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Praktische Diagnostik und Therapie des Restless-legs-Syndroms

Practical guidelines for diagnosis and therapy of restless legs syndrome

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Zusammenfassung

Das Restless-legs-Syndrom (RLS) ist die häufigste neurologische Schlaferkrankung und betrifft etwa 10 % der kaukasischen Bevölkerung. Die Erkrankung ist durch schmerzhafte Missempfindungen der Beine gekennzeichnet, die insbesondere am Abend und in der Nacht sowie bei Inaktivität auftreten, mit daraus resultierendem Bewegungsdrang und Schlafstörungen. Als Folge kommt es zu einer deutlichen Beeinträchtigung im Alltag sowie Minderung der Lebensqualität bei den Betroffenen. Adäquate Therapien stehen insbesondere mit dopaminergen und bisher nicht zugelassenen opioidergen und antikonvulsiven Substanzen zur Verfügung. Voraussetzung hierfür ist jedoch, dass die entsprechenden Patienten identifiziert und einer Therapie zugeführt werden, was v. a. im ambulanten Sektor häufig nicht der Fall ist. Mögliche Gründe für die erschwerte Diagnostik sind der noch nicht ausreichende Bekanntheitsgrad der Erkrankung, die häufige Überlappung mit Komorbiditäten sowie eine Imitation durch andere Erkrankungen, sog. „RLS mimics“. Ziel der vorliegenden Arbeit ist es daher, konkrete Anleitungen bei der Diagnosestellung und Therapie des RLS zur Verfügung zu stellen.

Summary

Restless legs syndrome (RLS) is the most common neurological sleep disorder affecting 10 % of the Caucasian population. The disorder is characterized by painful sensations in the lower limbs, especially during the evening, at night and during rest, resulting in an urge to move the legs and insomnia. As a result the quality of life is significantly reduced. Dopaminergic agents, opioids and anticonvulsants have proven to be effective for RLS with only the former being currently licensed; however, affected patients have to be identified, which is not always the case, especially in outpatient settings. Possible impediments to the adequate management of patients with RLS may include a lack of awareness, comorbidities and other medical conditions mimicking RLS. To overcome some of these difficulties practical guidelines for the diagnosis and therapy of RLS are provided.

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Literatur

  1. Allen R, Chen C, Soaita A et al (2010) A randomized, double-blind, 6-week, dose-ranging study of pregabalin in patients with restless legs syndrome. Sleep Med 11:512–519

    Article  PubMed  Google Scholar 

  2. Allen RP, Adler CH, Du W et al (2011) Clinical efficacy and safety of IV ferric carboxymaltose (FCM) treatment of RLS: a multi-centred, placebo-controlled preliminary clinical trial. Sleep Med 12:906–913

    Article  PubMed  Google Scholar 

  3. Allen RP, Barker PB, Horska A, Earley CJ (2013) Thalamic glutamate/glutamine in restless legs syndrome: increased and related to disturbed sleep. Neurology 80:2028–2034

    Article  CAS  PubMed  Google Scholar 

  4. Allen RP, Picchietti D, Hening WA et al (2003) Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med 4:101–119

    Article  PubMed  Google Scholar 

  5. Benes H, Garcia-Borreguero D, Ferini-Strambi L et al (2012) Augmentation in the treatment of restless legs syndrome with transdermal rotigotine. Sleep Med 13:589–597

    Article  PubMed  Google Scholar 

  6. Benes H, Kohnen R (2009) Validation of an algorithm for the diagnosis of Restless Legs Syndrome: the Restless Legs Syndrome-Diagnostic Index (RLS-DI). Sleep Med 10:515–523

    Article  PubMed  Google Scholar 

  7. Berger K, Kurth T (2007) RLS epidemiology – frequencies, risk factors and methods in population studies. Mov Disord 22(Suppl 18):S420–S423

    Article  PubMed  Google Scholar 

  8. Berger K, Eckardstein A von, Trenkwalder C et al (2002) Iron metabolism and the risk of restless legs syndrome in an elderly general population – the MEMO-Study. J Neurol 249:1195–1199

    Article  CAS  PubMed  Google Scholar 

  9. Chabli A, Michaud M, Montplaisir J (2000) Periodic arm movements in patients with the restless legs syndrome. Eur Neurol 44:133–138

    Article  CAS  PubMed  Google Scholar 

  10. Collado-Seidel V, Kohnen R, Samtleben W et al (1998) Clinical and biochemical findings in uremic patients with and without restless. Am J Kidney Dis 31:324–328

    Article  CAS  PubMed  Google Scholar 

  11. Connor JR, Boyer PJ, Menzies SL et al (2003) Neuropathological examination suggests impaired brain iron acquisition in restless legs syndrome. Neurology 61:304–309

