한국인 소아에서의 하지 불안 증후군의 임상적 양상에 대한 연구
Clinical Analysis of Restless Legs Syndrome in Korean Children
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목적:하지 불안 증후군(Restless leg syndrome, RLS)은 수면 장애로 분류되는 신경운동성 질환으로 하지의 움직이고 싶은 충동, 밤이나 저녁 또는 가만히 있을 때 심해지는 불편한 느낌이나 통증을 특징으로 하고 다리를 움직이거나 주물러 주면 나아지는 소견을 보이는 질환이다. 대개 성인에서 진단되지만, 소아에서 유병률이 2% 정도로 비교적 흔한 질환으로 본 연구는 소아에서 RLS가 의심되는 환자들을 대상으로 이들의 임상적 특징과 진단 및 치료에 대해 알아보고자 하였다. 방법:2011년 3월부터 2011년 9월까지 경북대 병원 소아과를 방문한 환자들 가운데, RLS의 진단기준에 부합하는 환자 7명의 의무기록을 후향적으로 분석하였다. 네 가지 필수 진단 기준 이외에도 부가적인 진단기준인 수면장애여부, RLS의 가족력 및 수면다원검사 결과를 조사하였으며, 혈액검사 및 치료, 경과를 분석하였다. 결과:대상 환아는 7명으로 남아는 5명(71.4%), 여아는 2명(28.6%) 이었고 진단 당시 연령은 7.5± 3.4세 였다. 병원을 방문한 주된 이유는 수면 중 이상행동을 보인 경우가 5명(71.4%)이었고, 다리의 통증(14.3%)과 두통(14.3%)이 각각 1명이었다. 6명의 환자가 수면장애를 호소하였고 RLS 의 가족력이 있는 환자는 3명 이었다. 3명의 환자는 본원에서 수면다원검사를 시행하였고, PLMI가 5 이상으로 RLS의 부가적인 진단기준에 부합되는 소견을 보였다. 모든 환자는 철분 결핍에 대한 검사를 시행하였으며, 빈혈에 해당하는 환자는 없었으나 5명은 철분 결핍 소견이 있었다. 심한 철분 결핍을 보였던 환자는 철분제제 투약(3 mg/kg/day) 1개월 뒤 추적 관찰에서 다리의 통증을 호소하는 것이 훨씬 나아졌고, pramipexole (0.125 mg)을 투약한 환자 2명은 더 이상 자다가 다리를 움찔거리는 증상이 없어졌고 수면의 질이 나아졌다고 하였다. 결론:RLS는 특징적인 4가지 증상으로 진단할 수 있는 수면장애로 소아에서도 흔하게 발생하지만, 소아는 증상을 표현할 수 있는 능력이 미숙하여 진단을 하기에 어려움이 있다. 그러나 RLS를 진단하려는 의사의 관심과 자세한 병력 청취로 진단율을 높일 수 있고, 수면다원검사를 통해 PLMI를 확인하고 다른 수면 장애를 배제함으로 진단에 도움을 받을 수 있다. 철분 결핍으로 인한 RLS의 경우는 철분보충 요법이 필요하고, 도파민 항진제가 효과적인 치료로 사용될 수 있다.
Abstract
Purpose:Restless legs syndrome (RLS) is a common neurologic sleep disorder, but it is frequently undiagnosed in Korean children. This study aimed to investigate clinical features of RLS in Korean children. Methods:We reviewed the medical records of seven patients who had been diagnosed with RLS at the pediatric department of Kyungpook National University Hospital from March to September 2011. Results:The mean age was 7.5±3.4 years (M:F=5:3). Chief complaints included abnormal movement during sleep (n=5, 71.4%), leg pain (n=1, 14.3%), and headache (n= 1, 14.3%). Three showed inattention or hyperactivity, and one patient was taking medication for attention deficit hyperactivity disorder (ADHD). Six (85.7%) had sleep disturbance, and family history for RLS was positive in 3 (42.9%). Three patients (42.9%) showed a periodic limb movement index of 5 or more per hour of sleep that was compatible with supportive criteria of RLS. Serum testing, including a complete blood count, iron, total iron binding capacity, and ferritin, was performed. Among 5 children who demonstrated iron deficiency, 1 showed very low ferritin of 7 ng/mL, and after oral iron supplementation (3 mg/kg/day) over 1 month, there was dramatic improvement in leg pain and daytime behavior. Two patients who underwent treatment with pramipexole (0.125 mg) also had much improvement in sleep onset and daytime behavior. Conclusion:RLS can have a serious impact on quality of life in pediatric patients, so we need to find the children with RLS. Iron repletion therapy is effective for the patient with RLS who shows iron deficiency. In addition, use of a dopamine agonist is an effective treatment option for pediatric RLS.
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