하지불안증후군의 진단과 치료
Diagnosis and Treatment of Restless Legs Syndrome
2
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
Restless legs syndrome (RLS) is a neurological disorder characterized by an irresistible urge to move one's body to stop uncomfortable or odd sensations. It most commonly affects the legs. Moving the affected body part, such as walking or stretching provide relief the urge to move the legs and any accompanying unpleasant sensation partially or totally. RLS is relatively common, affecting 5 to 15 % of the general population, with prevalence rates increasing alongside age. Restless legs syndrome can lead to sleep-onset or sleep-maintenance insomnia, and occasionally excessive daytime sleepiness, all leading to significant morbidity. Dopaminergic systems are known to be strongly related with RLS that are closely linked to CNS iron homeostasis. Besides defective dopaminergic system that is closely related with iron metabolism, genetic factors play a role in early-onset individual with a positive family history. The diagnosis can be made based on the symptom characteristics, differential diagnosis is important because many conditions could mimic RLS symptoms. Dopamine agonists (DAs) have been considered the first-line therapy, but with the growing appreciation of problems associated with long-term treatment, particularly augmentation and impulse control disorder, alpha-2-delta drugs, such as gabapentin, are now considered the first line of treatment in patients with troublesome RLS. In more severe cases, a combination therapy may be required.
Abstract
Restless legs syndrome (RLS) is a neurological disorder characterized by an irresistible urge to move one's body to stop uncomfortable or odd sensations. It most commonly affects the legs. Moving the affected body part, such as walking or stretching provide relief the urge to move the legs and any accompanying unpleasant sensation partially or totally. RLS is relatively common, affecting 5 to 15 % of the general population, with prevalence rates increasing alongside age. Restless legs syndrome can lead to sleep-onset or sleep-maintenance insomnia, and occasionally excessive daytime sleepiness, all leading to significant morbidity. Dopaminergic systems are known to be strongly related with RLS that are closely linked to CNS iron homeostasis. Besides defective dopaminergic system that is closely related with iron metabolism, genetic factors play a role in early-onset individual with a positive family history. The diagnosis can be made based on the symptom characteristics, differential diagnosis is important because many conditions could mimic RLS symptoms. Dopamine agonists (DAs) have been considered the first-line therapy, but with the growing appreciation of problems associated with long-term treatment, particularly augmentation and impulse control disorder, alpha-2-delta drugs, such as gabapentin, are now considered the first line of treatment in patients with troublesome RLS. In more severe cases, a combination therapy may be required.
참고문헌 (32)
- "Restless legs syndrome: detection and management in primary care. National Heart, Lung, and Blood Institute Working Group on Restless Legs Syndrome", Am Fam Physician, 62, pp.108~114 (2000)
- Cho YW, "Epidemiology of restless legs syndrome in Korean adults", Sleep, 31, pp.219~223 (2008)
- Berger K, "Sex and the risk of restless legs syndrome in the general population", Arch Intern Med, 164, pp.196~202 (2004)
- Hattan E, "Is there a higher risk of restless legs syndrome in peripheral neuropathy?", Neurology, 72, pp.955~960 (2009)
- Evidente VG, "How to help patients with restless legs syndrome. Discerning the indescribable and relaxing the restless", Postgrad Med, 105, pp.59~61 (1999)
- Cesnik E, "Transient RLS during pregnancy is a risk factor for the chronic idiopathic form", Neurology, 75, pp.2117~2120 (2010)