    Article  CAS  PubMed  Google Scholar 

  12. Cuellar NG (2012) The psychopharmacological management of RLS in psychiatric conditions: a review of the literature. J Am Psychiatr Nurses Assoc 18:214–225

    Article  PubMed  Google Scholar 

  13. DeAndrade MP, Johnson RL Jr, Unger EL et al (2012) Motor restlessness, sleep disturbances, thermal sensory alterations and elevated serum iron levels in Btbd9 mutant mice. Hum Mol Genet 21:3984–3992

    Article  CAS  PubMed  Google Scholar 

  14. Eisensehr I, Wetter TC, Linke R et al (2001) Normal IPT and IBZM SPECT in drug-naive and levodopa-treated idiopathic restless legs syndrome. Neurology 57:1307–1309

    Article  CAS  PubMed  Google Scholar 

  15. Ferini-Strambi L, Walters AS, Sica D (2013) The relationship among restless legs syndrome (Willis-Ekbom Disease), hypertension, cardiovascular disease, and cerebrovascular disease. J Neurol

  16. Garcia-Borreguero D, Hogl B, Ferini-Strambi L et al (2012) Systematic evaluation of augmentation during treatment with ropinirole in restless legs syndrome (Willis-Ekbom disease): results from a prospective, multicenter study over 66 weeks. Mov Disord 27:277–283

    Article  CAS  PubMed  Google Scholar 

  17. Garcia-Borreguero D, Kohnen R, Hogl B et al (2007) Validation of the Augmentation Severity Rating Scale (ASRS): a multicentric, prospective study with levodopa on restless legs syndrome. Sleep Med 8:455–463

    Article  PubMed  Google Scholar 

  18. Garcia-Borreguero D, Kohnen R, Silber MH et al (2013) The long-term treatment of restless legs syndrome/Willis-Ekbom disease: evidence-based guidelines and clinical consensus best practice guidance: a report from the International Restless Legs Syndrome Study Group. Sleep Med 14:675–684

    Article  PubMed  Google Scholar 

  19. Garcia-Borreguero D, Larrosa O, Llave Y de la et al (2002) Treatment of restless legs syndrome with gabapentin: a double-blind, cross-over study. Neurology 59:1573–1579

    Article  CAS  PubMed  Google Scholar 

  20. Grote L, Leissner L, Hedner J, Ulfberg J (2009) A randomized, double-blind, placebo controlled, multi-center study of intravenous iron sucrose and placebo in the treatment of restless legs syndrome. Mov Disord 24:1445–1452

    Article  PubMed  Google Scholar 

  21. Happe S, Vennemann M, Evers S, Berger K (2008) Treatment wish of individuals with known and unknown restless legs syndrome in. J Neurol 255:1365–1371

    Article  PubMed  Google Scholar 

  22. Hattan E, Chalk C, Postuma RB (2009) Is there a higher risk of restless legs syndrome in peripheral neuropathy? Neurology 72:955–960

    Article  PubMed  Google Scholar 

  23. Hening WA, Allen RP, Ondo WG et al (2010) Rotigotine improves restless legs syndrome: a 6-month randomized, double-blind, placebo-controlled trial in the United States. Mov Disord 25:1675–1683

    Article  PubMed  Google Scholar 

  24. Hening WA, Allen RP, Washburn M et al (2009) The four diagnostic criteria for Restless Legs Syndrome are unable to exclude. Sleep Med 10:976–981

    Article  PubMed Central  PubMed  Google Scholar 

  25. Hening WA, Walters AS, Wagner M et al (1999) Circadian rhythm of motor restlessness and sensory symptoms in the idiopathic restless legs syndrome. Sleep 22:901–912

    CAS  PubMed  Google Scholar 

  26. Hogl B, Garcia-Borreguero D, Kohnen R et al (2010) Progressive development of augmentation during long-term treatment with levodopa in restless legs syndrome: results of a prospective multi-center study. J Neurol 257:230–237

    Article  PubMed Central  PubMed  Google Scholar 

  27. Hogl B, Garcia-Borreguero D, Trenkwalder C et al (2011) Efficacy and augmentation during 6 months of double-blind pramipexole for restless legs syndrome. Sleep Med 12:351–360

    Article  PubMed  Google Scholar 

  28. Kavanagh D, Siddiqui S, Geddes CC (2004) Restless legs syndrome in patients on dialysis. Am J Kidney Dis 43:763–771

    Article  PubMed  Google Scholar 

  29. Manconi M, Govoni V, De Vito A et al (2004) Restless legs syndrome and pregnancy. Neurology 63:1065–1069

    Article  CAS  PubMed  Google Scholar 

  30. Michaud M, Soucy JP, Chabli A et al (2002) SPECT imaging of striatal pre- and postsynaptic dopaminergic status in restless legs syndrome with periodic leg movements in sleep. J Neurol 249:164–170

