Download PDF
Nervenheilkunde 2003; 22(08): 390-396
DOI: 10.1055/s-0038-1626320
Original- und Übersichtsarbeiten/Original and Review Articles
Schattauer GmbH

Das Restless-Legs-Syndrom: Klinik, Diagnose und Therapie

Restless legs syndrome: clinical features, diagnosis and treatment
M. Sabolek
1   Klinik für Neurologie (Direktor: Prof. Dr. A. C. Ludolph), Universität Ulm
,
A. Storch
1   Klinik für Neurologie (Direktor: Prof. Dr. A. C. Ludolph), Universität Ulm
› Author Affiliations
Further Information

Publication History

Publication Date:
19 January 2018 (online)

    Permissions and Reprints

Zusammenfassung

Das Restless-Legs-Syndrom (RLS) zählt mit einer Prävalenz von 2 bis 10% der erwachsenen Bevölkerung zu den häufigsten neurologischen Erkrankungen. Das RLS ist eine Erkrankung des zentralen Nervensystems mit sensiblen und motorischen Beschwerden der Beine, die in Ruhe auftreten, sowie ein Bewegungsdrang, der zu ausgeprägten Schlafstörungen führen kann. Es kommt als idiopathisches RLS oder in Assoziation mit vielen internistischen und neurologischen Erkrankungen vor. Die typische Anamnese und ein unauffälliger neurologischer Untersuchungsbefund beim idiopathischen RLS ermöglichen rasch die Diagnosestellung. Zusätzliche laborchemische und/oder elektrophysiologische Untersuchungen sind notwendig, um assoziierte Erkrankungen zu erfassen. Hier spielen insbesondere der Ausschluss einer Polyneuropathie, einer Niereninsuffizienz und einer Eisenstoffwechselstörung eine Rolle. Eine Polysomnographie mit der Registrierung von assoziierten Schlafstörungen und den typischen periodischen Beinbewegungen (PLMS) kann die Diagnose in unklaren Fällen unterstützen. Die Therapie besteht in einer symptomatischen Behandlung mit Dopaminergika als Mittel der ersten Wahl.

Summary

Restless legs syndrome (RLS) is one of the most common neurological disorders with a prevalence of 2 to 10% of the adult population. RLS is a disorder with sensory and motor symptoms of the legs frequently associated with an urge to move and with sleep disturbances. It occurs either as idiopathic RLS or in association with many medical or neurological disorders. The typical history and normal neurological examination lead to the clinical diagnosis. Additional laboratory and/or electrophysiological investigations are usually necessary to exclude associated disorders, such as neuropathy and uremia. Polysomnography supports the diagnosis of RLS by documenting the associated sleep disturbances and periodic limb movements in sleep (PLMS). The primary treatment of RLS is largely symptomatic and quite effective with dopaminergic drugs.

Schlüsselwörter

Restless-Legs-Syndrom - periodische Beinbewegungen im Schlaf (PLMS) - Dopaminergika

Keywords

Restless legs syndrome - periodic limb movements in sleep (PLMS) - dopaminergic drugs
 

