Restless legs and restless legs-like syndrome

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  • Letter to the Editor

    Restless legs and restless legs-like syndrome

    To the Editor:

    Four mandatory essential diagnostic criteria have been

    suggested for the diagnosis of restless legs syndrome (RLS)

    [1]. Supportive diagnostic criteria (positive family history,

    These data suggest the existence of RLS-like syndrome

    associated with depression and anxiety, in whom essen-

    tialbut not supportivecriteria for RLS are fulfilled and

    in whom treatment with antidepressants is helpful. Our

    observations prove the value of supportive diagnostic RLS

    criteria and confirm the high frequency of psychiatric

    [3] Bassetti CL, Mauerhofer D, Gugger M, et al. Restless legs syndrome: a

    clinical study of 55 patients. Eur Neurol 2001;45:6774.

    E-mail address: claudio.bassetti@usz.ch

    Sleep Medicine 7 (2006) 534

    www.elsevier.com/locate/sleepresponse to dopaminergic therapy, periodic limb move-

    ments in sleep) corroborate the diagnosis in cases with

    diagnostic uncertainty [1]. The presence of psychiatric

    symptoms was noted in patients with restless legs by

    Wittmaack in 1861, who coined the term anxietas tibiarum

    [2]. A recent study suggested a high frequency of

    psychiatric symptoms in RLS [3].

    In this retrospective study, we analyzed 74 consecutive

    RLS patients (38 women, mean ageGSD 57G15 years)from our sleep center (20032004). We differentiated

    patients with classical RLS (RLS-C with all essential

    criteria and R2 supportive criteria) from those with RLS-like syndrome (RLS-L with all essential criteria but no

    supportive criteria).

    There were 66 (89%) patients with RLS-C and 8 (11%)

    with RLS-L. RLS-L patients were younger (51G13 vs.63G14 years, PZ0.05) and more commonly female (75 vs.48%, PZ0.04). Psychiatric evaluations were performed inpatients, in whom a psychiatric disorder was suspected.

    Abnormalities were found in 17 (26%) RLS-C patients and

    in five (63%) RLS-L patients (PZ0.03, usually anxietyand depression). In 7 of 8 RLS-L patients, improvement of

    RLS was achieved with antidepressants. Pain complaints

    and restless lips [3] were more frequent in RLS-C (no

    quantification available).Received 31 August 2005; Received in revised form 20

    April 2006; Accepted 16 May 2006C.L. Bassetti*

    U. Kretzschmar

    E. Werth

    C.R. Baumann

    Neurologische PoliklinikUSZ, Frauenklinikstrasse

    26, 8091 Zurich, Switzerlandsymptoms in RLS. More studies are needed to understand

    whether or not (as we believe) this RLS-like syndrome

    belongs to the spectrum of RLS.

    References

    [1] Allen C, Picchietti D, Hening D, et al. Restless legs syndrome:

    diagnostic criteria, special considerations, and epidemiology. Sleep

    Med 2003;4:10119.

    [2] Wittmaack T. Pathologie und Therapie der Sensibilitatsneurosen.

    Leipzig: Schafer, 1861.1389-9457/$ - see front matter q 2006 Elsevier B.V. All rights reserved.

    doi:10.1016/j.sleep.2006.05.006

    * Corresponding author. Tel.: C11 41 1 255 55 03; fax: C11 41 1 255

    4649.

    Letter to the EditorReferences