Restless arms syndrome: prevalence, impact, and management strategies

Abstract

This literature review focuses on restless arms syndrome (RAS), an upper limb variant of restless legs syndrome (RLS). RLS, also known as Willis-Ekbom disease, is a frequently occurring neurological disorder characterized by an irresistible urge to move the lower limbs often accompanied by unpleasant sensations in the legs, worsened at rest and in the evening, improved by movement. Extension of leg restlessness to the upper limbs is frequently reported in typical patients who had RLS only in the legs and usually occurs later in the course of RLS, restlessness remaining most invalidating in the lower limbs. In RAS, the arms are predominantly affected with little or no involvement of the legs. Cases of restless shoulders syndrome or periodic arm movements without arm restlessness were not considered. A total of 9 articles with 10 cases were included and analyzed for the adherence to the five essential diagnostic criteria of the International RLS Study Group (IRLSSG) classification, as well as for the additional supportive features. All of the reported cases were classified as having definite RAS. The clinical history and disease evolution of two previously reported patients were completed and updated. Overall, the clinical picture of RAS does not differ from that of RLS, except for the symptoms localization on the upper limbs. Underlying mechanisms of the spread of RLS to upper limb restlessness and of RAS remain unknown. Whether RAS is a phenotypic variant of RLS or a separate entity needs further investigations. RAS likely remains underdiagnosed and according to IRLSSG diagnostic criteria RAS should be considered when RLS-like symptoms are present in one or both arms, especially when they have a circadian pattern and are improved by movement and dopaminergic therapy. Clinicians should be aware of this rare condition, especially as treatment using dopaminergic agonists proves to be very efficient.

Keywords: RLS equivalent; RLS variant; Willis-Ekbom disease; periodic arm movements; restless upper limb; restlessness of upper extremities.

Figure 1

Dopaminergic treatment response in patient number 7. Hypnograms of patient number 7 having vPSGs with a first night under the habitual dosage of 0.27 mg pramipexole (A), followed by vPSG on the second night after an abrupt drug withdrawal causing very severe sleep onset and maintenance insomnia with sleep loss due to a major rebound of restlessness (B) and a third night of vPSG after reintroduction of pramipexole 0.27 mg relieving symptoms and permitting the patient to recover sleep (C). Abbreviation: vPSG, videopolysomnography