The Burden of Restless Legs Syndrome

Karl Doghramji, MD and Paul Doghramji, MD

Karl Doghramji, MD
Professor of Psychiatry and Human Behavior
Jefferson Medical College
Director of the Sleep Disorders Center
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania

Paul P. Doghramji, MD, FAAFP
Family Physician, Collegeville Family Practice
Medical Director, Ursinus College
Collegeville, Pennsylvania

A 45 year old woman visited her doctor complaining of extreme tiredness that she has been consistently experiencing for 2 to 3 years. At the time, she was not taking any medication, and both her past medical history and physical exam were unremarkable. She commented to the physician that she thought there might be a metabolic issue, such as iron or vitamin B12 deficiency, or Lyme disease. The results of her lab tests demonstrated a hemoglobin level of 9.9 and a ferritin level of 4, indicating iron-deficiency anemia. Treatment with iron supplementation was able to raise her iron level to within normal limits, but her daytime sleepiness persisted. A thorough sleep history revealed difficulty falling asleep at night and waking up feeling unrefreshed. Upon further questioning, the patient reported feeling an uncontrollable urge to move her feet that began every evening and intensified as the night progressed. She was then given the diagnosis of restless-leg syndrome and started on antidepressant therapy, which helped relieve her symptoms as the dose was titrated upwards. Here, Dr. Karl Doghramji and Dr. Paul Doghramji discuss the etiology of restless-leg syndrome, the importance of distinguishing primary from secondary causes, and the most effective treatment modalities.

References

Connor JR, Ponnuru P, Wang XS, Patton SM, Allen RP, Earley CJ. Profile of altered brain iron acquisition in restless legs syndrome. Brain. 2011;134:959-968.
Duffy JF, Lowe AS, Silva EJ, Winkelman JW. Periodic limb movements in sleep exhibit a circadian rhythm that is maximal in the late evening/early night. Sleep Med. 2011;12:83-88.
Garcia-Borreguero D, Stillman P, Benes H, et al. Algorithms for the diagnosis and treatment of restless legs syndrome in primary care. BMC Neurol. 2011;11:28

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