    Article  PubMed  Google Scholar 

  31. Montplaisir J, Boucher S, Nicolas A et al (1998) Immobilization tests and periodic leg movements in sleep for the diagnosis of restless leg syndrome. Mov Disord 13:324–329

    Article  CAS  PubMed  Google Scholar 

  32. Oertel W, Trenkwalder C, Benes H et al (2011) Long-term safety and efficacy of rotigotine transdermal patch for moderate-to-severe idiopathic restless legs syndrome: a 5-year open-label extension study. Lancet Neurol 10:710–720

    Article  CAS  PubMed  Google Scholar 

  33. Oertel WH, Trenkwalder C, Zucconi M et al (2007) State of the art in restless legs syndrome therapy: practice recommendations for treating restless legs syndrome. Mov Disord 22(Suppl 18):S466–S475

    Article  PubMed  Google Scholar 

  34. Patton SM, Ponnuru P, Snyder AM et al (2011) Hypoxia-inducible factor pathway activation in restless legs syndrome patients. Eur J Neurol 18:1329–1335

    Article  CAS  PubMed  Google Scholar 

  35. Paulus W, Trenkwalder C (2006) Less is more: pathophysiology of dopaminergic-therapy-related augmentation in restless legs syndrome. Lancet Neurol 5:878–886

    Article  CAS  PubMed  Google Scholar 

  36. Schattschneider J, Bode A, Wasner G et al (2004) Idiopathic restless legs syndrome: abnormalities in central somatosensory processing. J Neurol 251:977–982

    Article  PubMed  Google Scholar 

  37. Schmidauer C, Sojer M, Seppi K et al (2005) Transcranial ultrasound shows nigral hypoechogenicity in restless legs syndrome. Ann Neurol 58:630–634

    Article  PubMed  Google Scholar 

  38. Schormair B, Kemlink D, Roeske D et al (2008) PTPRD (protein tyrosine phosphatase receptor type delta) is associated with restless legs syndrome. Nat Genet 40:946–948

    Article  CAS  PubMed  Google Scholar 

  39. Silver N, Allen RP, Senerth J, Earley CJ (2011) A 10-year, longitudinal assessment of dopamine agonists and methadone in the treatment of restless legs syndrome. Sleep Med 12:440–444

    Article  PubMed  Google Scholar 

  40. Stefansson H, Rye DB, Hicks A et al (2007) A genetic risk factor for periodic limb movements in sleep. N Engl J Med 357:639–647

    Article  CAS  PubMed  Google Scholar 

  41. Stiasny-Kolster K, Kohnen R, Moller JC et al (2006) Validation of the „L-DOPA test“ for diagnosis of restless legs syndrome. Mov Disord 21:1333–1339

    Article  PubMed  Google Scholar 

  42. Stiasny-Kolster K, Pfau DB, Oertel WH et al (2013) Hyperalgesia and functional sensory loss in restless legs syndrome. Pain 154:1457–1463

    Article  PubMed  Google Scholar 

  43. Sun ER, Chen CA, Ho G et al (1998) Iron and the restless legs syndrome. Sleep 21:371–377

    CAS  PubMed  Google Scholar 

  44. Szentkiralyi A, Volzke H, Hoffmann W et al (2013) The relationship between depressive symptoms and restless legs syndrome in two prospective cohort studies. Psychosom Med 75:359–365

    Article  PubMed  Google Scholar 

  45. Trenkwalder C, Benes H, Buschmann H et al (2012) S1-Leitlinie für Diagnostik und Therapie in der Neurologie Restless-Legs-Syndrom (RLS) und Periodic Limb Movement Disorders (PLMD). In: Diener H-C (Hrsg) Leitlinien für Diagnostik und Therapie in der Neurologie. Thieme, Stuttgart

  46. Trenkwalder C, Benes H, Grote L et al (2013) Oxycodone/Naloxone PR for efficient treatment of severe RLS after failure of previous medications – a double-blind, randomized, placebo-controlled study with open-label extension. Lancet Neurol (im Druck)

  47. Trenkwalder C, Benes H, Grote L et al (2007) Cabergoline compared to levodopa in the treatment of patients with severe restless legs syndrome: results from a multi-center, randomized, active controlled trial. Mov Disord 22:696–703

    Article  PubMed  Google Scholar 

  48. Trenkwalder C, Benes H, Poewe W et al (2008) Efficacy of rotigotine for treatment of moderate-to-severe restless legs syndrome: a randomised, double-blind, placebo-controlled trial. Lancet Neurol 7:595–604

