How to save legs that have nowhere to go?

Restless legs syndrome (RLS), also known as "restless legs syndrome", "Willis-Ekbom disease", is a common clinical neuromotor sensory disorder, mainly manifested as intense, almost irresistible The desire to move the legs, mostly in the evening or at night, aggravates when quiet or at rest, and relieves after activity
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The disease severely affects the quality of life of patients
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Author: Cao Xiaotang This article is published by the author authorized by the author, please do not reprint without authorization
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The key knowledge mind map refers to the "Guidelines for the Diagnosis and Treatment of Restless Legs Syndrome in China (2021 Edition)" [1], and summarizes the key clinical knowledge related to the disease as follows: Symptom severity assessment To assess the severity of RLS symptoms, the international The RLS Rating Scale (IRLS) [2], the scale includes a total of 10 questions, each question is divided into five severity categories, and each question is scored from 0-4 points, with a maximum score of 40 points
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1-10 is divided into mild RLS, 11-20 is divided into moderate RLS, 21-30 is divided into severe RLS, and 31-40 is very severe RLS.
Sleep disorder, impulse control disorder, generalized anxiety disorder, the first choice is α2δ ligand; RLS with depression, overweight, metabolic disorder, obstructive sleep apnea, history of stroke, the first choice is dopamine receptor agonist; RLS with RBD, the first choice is Dopamine receptor agonists are the first choice, and if necessary, use clonazepam in combination; non-drug therapy is recommended for pregnant patients first.
For refractory patients, if refractory factors are evaluated, low-dose clonazepam 0.
25-1 mg at night can be considered , if symptoms are very severe, consider low-dose oxycodone; in lactating patients, re-evaluate ferritin levels, take 300-900 mg of gabapentin or low-dose clonazepam at night, and if symptoms are very severe, give tramadol; children and adolescents, non-drug treatment is the first choice, pay attention to sleep hygiene habits, and iron is the first choice for drug treatment; common complications and treatment of worsening symptoms need to meet the A+B or A+C or A+B+C criteria: A.
Basic characteristics: ① In In the past 1 week, the severity of symptoms has increased for at least 5 days; ② the severity of symptoms cannot be explained by other factors; ③ the previous treatment was effective
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B.
There is a paradoxical response to drug treatment, that is, symptoms worsen when the drug dose is increased and improved when the drug dose is decreased
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C.
Symptoms appear earlier: ① the onset of symptoms is at least 4 hours earlier, or ② compared with the symptoms before treatment, the onset of symptoms is earlier (2-4 hours), as manifested by more than one of the following: a.
The symptom incubation period is shortened at rest; b.
Symptoms spread to other parts; c.
The intensity of symptoms increased; d.
The duration of sustained remission after treatment was shortened
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Common risk factors associated with worsening symptoms: iron deficiency; treatment with high-dose dopaminergic agents, especially those with short half-lives (degree of symptom worsening: levodopa > immediate-release dopamine agonists > delayed-release dopamine agonists drug); severity of symptoms at onset; long-term RLS drug therapy
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The steps for the treatment of worsening symptoms are shown in the figure below: Impulse control disorders mainly occur in patients receiving dopaminergic preparations, and clinical manifestations include compulsive gambling, increased libido, compulsive shopping, and stereotyped actions
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Risk factors are unclear, and when this complication occurs, it is recommended to discontinue dopaminergic agents, reduce the dose, and switch to or add non-dopaminergic agents
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Many case reports of variant restless legs syndrome in recent years have shown that RLS can also involve parts other than the lower extremities, including the oral cavity, abdomen, bladder, external genitalia, and face [3].
Research Group (IRLSSG) diagnostic criteria, called "variant RLS", are as follows: restless mouth syndrome [4]: ​​mainly manifested as discomfort (numbness, burning, numbness, burning) confined to the mouth or face , pain, etc.
), chewing, talking and other activities can relieve symptoms, aggravate at night, and dopaminergic agonists are effective
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The clinical manifestations of the disease are very similar to Burning mouth syndrome (BMS), and some scholars believe that it is a special subtype of BMS
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BMS is characterized by burning pain in the oral mucosa.