  • Literatur

  • 1 Adler CH. Treatment of restless legs syndrome with gabapentin. Clin Neuropharmacol 1997; 20: 148-51.
    CrossrefPubMedGoogle Scholar
  • 2 Akpinar S. Treatment of restless legs syndrome with levodopa plus benserazide. Arch Neurol 1982; 39: 739.
    PubMedGoogle Scholar
  • 3 Akpinar S. Restless legs syndrome treatment with dopaminergic drugs. Clin Neuropharmacol 1987; 10 (01) 69-79.
    CrossrefPubMedGoogle Scholar
  • 4 Allen RP, Earley CJ. Augmentation of the restless legs syndrome with carbidopa/levodopa. Sleep 1996; 19 (03) 205-13.
    CrossrefPubMedGoogle Scholar
  • 5 Aul EA, Davis BJ, Rodnitzky RL. The importance of formal serum iron studies in the assessment of restless legs syndrome. Neurology 1998; 51: 912-3.
    PubMedGoogle Scholar
  • 6 Bara-Jimenez W, Aksu M, Graham B, Sato S, Hallet M. Periodic limb movements in sleep: state dependent excitability of the spinal flexor reflex. Neurology 2000; 54: 1609-16.
    CrossrefPubMedGoogle Scholar
  • 7 Becker PM, Jamieson AO, Brown WD. Dopaminergic agents in restless legs syndrome and periodic limb movements of sleep: response and complications of extended treatment in 49 cases. Sleep 1993; 16 (08) 713-6.
    CrossrefPubMedGoogle Scholar
  • 8 Becker PM, Ondo W, Sharon D. Encouraging initial response of restless legs syndrome to pramipexole. Neurology 1998; 51: 1221-3.
    CrossrefPubMedGoogle Scholar
  • 9 Benes H, Kurella B, Kummer J, Kazenwadel J, Selzer R, Kohnen R. Rapid onset of action of levodopa in restless legs syndrome: a doubleblind, randomized, multicenter, crossover trial. Sleep 1999; 22 (08) 1073-81.
    CrossrefPubMedGoogle Scholar
  • 10 Benes H, Deißler A, Clarenbach P, Rodenbeck A, Hajak G. Lisurid in the management of restless legs syndrome – an extended poly-somnographic study. Mov Disord 2000; 15 (Suppl. 03) 134.
    Google Scholar
  • 11 Bucher SF, Seelos KC, Oertel WH, Reiser M, Trenkwalder C. Cerebral generators involved in the pathogenesis of the restless legs syndrome. Ann Neurol 1997; 41: 639-45.
    CrossrefPubMedGoogle Scholar
  • 12 Chokroverty S, Jankovic J. Restless legs syndrome. A disease in search of identity. Neurology 1999; 52: 907-10.
    CrossrefPubMedGoogle Scholar
  • 13 Collado-Seidel V, Kazenwadel J, Wetter TC, Kohnen R, Selzer R, Oertel WH, Trenkwalder C. A controlled study of additional sr-L-dopa in L-dopa-responsive restless legs syndrome with late-night symptoms. Neurology 1999; 52: 285-90.
    CrossrefPubMedGoogle Scholar
  • 14 Culpepper WJ, Badia P, Shaffer JI. Time-ofnight patterns in PLMS activity. Sleep 1992; 15: 306-11.
    PubMedGoogle Scholar
  • 15 Dinwiddie LC. Restless legs syndrome: not just a problem for dialysis patients. ANNA J 1997; 24 (06) 655-62.
    PubMedGoogle Scholar
  • 16 Earley CJ, Allen RP. Pergolide and carbidopa/levodopa treatment of the restless legs syndrome and periodic leg movements in sleep in a consecutive series of patients. Sleep 1996; 19: 801-10.
    CrossrefPubMedGoogle Scholar
  • 17 Earley CJ, Yaffee JB, Allen RP. Randomized, double-blind, placebo-controlled trial of pergolide in restless legs syndrome. Neurology 1998; 51: 1599-602.
    CrossrefPubMedGoogle Scholar
  • 18 Earley CJ, Connor JR, Beard JL, Malecki EA, Epstein DK, Allen RP. Abnormalities in CSF concentrations of ferritin and transferrin in restless legs syndrome. Neurology 2000; 54: 1698-700.
    CrossrefPubMedGoogle Scholar
  • 19 Ekbom KA. Restless legs: a clinical study. Acta Med Scand Suppl 1945; 158: 1-123.
