REVIEWS  SLEEP DISORDERS 

Minerva Pneumologica 2009 December;48(4):331-43

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Overview of restless legs sindrome and periodic limb movements

Manconi M.

Department of Neuroscience, Sleep Disorders Center, San Raffaele Scientific Institute, Milan, Italy

The restless legs syndrome (RLS) is a sleep-related movement disorder characterized by a disagreeable sensation in the limbs which worsens at night and in rest condition and is improved by movement. The majority of patients with RLS present periodic limb movements (PLM), insomnia and a good response to the dopamine-agonists compounds. The natural course of RLS is generally chronic with only sporadic and irregular periods of remission. In idiopathic cases the neurological examination is unremarkable and often a positive family history is reported. Standard diagnostic criteria for the clinical diagnosis of RLS and for the polysomnographic scoring of PLM, as well as specific tools to quantify the RLS severity are available. Several conditions, such as iron deficiency, renal failure, pregnancy, rheumatoid arthritis, antidopa-minergic medications and neurological disorders, may induce symptomatic forms of the syndrome. RLS is a common and often underdiagnosed disorder, with a prevalence around 5-10% in the general population. Although the pathogenesis of RLS/PLM is still unknown, there are pieces of evidence which support a dysfunction of the descending hypothalamic inhibitory dopaminergic pathways to the spinal cord. For their tolerability, safety, half-life and efficacy, which is evident immediately and also at low dosages, the nonergot derivate dopamine-agonists represent the first choice treatment in RLS. Iron, benzodiazepines and antiepileptic drugs are also available as a second line or combined treatment.