A survey-based approach on restless legs syndrome: practices and perspectives among Italian neurologists.
Education
Neurologists
Restless legs syndrome
Sensorimotor disorder
Survey
Journal
Journal of neurology
ISSN: 1432-1459
Titre abrégé: J Neurol
Pays: Germany
ID NLM: 0423161
Informations de publication
Date de publication:
12 Apr 2024
12 Apr 2024
Historique:
received:
19
02
2024
accepted:
26
03
2024
revised:
25
03
2024
medline:
12
4
2024
pubmed:
12
4
2024
entrez:
12
4
2024
Statut:
aheadofprint
Résumé
Restless Legs Syndrome (RLS) is a widely prevalent and complex neurological disorder. Despite notable advancements in managing RLS, the disorder continues to face challenges related to its recognition and management. This study seeks to gain comprehensive insights into the knowledge and clinical practices among Italian neurologists regarding RLS diagnosis, management, and treatment, comparing approaches among general neurologists, movement disorder specialists, and sleep experts. Members of the Italian Society of Neurology, the Italian Society of Parkinson and Movement Disorders, and the Italian Association of Sleep Medicine were invited to participate in a 19-question online survey. Among the 343 surveyed neurologists, 60% categorized RLS as a "sleep-related movement disorder." Forty% indicated managing 5-15 RLS patients annually, with sleep specialists handling the highest patient volume. Of note, only 34% adhered strictly to all five essential diagnostic criteria. The majority (69%) favored low-dosage dopamine agonists as their first-line treatment, with movement disorder specialists predominantly endorsing this approach, while sleep experts preferred iron supplementation. Regular screening for iron levels was widespread (91%), with supplementation typically guided by serum iron alterations. In cases of ineffective initial treatments, escalating dopamine agonist dosage was the preferred strategy (40%). These findings underscore a lack of a clear conceptualization of RLS, with a widespread misconception of the disorder as solely a movement disorder significantly influencing treatment approaches. Disparities in RLS understanding across neurology subspecialties underscore the necessity for improved diagnostic accuracy, targeted educational initiatives, and management guidelines to ensure consistent and effective RLS management.
Identifiants
pubmed: 38607430
doi: 10.1007/s00415-024-12356-7
pii: 10.1007/s00415-024-12356-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Allen RP, Picchietti DL, Garcia-Borreguero D, Ondo WG, Walters AS, Winkelman JW, Zucconi M, Ferri R, Trenkwalder C, Lee HB, International Restless Legs Syndrome Study Group (2014) Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated international restless legs syndrome study group (IRLSSG) consensus criteria—history, rationale, description, and significance. Sleep Med 15(8):860–873. https://doi.org/10.1016/j.sleep.2014.03.025
doi: 10.1016/j.sleep.2014.03.025
pubmed: 25023924
Silva GE, Goodwin JL, Vana KD, Vasquez MM, Wilcox PG, Quan SF (2014) Restless legs syndrome, sleep, and quality of life among adolescents and young adults. J Clin Sleep Med 10(7):779–786. https://doi.org/10.5664/jcsm.3872
doi: 10.5664/jcsm.3872
pubmed: 25024656
pmcid: 4067442
Chenini S, Barateau L, Guiraud L, Denis C, Rassu AL, Lopez R, Jaussent I, Dauvilliers Y (2022) Depressive symptoms and suicidal thoughts in restless legs syndrome. Mov Disord 37(4):812–825. https://doi.org/10.1002/mds.28903
