Breakthrough symptoms during the daytime in patients with restless legs syndrome (Willis-Ekbom disease)

• Published in: Sleep medicine 2012-02, Vol.13 (2), p.151-155
• Main Authors: Tzonova, D, Larrosa, O, Calvo, E, Granizo, J.J, Williams, A.-M, de la Llave, Y, García-Borreguero, D
• Format: Article
• Language: English
• Subjects: Adult; Aged; Benzothiazoles - therapeutic use; Circadian Rhythm - physiology; Clonazepam - therapeutic use; Cross-Sectional Studies - statistics & numerical data; Daytime symptoms; Dopamine Agonists - therapeutic use; Female; GABA Modulators - therapeutic use; Health Surveys - statistics & numerical data; Humans; Indoles - therapeutic use; Male; Middle Aged; Neurology; Prevalence; Restless legs syndrome; Restless Legs Syndrome - drug therapy; Restless Legs Syndrome - epidemiology; Restless Legs Syndrome - physiopathology; Sleep Medicine; Tetrahydronaphthalenes - therapeutic use; Thiophenes - therapeutic use; Treatment Outcome
• ISSN: 1389-9457; 1878-5506
• DOI: 10.1016/j.sleep.2011.09.015

Abstract Background It is often assumed that most patients with restless legs syndrome (RLS) only experience symptoms at night. However, previous studies have estimated the prevalence of daytime symptoms to be 10–60%. This study sought to investigate the prevalence and pattern of daytime symptoms in patients with moderate-to-severe RLS. Methods Observational, cross-sectional investigation. A self-administered questionnaire was sent out, on a random basis, to 310 patients with RLS by the Spanish RLS patient support group. Only individuals with a confirmed diagnosis of RLS were included in the final survey. Results In total, 224 individuals were included in the survey (response rate 72%). Over 55% of patients reported daytime crises on most (>3) days of the week, and 41% suffered daytime symptoms on a daily basis. These breakthrough crises were characterized by unexpected and sudden symptoms and were frequently precipitated by a reduction in daytime activity. The mean severity of these crises on a visual analogue scale (range 0–10) was 6.8 (standard deviation 2.1), and they had a major impact on quality of life. The prevalence of breakthrough crises was related to duration of illness but not to duration of treatment. Conclusion This study suggests that breakthrough crises are common in moderate-to-severe RLS and have a negative effect on quality of life. More studies are needed to investigate whether breakthrough crises reflect disease progression or, at least for those patients undergoing dopaminergic treatment, whether they represent an early indication of RLS augmentation.