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S16.1 Symposium summary
S22
2nd WASM World Congress, Bangkok, 4–8 February 2007 / Sleep Medicine 8 Suppl. 1 (2007) S11–S47
S15.C Pain and restless legs syndrome (RLS): clinical observations from 165 cases K. Ray Chaudhuri, S. Muzerengi. National RLS Clinic and NPF Centre of Excellence, King’s College Hospital, Denmark Hill, London, UK Background: Pain is an important aspect of symptom expression of RLS and occasionally may cause diagnostic difficulties. Objective: To define the type of pain and its management from a clinic population of 165 RLS cases. Methods: Analysis of database and interview of patients using a standard screening interview and questionnaire. Identification of cases with RLS associated pain. Results: Out of a total RLS patient database of 165 cases (mean age 59.422+14.89, Female 69.08%), 45 (27.2%) patients had painful RLS (mean age 57.53+14.62, male 26.67%). The ethnic spread was mainly Caucasians 91.11% and 42.22% had a family history of RLS while in 29%, pain was a specific feature of augmentation. In the painful RLS group, 20% paroxysmal RLS while 51.11% constant RLS including cases with augmentation. Pain variants included upper limb pain, chin and posterior neck pain and pain mimicking radicular pain. Patients used sensory feedback with hot compress, massage and gabapentin (17.78%) with dopamine agonists (pramipexole and ropinirole) was most effective. Screening for neuropathy was negative in those with lower limb pain. Conclusions: Pain needs to be recognised as an important aspect of idiotpthic RLS as well as those with augmentation.
S16. Advances in epidemiology of RLS: prevalence by age and severity including pediatric prevalence, major factors affecting prevalence, significant co-morbid conditions, theoretical and practical considerations for future studies
S16.1 Symposium summary R.P. Allen. Johns Hopkins University, Baltimore, MD, USA The early epidemiological studies produced very distorted views of RLS that contributed to the recent public controversy over pharmaceutical companies exaggerating significance of RLS to promote excessive drug sales. The new studies covered in this symposium provide a much more accurate view of both RLS prevalence and factors contributing to RLS. The methods for doing this more careful work will be emphasized. This symposium will thus serve both to correct some erroneously held views of RLS and also provide access to better methods that can be used by those attending the symposium. Thus this provides important clinical knowledge and clinical research support needed to ask some important questions about RLS including the issue of racial/geographic differences in prevalence. • Chair: Birgit H¨ogl, Leopold-Franzens-University, Innsbruck, Austria • 1st speaker: Wayne Hening, UMDNJ, New Jersey, USA • 2nd speaker: Dan Picchietti, Carle Clinic, Illinois, USA • 3rd speaker: Birgit H¨ogl, Leopold-Franzens-University, Innsbruck, Austria • 4th speaker/discussant: Hochang Benjamin Lee, Johns Hopkins University, Baltimore, MD, USA Recent advances in RLS epidemiological studies have altered somewhat our view of RLS and factors contributing to it. Early studies were poorly done and gave both inflated rates of RLS and failed to account for wide variation in RLS severity. This produced numbers that were at odds with the clinical experience feeding the recent controversy over pharmaceutical companies exaggerating disease significance to promote product marketing. Fortunately we now have better studies using validated questions with reasonable positive predictive values. We also have developed methods for evaluating prevalence in relation to severity and for assessing significant clinical features related to RLS. When the better methods are applied we get somewhat different results than in the earlier studies. Some of the factors that seemed relevant now appear not to relate to RLS while other factors appear to be more significant. The actual prevalence in relation to gender, age and severity can be more accurately stated.