doi: 10.1002/mds.28903
pubmed: 34985142
Wang S, Zheng X, Huang J, Lin J, Yang T, Xiao Y, Jiang Q, Li C, Shang H (2023) Restless legs syndrome and cognitive function among adults: a systematic review and meta-analysis. J Neurol 270(3):1361–1370. https://doi.org/10.1007/s00415-022-11484-2
doi: 10.1007/s00415-022-11484-2
pubmed: 36472687
Picchietti DL, Van Den Eeden SK, Inoue Y, Berger K (2017) Achievements, challenges, and future perspectives of epidemiologic research in restless legs syndrome (RLS). Sleep Med 31:3–9. https://doi.org/10.1016/j.sleep.2016.06.007
doi: 10.1016/j.sleep.2016.06.007
pubmed: 27567163
Whittom S, Dauvilliers Y, Pennestri MH, Vercauteren F, Molinari N, Petit D, Montplaisir J (2007) Age-at-onset in restless legs syndrome: a clinical and polysomnographic study. Sleep Med 9(1):54–59. https://doi.org/10.1016/j.sleep.2007.01.017
doi: 10.1016/j.sleep.2007.01.017
pubmed: 17644418
Manconi M, Ulfberg J, Berger K, Ghorayeb I, Wesström J, Fulda S, Allen RP, Pollmächer T (2012) When gender matters: restless legs syndrome. Report of the “RLS and woman” workshop endorsed by the European RLS study group. Sleep Med Rev 16(4):297–307. https://doi.org/10.1016/j.smrv.2011.08.006
doi: 10.1016/j.smrv.2011.08.006
pubmed: 22075215
Gupta R, Dhyani M, Kendzerska T, Pandi-Perumal SR, BaHammam AS, Srivanitchapoom P, Pandey S, Hallett M (2016) Restless legs syndrome and pregnancy: prevalence, possible pathophysiological mechanisms and treatment. Acta Neurol Scand 133(5):320–329. https://doi.org/10.1111/ane.12520
doi: 10.1111/ane.12520
pubmed: 26482928
Trenkwalder C, Allen R, Högl B, Paulus W, Winkelmann J (2016) Restless legs syndrome associated with major diseases: a systematic review and new concept. Neurology 86:1336–1343. https://doi.org/10.1212/WNL.0000000000002542
doi: 10.1212/WNL.0000000000002542
pubmed: 26944272
pmcid: 4826337
Silber MH, Buchfuhrer MJ, Earley CJ, Koo BB, Manconi M, Winkelman JW, Scientific and Medical Advisory Board of the Restless Legs Syndrome Foundation (2021) The management of restless legs syndrome: an updated algorithm. Mayo Clin Proc 96(7):1921–1937. https://doi.org/10.1016/j.mayocp.2020.12.026
doi: 10.1016/j.mayocp.2020.12.026
pubmed: 34218864
Manconi M, Garcia-Borreguero D, Schormair B, Videnovic A, Berger K, Ferri R, Dauvilliers Y (2021) Restless legs syndrome. Nat Rev Dis Primers 7(1):80. https://doi.org/10.1038/s41572-021-00311-z
doi: 10.1038/s41572-021-00311-z
pubmed: 34732752
Koo BB, Bagai K, Walters AS (2016) Restless legs syndrome: current concepts about disease pathophysiology. Tremor Other Hyperkinet Mov (N Y) 6:401. https://doi.org/10.7916/D83J3D2G
doi: 10.7916/D83J3D2G
pubmed: 27536462
Khan FH, Ahlberg CD, Chow CA, Shah DR, Koo BB (2017) Iron, dopamine, genetics, and hormones in the pathophysiology of restless legs syndrome. J Neurol 264(8):1634–1641. https://doi.org/10.1007/s00415-017-8431-1
doi: 10.1007/s00415-017-8431-1
pubmed: 28236139
Lanza G, DelRosso LM, Ferri R (2022) Sleep and homeostatic control of plasticity. Handb Clin Neurol 184:53–72. https://doi.org/10.1016/B978-0-12-819410-2.00004-7
doi: 10.1016/B978-0-12-819410-2.00004-7
pubmed: 35034758