    Article  CAS  PubMed  Google Scholar 

  49. Trenkwalder C, Collado Seidel V, Kazenwadel J et al (2003) One-year treatment with standard and sustained-release levodopa: appropriate long-term treatment of restless legs syndrome? Mov Disord 18:1184–1189

    Article  PubMed  Google Scholar 

  50. Trenkwalder C, Hening WA, Montagna P et al (2008) Treatment of restless legs syndrome: an evidence-based review and implications for clinical practice. Mov Disord 23:2267–2302

    Article  PubMed  Google Scholar 

  51. Trenkwalder C, Hening WA, Walters AS et al (1999) Circadian rhythm of periodic limb movements and sensory symptoms of restless legs syndrome. Mov Disord 14:102–110

    Article  CAS  PubMed  Google Scholar 

  52. Trenkwalder C, Hundemer HP, Lledo A et al (2004) Efficacy of pergolide in treatment of restless legs syndrome: the PEARLS Study. Neurology 62:1391–1397

    Article  CAS  PubMed  Google Scholar 

  53. Trenkwalder C, Kohnen R, Allen RP et al (2007) Clinical trials in restless legs syndrome – recommendations of the European RLS. Mov Disord 22(Suppl 18):S495–S504

    PubMed  Google Scholar 

  54. Vadasz D, Ries V, Oertel WH (2013) Intravenous iron sucrose for restless legs syndrome in pregnant women with low serum ferritin. Sleep Med 14(11):1214–1216

    Article  PubMed  Google Scholar 

  55. Voon V, Schoerling A, Wenzel S et al (2011) Frequency of impulse control behaviours associated with dopaminergic therapy in restless legs syndrome. BMC Neurol 11:117

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  56. Walters AS, Hickey K, Maltzman J et al (1996) A questionnaire study of 138 patients with restless legs syndrome: the ‚Night-Walkers‘ survey. Neurology 46:92–95

    Article  CAS  PubMed  Google Scholar 

  57. Wetter TC, Eisensehr I, Trenkwalder C (2004) Functional neuroimaging studies in restless legs syndrome. Sleep Med 5:401–406

    Article  PubMed  Google Scholar 

  58. Winkelmann J, Czamara D, Schormair B et al (2011) Genome-wide association study identifies novel restless legs syndrome susceptibility loci on 2p14 and 16q12.1. PLoS Genet 7:e1002171

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  59. Winkelmann J, Schormair B, Lichtner P et al (2007) Genome-wide association study of restless legs syndrome identifies common. Nat Genet 39:1000–1006

    Article  CAS  PubMed  Google Scholar 

  60. Winkelmann J, Wetter TC, Collado-Seidel V et al (2000) Clinical characteristics and frequency of the hereditary restless legs syndrome in a population of 300 patients. Sleep 23:597–602

    CAS  PubMed  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Krenzer gibt an, dass in der Vergangenheit eine Förderung durch Boehringer Ingelheim (BIF MD Fellowship) bestand. W.H. Oertel gibt an, im Besitz von Aktien (Roche) und beratend für Desitin, Proteosys, Novartis und Orion Pharma tätig zu sein. Er ist im Beratungsausschuss bei Bayer-Schering, Bioprojet, Boehringer Ingelheim, Merck-Serono, Mundipharma, Novartis, Orion Pharma, Schwarz Pharma Neuroscience/(UCB), Teva tätig und erhielt Honorare von Boehringer Ingelheim, Desitin, GlaxoSmithKline, Novartis, Orion Pharma, Schwarz Pharma Neuroscience/(UCB) und Teva. Weiterhin besteht finanzielle Förderung durch die Deutsche Forschungsgemeinschaft (DFG). C. Trenkwalder gibt an, dass Interessenkonflikte bez. der vorliegenden Arbeit Vifor, UCB, Mundipharma und Boehringer Ingelheim betreffen.

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Authors and Affiliations

  1. Klinik für Neurologie, Philipps-Universität Marburg, Marburg, Deutschland

    M. Krenzer & W. Oertel

  2. Paracelsus-Elena-Klinik Kassel, Klinikstr. 16, 34128, Kassel, Deutschland

    C. Trenkwalder

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  1. M. Krenzer
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  2. W. Oertel
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  3. C. Trenkwalder
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Correspondence to C. Trenkwalder.

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Krenzer, M., Oertel, W. & Trenkwalder, C. Praktische Diagnostik und Therapie des Restless-legs-Syndroms. Nervenarzt 85, 9–18 (2014). https://doi.org/10.1007/s00115-013-3888-3

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