Restless Leg Syndrome
Definition: also known as Wittmaack-Ekbom's syndrome, and colloquially as "the jimmylegs" is a condition that is characterized by an irresistible urge to move one's body to stop uncomfortable or odd sensations. Restless Legs Syndrome is best described as a neurological sensory-motor disorder characterized by four essential diagnostic criteria:
Patients report an irresistible leg movement that is often accompanied by creeping sensations deep in the limbs. The symptoms of RLS are not confined to the legs, but can also occur in the upper limbs. The majority of symptoms of RLS occur in the evening and at night. Lying down in bed is associated with increased paresthesia and an irresistible urge to move, often accompanied by periodic limb movements which interfere with sleep onset and with consolidation of sleep.
Restless Legs Syndrome is one of the most frequent neurological diseases, with an estimated prevalence of 7% to 11% of the general population.
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Why RLS and PLMs May Get Worse With Treatment
"Rebound and Augmentation in RLS: Reports in the literature indicate treatment of RLS with dopaminergic medications can result in a shifting of symptoms to the early morning hours, referred to as rebound. Rebound was not reported in the clinical trials of MIRAPEX tablets but the trials were generally not of sufficient duration to capture this phenomenon. Augmentation has also been described during therapy for RLS. Augmentation refers to the earlier onset of symptoms in the evening (or even the afternoon), increase in symptoms, and spread of symptoms to involve other extremities. In a controlled trial of MIRAPEX tablets for RLS, approximately 20% of both the MIRAPEX- and placebo-treated patients reported at least a 2-hour earlier onset of symptoms during the day by the end of 3 months of treatment. The frequency and severity of augmentation and/or rebound after longer-term use of MIRAPEX tablets and the appropriate management of these events have not been adequately evaluated in controlled clinical trials." (Mirapex package insert)
No evidence of augmentation with routine treatment in a 6-month, multicenter, double blind, placebo-controlled RLS trial W.A. Hening, R. Allen, J.W. Winkelman, E. Schollmayer (Piscataway, NJ)
European Medicines Agency Restless Leg Syndrome Resport
Anne-Marie Williams and Diego Garcia-Borreguero Current Treatment Options in Neurology 2009, 11(5):327–332 Management of restless legs syndrome augmentation
Sources
Johns Hopkins Powerpoint Presentation
Treatment of Restless Legs Syndrome: An Evidence-Based Review and Implications for Clinical Practice