Neurologic movement disorder characterized by an
unpleasant sensation in the lower extremities, eliciting intolerable
restlessness with twitching and jumping of the legs when the patient is at
rest, especially at night.
Restless Legs Syndrome; Acromelalgia-Painful Legs-Moving
Toes Syndrome; Anxietas Tibialis Syndrome; Asthenia Crurum Dolorosa;
Asthenia Crurum Paresthetica Syndrome; Ekbom Syndrome; Leg Jitters Syndrome;
Moving Toe Syndrome; Painful Leg Syndrome, Wittmaack-Ekbom Sequence.
First described by the English anatomist Thomas Willis in
1672, then by Theodor Wittmaack, a German clinician, in 1861. Restless legs
syndrome may occur as a primary condition (idiopathic) or may be a result of
other conditions (secondary or symptomatic restless legs syndrome).
Prevalence is evaluated at 5.5% of the general
population, with a female predominance. Prevalence increases with age.
The disorder is usually familial and inherited
as an autosomal dominant trait. Candidate gene map locus is 12-q21.
Unknown. Idiopathic myoclonic jerks occur just
prior to sleep and severely affect it. However, it disappears with the onset
of stage 1 REM (rapid eye movement) sleep. It is associated with a variety of conditions, including
iron deficiency, folic acid anemia, B vitamin deficiency, drug intake
(phenothiazine), barbiturate withdrawal, diabetes, renal insufficiency,
neuropathy, stroke, and chronic respiratory illness. It is common during
pregnancy and is precipitated by fatigue, anxiety, and stress.
History of repeated, asymmetric flexion jerks of the
legs occurring at night just before and interfering with sleep.
Acromelalgia, myoclonus, and paresthesia are characteristic.
Symptoms worsen with age. Hereditary acromelalgia
is a lifelong condition with no cure. Opioids are effective for relieving
pain, and correction of iron deficiency may improve symptoms for some
patients. Sleep deprivation may become severe with increasing age.
Check usual medication (affected
patients often take either neuroleptic and/or sedative medications).
Ensure that regular medications are continued until the morning of surgery.
Check red blood cell count and evaluate for iron deficiency.
No specific considerations with this
None reported. Most affected patients
take medications such as temazepam, levodopa/carbidopa, bromocriptine,
pergolide mesylate, oxycodone, propoxyphene, and codeine, which are
effective in relieving symptoms but may interfere with anesthetic techniques
and requirements for postoperative pain relief.
Erythromelalgia: Characterized by repeated episodes of paroxysmal
vasodilation with burning pain in the hands and feet. Diminished sensitivity
to temperature changes, especially with cold acting as pain depressor and
heat as stimulator. Affects middle-aged patients of both sexes. Unknown
etiology but may occasionally be inherited as an autosomal dominant trait.
Odin P, Mrowka M, Shing M: Restless legs syndrome. Eur J Neurol 9(suppl 3):59, 2002.
Ohayon MM, Roth T: Prevalence of restless legs syndrome and periodic limb
movement disorder in the general population. J Psychosom Res
Stiasny K, Oertel WH, Trenkwalder C: Clinical symptomatology and treatment
of restless legs syndrome and periodic limb ...