The burning sensation is usually located on the tip of the tongue, the side of the tongue, the back of the tongue, the upper palate, and the inner lip mucosa
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The key point of distinguishing the two is that the symptoms of restless mouth syndrome can be relieved after chewing, talking and other actions, and the dopaminergic drug treatment is effective
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Restless abdomen syndrome [5, 6]: There have been reports at home and abroad, manifesting as abdominal discomfort, which can be relieved by massage or beating, often accompanied by periodic leg movements and sleep disturbances
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At present, the diagnosis is mainly based on the following four aspects: (1) The clinical manifestations conform to the characteristics of RLS symptoms and the diagnostic criteria of IRLSSG; (2) Periodic leg movements can be seen in PSG; (3) Complete abdominal examinations to exclude digestive system diseases; (4) Dopamine receptor agonist therapy is effective
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Restless arms syndrome [7]: When the discomfort is only present in the upper extremities, or first appears in the upper extremities and gradually progresses to the lower extremities, it is called "restless arms syndrome", which is aggravated by rest and at night, and with activity relieved later
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Restless bladder syndrome [8]: It presents with atypical urinary symptoms, has obvious circadian rhythm, and has normal urinary system examinations, which is effective for dopamine receptor agonist therapy
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Note that with overactive bladder (OAB), OAB can be induced by cold factors, the symptoms persist, the urinary system examination shows detrusor contraction, and dopamine receptor agonists are ineffective
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Restless Head Syndrome [9]: Presents with numbness, tingling, cramp-like pain in the head, and a feeling of being stung by a bee, relieved by rubbing the head, diagnosis according to the third edition of the International Classification of Headache Disorders Standard, these patients are often pre-diagnosed with a somatization disorder and referred to a psychiatric outpatient clinic for medication with selective serotonin reuptake inhibitors (SSRIs)
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However, the use of SSRIs reduces dopamine production, which leads to worsening rather than improving symptoms in patients
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For variant restless legs syndrome, there are still few case reports at present.
The diagnosis mainly depends on clinical symptoms and the treatment effect of dopaminergic receptor agonists.
There is a lack of further verification of auxiliary examination.
Its etiology and pathophysiological mechanism still need to be further explored in the future Research and discussion
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References: [1] Chinese Medical Association Neurology Branch Sleep Group, Chinese Medical Association Neurology Branch Sleep Disorder Group, Chinese Sleep Research Association Sleep Disorder Professional Committee.
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LeBrocq, A.
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Validation of the International Restless Legs Syndrome Study Group rating scale for restless legssyndrome.
Sleep Med, 2003, 4 (2): 121-132[3] A.
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Not only limbs inatypical restless legs syndrome.
Sleep Med Rev, 2018, 38: 50-55[4] Y.
Jung, A.
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Restless mouth syndrome.
Neurol Clin Pract, 2017, 7(3) : e29-e30[5] Z.
Sun, Y.
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Li, L.
Yang, X.
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Teaching Video NeuroImage: Restless Abdomen: ARare Variant of Restless Legs Syndrome.
Neurology , 2022.
[6] XX Wang, XY Zhu, Z.
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Restless abdomen: a spectrum or aphenotype variant of restless legs syndrome? BMC Neurol, 2020, 20 (1): 298[7] U.
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Restlessarm syndrome: a rare disease? BMJ Case Rep, 2021, 14 ( 9):[8] K.
Suzuki, M.
Miyamoto, T.
Uchiyama, T.
Miyamoto, T.
Matsubara, K.
Hirata.
Restless Bladder in an ElderlyWoman: An Unusual Feature or a Variant of Restless Legs Syndrome? Intern Med, 2016, 55 (18): 2713-2716[9] F.
Balgetir, M.
Gönen, A.
Berilgen, E.
Aytaç, CF Demir, B.
Müngen.
Restless legs syndrome affecting the head region: "restless head syndrome".
Neurol Sci, 2022, 43(4):2565-2570.
Matsubara, K.
Hirata.
Restless Bladder in an ElderlyWoman: An Unusual Feature or a Variant of Restless Legs Syndrome? Intern Med, 2016, 55 (18): 2713-2716[9] F.
Balgetir, M.
Gönen, A.
Berilgen , E.
Aytaç, CF Demir, B.
Müngen.
Restless legs syndrome affecting the head region: "restless head syndrome".
Neurol Sci, 2022, 43(4):2565-2570.
Matsubara, K.
Hirata.
Restless Bladder in an ElderlyWoman: An Unusual Feature or a Variant of Restless Legs Syndrome? Intern Med, 2016, 55 (18): 2713-2716[9] F.
Balgetir, M.
Gönen, A.
Berilgen , E.
Aytaç, CF Demir, B.
Müngen.
Restless legs syndrome affecting the head region: "restless head syndrome".
Neurol Sci, 2022, 43(4):2565-2570.