These techniques have now been extended in two important ways. First there is now a large epidemiological study of children in two separate countries. These results will be presented here for the first time in an international forum. The conditions associated with occurrence of RLS both in children and adults are also now better understood both from these large epidemiological studies and also from two more intense studies involving direct diagnoses by trained medical professionals. One of the critical issues that needs to be more carefully examined is that of racial and geographic differences in the prevalence of RLS. The problems with existing data and the best methods for future studies will be considered in this symposium by a discussant who is an expert in medical epidemiology. S16.A Epidemiology of restless legs syndrome in Korean adults C.Y. Won. Department of Neurology, Keimyung University, Dongsan Medical Center, Taegu, Republic of Korea Restless legs syndrome (RLS) is a common sensorimotor disorder. However, only a few Asian epidemiologic studies have been done. Therefore, we performed an epidemiologic study of RLS in a large Korean adult population. We developed the Korean version of the Johns Hopkins telephone diagnostic interview for the RLS. A total of 5000 subjects were completely interviewed using a computer aided telephone interview method. A representative sample with aged 20 to 69 was constituted according to a stratified, multistage random sampling method. Responses were analyzed to produce an estimate of prevalence of RLS symptoms of any frequency and sleep disturbance. Of the 5000 respondents (2,470 men and 2,530 women), 194 (3.9%) reported all 4 diagnostic symptoms of RLS at any frequency, as definite RLS and 179 (3.6%) reported 3 diagnostic symptoms, as probable RLS. Three hundred seventy-three respondents (7.5%) met the criteria for definite or probable RLS sufferers. The prevalence of RLS was generally approximately higher for women than men (4.4% vs. 3.3% for definite, 8.7% vs. 6.2% for definite plus probable). Fifties is the highest age group in definite RLS and definite or probable RLS sufferers. Over all, 89.7% of the definite RLS group has the symptoms currently, but only 13.6% of the sufferers take medicine now. And 47.7% of those sufferers have two or more episodes per week, while 29.3% of them have two or more per week and suffer moderate to severe distress. Of the definite RLS group with current symptoms 20.7 % suffer with moderate to severe distress and sleep disturbance. RLS is a common but underdiagnosed neurological disorder in Korea and affects sleep considerably. Our epidemiology results are comparable to those of other countries. S16.B RLS, race, and psychiatric symptoms: the findings from the RLS in Baltimore Epidemiologic Catchement Area (RiBECA) Study H.B. Lee. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA Objective: Based on the Wave IV of the Baltimore ECA Follow-up Study, we examined the the association between restless legs syndrome (RLS) and DSM IV major depressive disorder (MDD) or panic disorder in the community. Methods: Of 1071 participants, 1024 completed the seven-item RLS Questionnaire and Diagnostic Interview Schedule administered by trained lay interviewers. We compared RLS cases with non-RLS controls on lifetime and 12-month prevalence rates of MDD or panic disorder. Results: 33.3% of subjects with RLS (13 out of 42) and 16.7% of subjects without RLS (80 out of 957) had a lifetime diagnosis of one or more DSM IV psychiatric diagnoses. Crude (3.0, 95% confidence interval [1.4, 6.5]) and adjusted (2.8 [2.3, 6.7]) odds ratios for risk of MDD and crude (4.7 [2.0, 11.3]) and adjusted (5.0 [2.0, 12.8]) odds ratios for panic disorder suggested a strong association between RLS and MDD or panic disorder. Conclusions: Future investigations should examine the symptomatic and/or pathophysiological overlap between RLS and MDD or panic disorder. Contributed support: research support from NIH.
2nd WASM World Congress, Bangkok, 4–8 February 2007 / Sleep Medicine 8 Suppl. 1 (2007) S11–S47
S15.C Pain and restless legs syndrome (RLS): clinical observations from 165 cases K. Ray Chaudhuri, S. Muzerengi. National RLS Clinic and NPF Centre of Excellence, King’s College Hospital, Denmark Hill, London, UK Background: Pain is an important aspect of symptom expression of RLS and occasionally may cause diagnostic difficulties. Objective: To define the type of pain and its management from a clinic population of 165 RLS cases. Methods: Analysis of database and interview of patients using a standard screening interview and questionnaire. Identification of cases with RLS associated pain. Results: Out of a total RLS patient database of 165 cases (mean age 59.422+14.89, Female 69.08%), 45 (27.2%) patients had painful RLS (mean age 57.53+14.62, male 26.67%). The ethnic spread was mainly Caucasians 91.11% and 42.22% had a family history of RLS while in 29%, pain was a specific feature of augmentation. In the painful RLS group, 20% paroxysmal RLS while 51.11% constant RLS including cases with augmentation. Pain variants included upper limb pain, chin and posterior neck pain and pain mimicking radicular pain. Patients used sensory feedback with hot compress, massage and gabapentin (17.78%) with dopamine agonists (pramipexole and ropinirole) was most effective. Screening for neuropathy was negative in those with lower limb pain. Conclusions: Pain needs to be recognised as an important aspect of idiotpthic RLS as well as those with augmentation.
