritin level is low.
a) Ferrous sulfate - iron supplement. Dose: 325 mg three times daily for 3-6 months, is the preferred therapy
DO A FOLLOW UP.
Non-pharmacologic treatment of RLS
1) Avoidance of aggravating drugs and substances like caffeine
2) Increase exercise
3) Leg massage
What should be done with refractory RLS?
Refractory RLS may need referral to MO.