    Google Scholar
  • 20 Ekbom KA. Restless legs syndrome. Neurology 1960; 10: 868-73.
    CrossrefPubMedGoogle Scholar
  • 21 Feigen A. Restless legs syndrome. JAMA 1995; 274: 1191-2.
    PubMedGoogle Scholar
  • 22 Gemignani F, Marbini A, Di Giovanni G, Salih S, Terzano MG. Charcot-Marie-Tooth disease type 2 with restless legs syndrome. Neurology 1999; 52: 1064-6.
    CrossrefPubMedGoogle Scholar
  • 23 Garcia-Borreguero D, Larrosa O, de la Llave Y, Verger K, Masramon X, Hernandez G. Treatment of restless legs syndrome with gabapentin: A double-blind, cross-over study. Neurology 2002; 59: 1573-9.
    CrossrefPubMedGoogle Scholar
  • 24 Goodman DS, Brodie C, Ayrida EA. Restless legs syndrome in pregnancy. Br Med J 1988; 297: 1101-2.
    Google Scholar
  • 25 Grandjean P. Das Restless-Legs-Syndrom – Neuere Aspekte. Review. Schweiz Rundschau Med Praxis 1997; 86: 732-6.
    Google Scholar
  • 26 Guilleminault C, Cetel M, Philip P. Dopaminergic treatment of restless legs and rebound phenomenon. Neurology 1993; 43 (02) 445.
    CrossrefPubMedGoogle Scholar
  • 27 Haan J. Ropinirol in der Therapie des Restless Legs Syndroms (RLS). Somnologie 1999; 03 (Suppl. 01) 18-9.
    Google Scholar
  • 28 Hening WA, Walters AS, Kavey N, Gidro-Frank S, Cote L, Fahn S. Dyskinesias while awake and periodic movements in sleep in restless legs syndrome: treatment with opioids. Neurology 1986; 36: 1363-6.
    CrossrefPubMedGoogle Scholar
  • 29 Hening WA, Walters AS, Wagner M, Rosen R, Chen V, Kim S, Shah M, Thai O. Circadian rhythm of motor restlessness and sensory symptoms in the idiopathic restless legs syndrome. Sleep 1999; 22 (07) 901-12.
    CrossrefPubMedGoogle Scholar
  • 30 Janzsen L, Rich JA, Vercaigne LM. An overview of levodopa in the management of restless legs syndrome in a dialysis population: pharmacokinetics, clinical trials, and complications of therapy. Ann Pharmacother 1999; 33: 86-92.
    CrossrefPubMedGoogle Scholar
  • 31 Jones HJS, Derodra JK. Restless legs syndrome – a review. Eur J Vasc Endovasc Surg 1997; 14: 430-2.
    CrossrefPubMedGoogle Scholar
  • 32 Kanter AH. The effect of sclerotherapy on restless legs syndrome. Dermat Surg 1995; 21: 328-32.
    Google Scholar
  • 33 Kimmel PL. Go to bed and get a good night’s sleep: you need your rest. Am J Kidney Dis 2000; 35 (06) 1221-3.
    CrossrefPubMedGoogle Scholar
  • 34 Kraus T, Schuld A, Pollmächer T. Periodic leg movements in sleep and restless legssyndrome probably caused by olanzapine. J Clin Psychopharmacol 1999; 19: 478-9.
    CrossrefPubMedGoogle Scholar
  • 35 Kurlan R. Postprandial (reactive) hypoglycemia and restless legs syndrome: related neurologic disorders?. Movement Disorders 1998; 13: 619-20.
    CrossrefPubMedGoogle Scholar
  • 36 Lauerma H, Markkula J. Treatment of restless legs syndrome with tramadol: an open study. J Clin Psychiatry 1999; 60: 241-4.
    CrossrefPubMedGoogle Scholar
  • 37 Lin SC, Kaplan J, Burger CD, Fredrickson PA. Effect of pramipexole in treatment of resistant restless legs syndrome. Mayo Clin Proc 1998; 73: 497-500.
    CrossrefPubMedGoogle Scholar
  • 38 Mellick GA, Mellick LB. Management of restless legs syndrome with gabapentin. Sleep 1996; 19: 224-6.
    CrossrefPubMedGoogle Scholar
  • 39 Montagna P, de Bianchi LS, Succoni M, Cirignotta F, Lugaresi E. Clonazepam and vibration in restless legs syndrome. Acta Neurol Scand 1984; 69: 428-30.
    CrossrefPubMedGoogle Scholar