S16. Advances in epidemiology of RLS: prevalence by age and severity including pediatric prevalence, major factors affecting prevalence, significant co-morbid conditions, theoretical and practical considerations for future studies
S16.1 Symposium summary R.P. Allen. Johns Hopkins University, Baltimore, MD, USA The early epidemiological studies produced very distorted views of RLS that contributed to the recent public controversy over pharmaceutical companies exaggerating significance of RLS to promote excessive drug sales. The new studies covered in this symposium provide a much more accurate view of both RLS prevalence and factors contributing to RLS. The methods for doing this more careful work will be emphasized. This symposium will thus serve both to correct some erroneously held views of RLS and also provide access to better methods that can be used by those attending the symposium. Thus this provides important clinical knowledge and clinical research support needed to ask some important questions about RLS including the issue of racial/geographic differences in prevalence. • Chair: Birgit H¨ogl, Leopold-Franzens-University, Innsbruck, Austria • 1st speaker: Wayne Hening, UMDNJ, New Jersey, USA • 2nd speaker: Dan Picchietti, Carle Clinic, Illinois, USA • 3rd speaker: Birgit H¨ogl, Leopold-Franzens-University, Innsbruck, Austria • 4th speaker/discussant: Hochang Benjamin Lee, Johns Hopkins University, Baltimore, MD, USA Recent advances in RLS epidemiological studies have altered somewhat our view of RLS and factors contributing to it. Early studies were poorly done and gave both inflated rates of RLS and failed to account for wide variation in RLS severity. This produced numbers that were at odds with the clinical experience feeding the recent controversy over pharmaceutical companies exaggerating disease significance to promote product marketing. Fortunately we now have better studies using validated questions with reasonable positive predictive values. We also have developed methods for evaluating prevalence in relation to severity and for assessing significant clinical features related to RLS. When the better methods are applied we get somewhat different results than in the earlier studies. Some of the factors that seemed relevant now appear not to relate to RLS while other factors appear to be more significant. The actual prevalence in relation to gender, age and severity can be more accurately stated.
These techniques have now been extended in two important ways. First there is now a large epidemiological study of children in two separate countries. These results will be presented here for the first time in an international forum. The conditions associated with occurrence of RLS both in children and adults are also now better understood both from these large epidemiological studies and also from two more intense studies involving direct diagnoses by trained medical professionals. One of the critical issues that needs to be more carefully examined is that of racial and geographic differences in the prevalence of RLS. The problems with existing data and the best methods for future studies will be considered in this symposium by a discussant who is an expert in medical epidemiology. S16.A Epidemiology of restless legs syndrome in Korean adults C.Y. Won. Department of Neurology, Keimyung University, Dongsan Medical Center, Taegu, Republic of Korea Restless legs syndrome (RLS) is a common sensorimotor disorder. However, only a few Asian epidemiologic studies have been done. Therefore, we performed an epidemiologic study of RLS in a large Korean adult population. We developed the Korean version of the Johns Hopkins telephone diagnostic interview for the RLS. A total of 5000 subjects were completely interviewed using a computer aided telephone interview method. A representative sample with aged 20 to 69 was constituted according to a stratified, multistage random sampling method. Responses were analyzed to produce an estimate of prevalence of RLS symptoms of any frequency and sleep disturbance. Of the 5000 respondents (2,470 men and 2,530 women), 194 (3.9%) reported all 4 diagnostic symptoms of RLS at any frequency, as definite RLS and 179 (3.6%) reported 3 diagnostic symptoms, as probable RLS. Three hundred seventy-three respondents (7.5%) met the criteria for definite or probable RLS sufferers. The prevalence of RLS was generally approximately higher for women than men (4.4% vs. 3.3% for definite, 8.7% vs. 6.2% for definite plus probable). Fifties is the highest age group in definite RLS and definite or probable RLS sufferers. Over all, 89.7% of the definite RLS group has the symptoms currently, but only 13.6% of the sufferers take medicine now. And 47.7% of those sufferers have two or more episodes per week, while 29.3% of them have two or more per week and suffer moderate to severe distress. Of the definite RLS group with current symptoms 20.7 % suffer with moderate to severe distress and sleep disturbance. RLS is a common but underdiagnosed neurological disorder in Korea and affects sleep considerably. Our epidemiology results are comparable to those of other countries. S16.B RLS, race, and psychiatric symptoms: the findings from the RLS in Baltimore Epidemiologic Catchement Area (RiBECA) Study H.B. Lee. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA Objective: Based on the Wave IV of the Baltimore ECA Follow-up Study, we examined the the association between restless legs syndrome (RLS) and DSM IV major depressive disorder (MDD) or panic disorder in the community. Methods: Of 1071 participants, 1024 completed the seven-item RLS Questionnaire and Diagnostic Interview Schedule administered by trained lay interviewers. We compared RLS cases with non-RLS controls on lifetime and 12-month prevalence rates of MDD or panic disorder. Results: 33.3% of subjects with RLS (13 out of 42) and 16.7% of subjects without RLS (80 out of 957) had a lifetime diagnosis of one or more DSM IV psychiatric diagnoses. Crude (3.0, 95% confidence interval [1.4, 6.5]) and adjusted (2.8 [2.3, 6.7]) odds ratios for risk of MDD and crude (4.7 [2.0, 11.3]) and adjusted (5.0 [2.0, 12.8]) odds ratios for panic disorder suggested a strong association between RLS and MDD or panic disorder. Conclusions: Future investigations should examine the symptomatic and/or pathophysiological overlap between RLS and MDD or panic disorder. Contributed support: research support from NIH.