Legs bothering you? Well join the The White Noise Podcast as we pick the brain of Dr. Andy Berkowski, clinical associate professor and restless leg expert at the University of Michigan. Learn all about the diagnosis and management of restless legs syndrome. There is also a guest appearance by hepcidin, the bouncer at Club Ferritin.
CME credit link will be here when available
Show Notes – Season 1, Episode 4 – Restless legs syndrome
– Initial thoughts on case
14:00 – Diagnosis of restless legs syndrome
16:50 – Diagnostic criteria for restless legs syndrome
– Difficulties in diagnosis
– Key questions to ask in taking history
24:00 – Periodic limbs vs restless legs syndrome
28:30 – Pathogenesis of restless legs syndrome
– History of Willis-Ekbom disease
36:40 – Medications for restless legs syndrome
– PO vs IV iron supplementation
– Non pharmacologic therapies
– Medications that worsen restless leg syndrome
1:16:00 – Screening for restless legs syndrome
1:18:00 – Follow-up of restless legs syndrome patients
1:18:50 – Sleep apnea and restless legs syndrome
Augmentation: The process by which the symptoms of restless legs syndrome occur earlier in the day, become more severe, are less responsive to treatment, and spread to other parts of the body (e.g. arms and trunk), usually due to treatment with escalating doses of dopaminergic medications.
Restless legs syndrome: A condition characterized by an urge to move one’s legs (often accompanied by unpleasant sensations in the legs) that is most prominent at rest, partially or totally relieved by movement, and classically worse in the evening. The symptoms must not be better explained by another condition such as peripheral neuropathy.
Periodic limb movements of sleep: Periodic, repetitive, stereotyped limb movements that occur during sleep. American Academy of Sleep Medicine (AASM) scoring criteria require a minimum of 4 limb movements in series with 5-90 seconds between movements. Periodic limb movements of sleep are seen in the majority of patients with restless legs syndrome who undergo polysomnography.
Periodic limb movement disorder: A disorder characterized by more than 15 periodic limb movements per hour of sleep in adults (greater than 5 in children) that cause a significant sleep disturbance and/or functional impairment not better explained by a different disease entity.
Akathisia: An inner sense of restlessness and desire to move that is often caused by dopamine antagonist medications, is usually generalized (not limited to the legs), and is unlikely to be totally relieved by movement.
Diagnosis of restless legs syndrome:
Treatment of restless legs syndrome:
Listeners of this episode will able to recognize restless legs syndrome in the clinic and be familiar with treatment strategies.
After listening to this episode, listeners will be able to…
1. Recognize patients with restless legs syndrome disorder based on history.
2. Compare the different forms of iron supplementation, and formulate a therapeutic plan for the patient.
3. Describe the various treatments for restless legs syndrome.
4. Implement a treatment plan based on a patient’s specific needs.
5. Recognize patients undergoing augmentation, and formulate treatment plans.
6. Be familiar with the opioids used in management of restless legs syndrome.
7. Discuss the risks and benefits of different pharmacologic treatment options with the patient.
Dr. Berkowski's Suggested reading list.
restless legs syndrome"
White Paper on prevention and treatment of RLS by IRLSSG "Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis-Ekbom disease in adults and children: an IRLSSG task force report"Restless Legs Syndrome FoundationRestless Legs Syndrome, National Sleep FoundationRestless Legs Syndrome, American Thoracic Society Patient Education/Information SeriesThe Big Fat Surprise by Nina Teicholz Glass Game of Thrones The authors of The White Noise Podcast do not have any relevant financial disclosures.