  • 40 Montplaisir J, Godbout R, Boghen D, DeChamplain J, Young SN, Lapierre G. Familial restless legs with periodic movements in sleep: electrophysiologic, biochemical, and pharmacologic study. Neurology 1985; 35: 130-4.
    CrossrefPubMedGoogle Scholar
  • 41 Montplaisir J, Godbout R, Poirier G, Bedard MA. Restless legs syndrome and periodic movements in sleep: physiopathology and treatment with L-dopa. Clin Neuropharmacol 1986; 09: 456-63.
    CrossrefPubMedGoogle Scholar
  • 42 Montplaisir J, Boucher S, Poirier G, Lavigne G, Lapierre O, Lesperance P. Clinical, poly-somnographic, and genetic characteristics of restless legs syndrome: a study of 133 patients diagnosed with new standard criteria. Mov Disord 1997; 12: 61-5.
    CrossrefPubMedGoogle Scholar
  • 43 Montplaisir J, Boucher S, Nicolas A, Lesperance P, Gosselin A, Rompre P, Lavigne P. Immobilization tests and periodic leg movements in sleep for the diagnosis of restless leg syndrome. Mov Disord 1998; 13 (02) 324-9.
    CrossrefPubMedGoogle Scholar
  • 44 Montplaisir J, Nicolas A, Denesle R, Gomez-Mancilla B. Restless legs syndrome improved by pramipexole: a double-blind randomized trial. Neurology 1999; 52: 938-43.
    CrossrefPubMedGoogle Scholar
  • 45 Noel S, Korri H, Vanderheyden JE. Low dosage of pergolide in the treatment of restless legs syndrome (letter). Acta Neurol Belgica 1998; 98: 52-3.
    Google Scholar
  • 46 Ondo W, Jankovic J. Restless legs syndromeclinico-etiologic correlates. Neurol 1996; 47: 1435-41.
    CrossrefPubMedGoogle Scholar
  • 47 Ondo W. Ropinirole for restless legs syndrome. Movement Disorders 1999; 14: 138-40.
    CrossrefPubMedGoogle Scholar
  • 48 O’Keefe ST. Restless legs syndrome. A review. Arch Intern Med 1996; 156: 243-8.
    CrossrefPubMedGoogle Scholar
  • 49 Pieta J, Millar T, Zacharias J, Fine A, Kryger M. Effect of pergolide on restless legs and leg movements in sleep in uremic patients. Sleep 1998; 21: 617-22.
    CrossrefPubMedGoogle Scholar
  • 50 Read DJ, Feest TG, Nassim MA. Clonazepam: effective treatment for restless legs syndrome in uraemia. Br Med J 1981; 283: 885-6.
    PubMedGoogle Scholar
  • 51 Reynolds G, Blake DR, Hall HS, Williams A. Restless legs syndrome and rheumatoid arthritis. Br Med J 1986; 292: 659-60.
    CrossrefPubMedGoogle Scholar
  • 52 Rothdach A, Trenkwalder C, Haberstock J, Keil U, Berger K. Prevalence and risk factors of RLS in an elderly population: The MEMO study. Neurology 2000; 54: 1064-8.
    CrossrefPubMedGoogle Scholar
  • 53 Routtinen HM, Partinen M, Hublin C, Bergman J, Haaparanta M, Solin O, Rinne JO. An FDOPA PET study in patients with periodic limb movement disorder and restless legs syndrome. Neurology 2000; 54: 502-4.
    CrossrefPubMedGoogle Scholar
  • 54 Rutkove SB, Matheson JK, Logigian EL. Restless legs syndrome in patients with polyneuropathy. Muscle Nerve 1996; 19: 670-2.
    CrossrefPubMedGoogle Scholar
  • 55 Saletu M, Anderer P, Saletu-Zyhlaz G, Hauer C, Saletu B. Acute placebo-controlled sleep laboratory studies and clinical follow-up with pramipexole in restless legs syndrome. Eur Arch Psychiatry Clin Neurosci 2002; 252: 185-94.
    CrossrefPubMedGoogle Scholar
  • 56 Schoels L, Haan J, Ries O, Amoiridis G, Przuntek H. Sleep disturbance in spinocerebellar ataxias: is the SCA3 mutation a cause of restless legs syndrome?. Neurology 1998; 51: 1603-7.
    CrossrefPubMedGoogle Scholar
  • 57 Silber MH, Shepard JW, Wisbey JA. Pergolide in the management of restless legs syndrome: an extended study. Sleep 1997; 20: 878-82.
