Demographic and clinical characteristics of patients with restless legs syndrome in spine clinic

Abstract

Objective: The restless legs syndrome (RLS) is a common disorder affecting up to 5% to 15% of the general population, in which the incidence increases with age, and includes paresthesia in the legs. The purpose of this study is to investigate the incidence of RLS in spine center and to review clinical manifestations of this syndrome and its current treatments.

Methods: Over a period of a year, retrospective medical record review and lumbar magnetic resonance images were performed on 32 patients with RLS in spine clinic who were diagnosed by National Institutes of Health criteria. Affected limbs were classified as five. Two grading systems were used in the evaluation of neural compromises.

Results: The incidence of RLS was 5.00% (32/639). There were 16 males (50%) and 16 females (50%). The median age at diagnosis was 55.4 years (range, 25-93 years). There are no correlation between the affected limbs of RLS and neural compromises on the lumbar spine.

Conclusion: The RLS is a clearly common neurologic disorder of the limbs, usually the legs. The awareness of this syndrome can help reduce diagnostic error; thereby, avoiding the morbidity and expense associated with unnecessary studies or inappropriate treatments in RLS patients.

Keywords: Insomnia; Lumbar disc herniation; Pramipexole; Pregabalin; Restless legs syndrome; Spinal stenosis.

Fig. 1

We classified the affected limbs into five types. The symmetric distributions are as follows : Type A, below knees to feet (A); Type B, from proximal thigh to feet (B); Type C, both feet (C); Type D, both lower arms and lower legs (D); the asymmetric distribution is type E, including asymmetric severity with unusual localization (E).

Fig. 2

We summarized mean values of MRI grades for each type. Type B and D have extended symptoms compared with Type A, but neural compromise are not equal to clinical presentations. RFS : right foraminal stenosis, LFS : left foraminal stenosis, CS : central stenosis.

Fig. 3

Spine T2-weighted MR images (A : axial at L4-5) show a left foraminal disc herniation with stenosis. T2-weighted foraminal MR images (B : left side, C : right side) reveal that collapsed nerve root of the left L4-5 at the intervertebral foramen, grade 3 (arrow) and no obliteration of the right foraminal space, grade 0 in a 68-year-old female patient.