- Takaki J, "Clinical and psychological aspects of restless legs syndrome in uremic patients on hemodialysis", Am J Kidney Dis, 41, pp.833~839 (2003)
- Lane RM, "SSRI-induced extrapyramidal side-effects and akathisia:implications for treatment", J Psychopharmacol, 12, pp.192~214 (1998)
- Allen RP, "Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health", Sleep Med, 4, pp.101~119 (2003)
- Abetz L, "Evaluating the quality of life of patients with restless legs syndrome", Clin Ther, 26, pp.925~935 (2004)
- Ekbom K, "Restless legs syndrome", J Intern Med, 266, pp.419~431 (2009)
- Kim JB, "Psychosomatic symptom profiles in patients with restless legs syndrome", Sleep Breath, 17, pp.1055~1061 (2013)
- "American Academy of Sleep Medicine. The International Classification of Sleep Disorders" (2005), Westchester
- Eun M-Y, "Comparison of Sleep Quality and Polysomnographic Findings in Patients with RLS according to the Presence of Periodic Limb Movements during Sleep", J Korean Sleep Res Soc, 8, pp.4~8 (2012)
- Allen RP, "Restless legs syndrome: a review of clinical and pathophysiologic features", J Clin Neurophysiol, 18, pp.128~147 (2001)
- Winkelman JW, "Considering the causes of RLS", Eur J Neurol, 13(3), pp.8~14 (2006)
- Connor JR, "Profile of altered brain iron acquisition in restless legs syndrome", Brain, 134, pp.959~968 (2011)
- Trenkwalder C, "Recent advances in the diagnosis, genetics and treatment of restless legs syndrome", J Neurol, 256, pp.539~553 (2009)
- Hening WA, "The four diagnostic criteria for Restless Legs Syndrome are unable to exclude confounding conditions ("mimics")", Sleep Med, 10, pp.976~981 (2009)
- Hening WA, "The Johns Hopkins telephone diagnostic interview for the restless legs syndrome: preliminary investigation for validation in a multi-center patient and control population", Sleep Med, 4, pp.137~141 (2003)
- Gamaldo CE, "Restless legs syndrome: a clinical update", Chest, 130, pp.1596~1604 (2006)
- Hening WA, "Restless Legs Syndrome", Curr Treat Options Neurol, 1, pp.309~319 (1999)
- Ferreri F, "Neurophysiological investigations in restless legs syndrome and other disorders of movement during sleep", Sleep Med, 5, pp.397~399 (2004)
- Giannaki CD, "A single-blind randomized controlled trial to evaluate the effect of 6 months of progressive aerobic exercise training in patients with uraemic restless legs syndrome", Nephrology Dialysis Transplantation, 28, pp.2834~2840 (2013)
- Mitchell UH, "Medical devices for restless legs syndrome - clinical utility of the Relaxis pad", Ther Clin Risk Manag, 11, pp.1789~1794 (2015)
- Montplaisir J, "Gomez-Mancilla B. Restless legs syndrome improved by pramipexole - A double-blind randomized trial", Neurology, 52, pp.938~943 (1999)
- Ondo W, "Ropinirole for restless legs syndrome", Movement Disorders, 14, pp.138~140 (1999)
- Giorgi L, "Ropinirole in Patients With Restless Legs Syndrome and Baseline IRLS Total Scores >= 24: Efficacy and Tolerability in a 26-Week, Double-Blind, Parallel-Group, Placebo-Controlled Study Followed by a 40-Week Open-Label Extension", Clinical Therapeutics, 35, pp.1321~1336 (2013)
- Baldwin CM, "Rotigotine transdermal patch - In restless legs syndrome", Cns Drugs, 22, pp.797~806 (2008)
- Garcia-Borreguero D, "Diagnostic standards for dopaminergic augmentation of restless legs syndrome: report from a World Association of Sleep Medicine-International Restless Legs Syndrome Study Group consensus conference at the Max Planck Institute", Sleep Med, 8, pp.520~530 (2007)
- Manconi M, "Dissociation of periodic leg movements from arousals in restless legs syndrome", Ann Neurol, 71, pp.834~844 (2012)
- Bogan RK, "Long-term Maintenance Treatment of Restless Legs Syndrome With Gabapentin Enacarbil: A Randomized Controlled Study", Mayo Clinic Proceedings, 85, pp.512~521 (2010)