Earley CJ, Connor J, Garcia-Borreguero D, Jenner P, Winkelman J, Zee PC, Allen R (2014) Altered brain iron homeostasis and dopaminergic function in restless legs syndrome (Willis-Ekbom disease). Sleep Med 15(11):1288–1301. https://doi.org/10.1016/j.sleep.2014.05.009
doi: 10.1016/j.sleep.2014.05.009
pubmed: 25201131
Trenkwalder C, Tinelli M, Sakkas GK, Dauvilliers Y, Ferri R, Rijsman R, Oertel W, Jaarsma J (2021) Socioeconomic impact of restless legs syndrome and inadequate restless legs syndrome management across European settings. Eur J Neurol 28(2):691–706. https://doi.org/10.1111/ene.14582
doi: 10.1111/ene.14582
pubmed: 33043569
Wijemanne S, Ondo W (2017) Restless legs syndrome: clinical features, diagnosis and a practical approach to management. Pract Neurol 17(6):444–452. https://doi.org/10.1136/practneurol-2017-001762
doi: 10.1136/practneurol-2017-001762
pubmed: 29097554
Shin JW, Lee JH, Kim H, Lee DH, Baek KH, Sunwoo JS, Byun JI, Kim TJ, Jun JS, Han D, Jung KY (2020) Bioinformatic analysis of proteomic data for iron, inflammation, and hypoxic pathways in restless legs syndrome. Sleep Med 75:448–455. https://doi.org/10.1016/j.sleep.2020.09.002
doi: 10.1016/j.sleep.2020.09.002
pubmed: 32992101
Mondello S, Kobeissy FH, Mechref Y, Zhao J, El Hayek S, Zibara K, Moresco M, Plazzi G, Cosentino FII, Ferri R (2021) Searching for novel candidate biomarkers of RLS in blood by proteomic analysis. Nat Sci Sleep 13:873–883. https://doi.org/10.2147/NSS.S311801
doi: 10.2147/NSS.S311801
pubmed: 34234594
pmcid: 8243594
Raja P, Srijithesh PR, Mythirayee S, Yadav R (2022) Clinicians heuristic impression of the presentations of restless legs syndrome: a survey among medical graduate trainees in an academic hospital in India. Ann Indian Acad Neurol 25(3):507–510. https://doi.org/10.4103/aian.aian_655_21
doi: 10.4103/aian.aian_655_21
pubmed: 35936589
pmcid: 9350808
Antelmi E, Rocchi L, Latorre A, Belvisi D, Magrinelli F, Bhatia KP, Tinazzi M (2022) Restless legs syndrome: known knowns and known unknowns. Brain Sci 12(1):118. https://doi.org/10.3390/brainsci12010118
doi: 10.3390/brainsci12010118
pubmed: 35053861
pmcid: 8773543
Antelmi E, Mogavero MP, Lanza G, Cartella SM, Ferini-Strambi L, Plazzi G, Ferri R, Tinazzi M (2024, under revision) Sensory aspects of restless legs syndrome: clinical, neurophysiological and neuroimaging perspectives. Sleep Med Rev
Eysenbach G (2004) Improving the quality of web surveys: the checklist for reporting results of internet e-surveys (CHERRIES). J Med Internet Res 6:e34. https://doi.org/10.2196/jmir.6.3.e34
doi: 10.2196/jmir.6.3.e34
pubmed: 15471760
pmcid: 1550605
American Academy of Sleep Medicine (2023) International classification of sleep disorders, 3rd ed, text revision. Darien, IL.
Dafkin C, McKinon W, Kerr S (2019) Restless legs syndrome: clinical changes in nervous system excitability at the spinal cord level. Sleep Med Rev 47:9–17. https://doi.org/10.1016/j.smrv.2019.05.005
doi: 10.1016/j.smrv.2019.05.005
pubmed: 31212170
Antelmi E, Squintani GM, Sandri A, Lippolis M, Segatti A, Tinazzi M (2023) Defect of the endogenous inhibitory pain system in idiopathic restless legs syndrome: a laser evoked potentials study. Mov Disord 38(9):1688–1696. https://doi.org/10.1002/mds.29509
doi: 10.1002/mds.29509
pubmed: 37314385
Yang H, Wang L, Li X, Wang K, Hou Y, Zhang X, Chen Z, Liu C, Yin C, Wu S, Huang Q, Lin Y, Bao Y, Chen Y, Wang Y (2019) A study for the mechanism of sensory disorder in restless legs syndrome based on magnetoencephalography. Sleep Med 53:35–44. https://doi.org/10.1016/j.sleep.2018.07.026