    CrossrefPubMedGoogle Scholar
  • 58 Stiasny K, Roebbecke J, Schüler P, Oertel WH. The treatment of idiopathic restless legs syndrome (RLS) with the D2-agonist cabergoline – an open clinical trial. Sleep 2000; 23: 349-54.
    PubMedGoogle Scholar
  • 59 Telstad W, Sorenson O, Larsen S, Lillevold PE, Stensrud P, Nyberg-Hansen R. Treatment of restless legs syndrome with carbamazepine: a double blind study. Br Med J 1984; 288: 444-3.
    CrossrefPubMedGoogle Scholar
  • 60 Trenkwalder C, Stiasny K, Pollmacher T, Wetter TC, Schwarz J, Kohnen R, Kazenwadel J, Kruger HP, Ramm S, Kunzel M. et al. L-dopa therapy of uremic and idiopathic restless legs syndrome: a double-blind, crossover trial. Sleep 1995; 18: 681-8.
    CrossrefPubMedGoogle Scholar
  • 61 Trenkwalder C, Collado-Seidel C, Gasser T, Oertel WH. Clinical symptoms and possible anticipation in a large kindred of familial restless legs syndrome. Mov Disord 1996; 11: 389-94.
    CrossrefPubMedGoogle Scholar
  • 62 Trenkwalder C, Walters AS, Hening W. Periodic limb movement and restless legs syndrome. Neurol Clinics 1996; 14: 629-50.
    Google Scholar
  • 63 Trenkwalder C. Restless Legs Syndrom: Klinik, Differentialdiagnose, Neurophysiologie, Therapie. Berlin, Heidelberg: Springer; 1998: 131-45.
    Google Scholar
  • 64 Trenkwalder C, Hening WA, Walters AS, Campbell SS, Rahman K, Chokroverty S. Circadian rhythm of periodic limb movements and sensory symptoms of restless legs syndrome. Mov Disord 1999; 14 (01) 102-10.
    CrossrefPubMedGoogle Scholar
  • 65 Turjanski N, Lees AJ, Brooks DJ. Striatal dopaminergic function in restless legs syndrome. 18F-dopa and 11C-raclopride PET studies. Neurology 1999; 52: 932-7.
    CrossrefPubMedGoogle Scholar
  • 66 Wagner ML, Walters AS, Coleman RG, Hening WA, Grasing K, Chokroverty S. Randomized, double-blind, placebo-controlled study of clonidine in restless legs syndrome. Sleep 1996; 19: 52-8.
    CrossrefPubMedGoogle Scholar
  • 67 Walters AS, Wagner ML, Hening WA, Grasing K, Mills R, Chokroverty S, Kavey N. Successful treatment of the idiopathic restless legs syndrome in a randomized double-blind trial of oxycodone versus placebo. Sleep 1993; 16: 327-32.
    CrossrefPubMedGoogle Scholar
  • 68 Walters AS. The international restless legs syndrome study group. Towards a better definition of the restless legs syndrome. Mov Disord 1995; 11: 241-5.
    Google Scholar
  • 69 Walters AS, Hickey K, Maltzman J, Joseph D, Hening W, Wilson V, Chokroverty S. A questionnaire study of 138 patients with restless legs syndrome: the night-walkers-survey. Neurology 1996; 46: 92-5.
    CrossrefPubMedGoogle Scholar
  • 70 Wetter TC, Stiasny K, Winkelmann J, Buhlinger A, Brandenburg U, Penzel T, Medori R, Rubin M, Oertel WH, Trenkwalder C. A randomized controlled study of pergolide in patients with restless legs syndrome. Neurology 1999; 52: 944-50.
    CrossrefPubMedGoogle Scholar
  • 71 Willis T. The London practice of physick. London: Bassett, Dring Harper, and Crook; 1692
    Google Scholar
  • 72 Winkelmann J, Wetter TC, Collado-Seidel V, Gasser T, Dichgans M, Yassouridis A, Trenkwalder C. Frequency and characteristics of the hereditary restless legs syndrome in a population of 300 patients. Sleep 2000; 23: 597-602.
    PubMedGoogle Scholar
  • 73 Yunus MB, Aldag JC. Restless legs syndrome and leg cramps in fibromyalgia syndrome: a controlled study. BMJ 1996; 312: 1339.
    CrossrefPubMedGoogle Scholar