Episode #4 Restless Legs Syndrome The White Noise Podcast

Legs bothering you? Well join the The White Noise Podcast as we pick the brain of Dr. Andy Berkowski, clinical associate professor and restless leg expert at the University of Michigan. Learn all about the diagnosis and management of restless legs syndrome. There is also a guest appearance by hepcidin, the bouncer at Club Ferritin.





CME credit link will be here when available





Show Notes – Season 1, Episode 4 – Restless legs syndrome





Time stamps



0:30
– Introduction



2:30
– Interview starts



7:40
– Picks of the month



12:50
– Case



13:50
– Initial thoughts on case



14:00 – Diagnosis of restless legs syndrome



16:50 – Diagnostic criteria for restless legs syndrome



17:40
– Difficulties in diagnosis



22:20
– Key questions to ask in taking history



24:00 – Periodic limbs vs restless legs syndrome



28:30 – Pathogenesis of restless legs syndrome



31:00
– History of Willis-Ekbom disease



35:50
– Case



36:40 – Medications for restless legs syndrome



38:30
– Dopamine agonists



43:30
– Alpha-2-delta-ligands



45:00
– Iron therapy



50:10
– PO vs IV iron supplementation



58:45
– IV iron formulations



1:00:30
– Narcotics



1:05:03
– Augmentation



1:09:00
– Non pharmacologic therapies



1:11:10
– Medications that worsen restless leg syndrome



1:16:00 – Screening for restless legs syndrome



1:18:00 – Follow-up of restless legs syndrome patients



1:18:50 – Sleep apnea and restless legs syndrome



1:20:10
– Take home points



1:22:00
– Interview end





Definitions



Augmentation: The process by which the symptoms of restless legs syndrome occur earlier in the day, become more severe, are less responsive to treatment, and spread to other parts of the body (e.g. arms and trunk), usually due to treatment with escalating doses of dopaminergic medications.



Restless legs syndrome: A condition characterized by an urge to move one’s legs (often accompanied by unpleasant sensations in the legs) that is most prominent at rest, partially or totally relieved by movement, and classically worse in the evening. The symptoms must not be better explained by another condition such as peripheral neuropathy.



Periodic limb movements of sleep: Periodic, repetitive, stereotyped limb movements that occur during sleep. American Academy of Sleep Medicine (AASM) scoring criteria require a minimum of 4 limb movements in series with 5-90 seconds between movements. Periodic limb movements of sleep are seen in the majority of patients with restless legs syndrome who undergo polysomnography.



Periodic limb movement disorder: A disorder characterized by more than 15 periodic limb movements per hour of sleep in adults (greater than 5 in children) that cause a significant sleep disturbance and/or functional impairment not better explained by a different disease entity.



Akathisia: An inner sense of restlessness and desire to move that is often caused by dopamine antagonist medications, is usually generalized (not limited to the legs), and is unlikely to be totally relieved by movement.





Clinical Pearls




Restless legs is a clinical diagnosis



The hallmark of the disease is a SENSATION  of the need to move.



There must be a circadian component to make a diagnosis.



Augmentation will almost inevitably occur with dopamine agonists.



Target ferritin >75 and transferrin saturation greater than 20% for iron repletion.



Obtain fasting ferritin levels.



Some times less iron is better than too much;