doi: 10.1016/j.sleep.2018.07.026
pubmed: 30414507
Mogavero MP, Mezzapesa DM, Savarese M, DelRosso LM, Lanza G, Ferri R (2021) Morphological analysis of the brain subcortical gray structures in restless legs syndrome. Sleep Med 88:74–80. https://doi.org/10.1016/j.sleep.2021.10.025
doi: 10.1016/j.sleep.2021.10.025
pubmed: 34740168
Park KM, Kim KT, Lee DA, Cho YW (2022) Structural brain connectivity in patients with restless legs syndrome: a diffusion tensor imaging study. Sleep 45(7):zsac099. https://doi.org/10.1093/sleep/zsac099
doi: 10.1093/sleep/zsac099
pubmed: 35485481
Chaudhuri KR, Forbes A, Grosset D, Lees A, Shneerson J, Schapira A, Stillman P, Williams A (2004) Diagnosing restless legs syndrome (RLS) in primary care. Curr Med Res Opin 20(11):1785–1795. https://doi.org/10.1185/030079904X5472
doi: 10.1185/030079904X5472
pubmed: 15537479
Allen RP, Stillman P, Myers AJ (2010) Physician-diagnosed restless legs syndrome in a large sample of primary medical care patients in western Europe: prevalence and characteristics. Sleep Med 11(1):31–37. https://doi.org/10.1016/j.sleep.2009.03.007
doi: 10.1016/j.sleep.2009.03.007
pubmed: 19464949
Garcia-Borreguero D, Stillman P, Benes H, Buschmann H, Chaudhuri KR, Gonzalez Rodríguez VM, Högl B, Kohnen R, Monti GC, Stiasny-Kolster K, Trenkwalder C, Williams AM, Zucconi M (2011) Algorithms for the diagnosis and treatment of restless legs syndrome in primary care. BMC Neurol 11:28. https://doi.org/10.1186/1471-2377-11-28
doi: 10.1186/1471-2377-11-28
pubmed: 21352569
pmcid: 3056753
Karroum EG, Golmard JL, Leu-Semenescu S, Arnulf I (2012) Sensations in restless legs syndrome. Sleep Med 13(4):402–408. https://doi.org/10.1016/j.sleep.2011.01.021
doi: 10.1016/j.sleep.2011.01.021
pubmed: 22296915
Kwatra V, Khan MA, Quadri SA, Cook TS (2018) Differential diagnosis and treatment of restless legs syndrome: a literature review. Cureus 10(9):e3297. https://doi.org/10.7759/cureus.3297
doi: 10.7759/cureus.3297
pubmed: 30443467
pmcid: 6235628
Antelmi E, Lippolis M, Biscarini F, Tinazzi M, Plazzi G (2021) REM sleep behavior disorder: mimics and variants. Sleep Med Rev 60:101515. https://doi.org/10.1016/j.smrv.2021.101515
doi: 10.1016/j.smrv.2021.101515
pubmed: 34186416
Garcia-Borreguero D, Silber MH, Winkelman JW, Högl B, Bainbridge J, Buchfuhrer M, Hadjigeorgiou G, Inoue Y, Manconi M, Oertel W, Ondo W, Winkelmann J, Allen RP (2016) Guidelines for the first-line treatment of restless legs syndrome/Willis-Ekbom disease, prevention and treatment of dopaminergic augmentation: a combined task force of the IRLSSG, EURLSSG, and the RLS-foundation. Sleep Med 21:1–11. https://doi.org/10.1016/j.sleep.2016.01.017
doi: 10.1016/j.sleep.2016.01.017
pubmed: 27448465
Winkelman JW (2022) High national rates of high-dose dopamine agonist prescribing for restless legs syndrome. Sleep 45(2):zsab212. https://doi.org/10.1093/sleep/zsab212
doi: 10.1093/sleep/zsab212
pubmed: 34417810
Allen RP, Picchietti DL, Auerbach M, Cho YW, Connor JR, Earley CJ, Garcia-Borreguero D, Kotagal S, Manconi M, Ondo W, Ulfberg J, Winkelman JW (2018) Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis-Ekbom disease in adults and children: an IRLSSG task force report. Sleep Med 41:27–44. https://doi.org/10.1016/j.sleep.2017.11.1126
doi: 10.1016/j.sleep.2017.11.1126
pubmed: 29425576