• Primary: autosomal dominant; chr 12q pseudo-dominant; F=M; any age
• Secondary: iron def w/without anemia; TCA; stimulants; Dopamine antagonist; Low serum ferritin levels or iron deficiency with without anemia TCA; stimulants; Dopamine antagonist; lithium; SSRIs;  Renal failure, Pregnancy, Peripheral neuropathies, myelopathy; postgastrectomy; Fibromyalgia; PVD; thyroid dis; varicose veins; smoking, lithium; SSRIs; pregnancy; myelopathy; End-stage renal disease; postgastrectomy; Fibromyalgia; peripheral neuropathy; PVD; thyroid dis; varicose veins; smoking;
• Avoid: caffeine; alcohol; Reglan; antiemetics; heat; fatigue; passively sitting;
  • Prevalence: 15-25 %
• D/D: leg cramps; diabetic polyneuropathy; arthritis; akathesia; burning feet synd; painful legs moving toes synd; cramps;
• Diag criteria: urge to move legs/limbs; unpleasant sensation in legs; worsen during periods of rest / inactivity; relieved by movement; worse in the   evening or  night;
• associated features: responsive to dopaminergic; periodic limb movements during waking or sleep; + F/H > 60%
• S/S: creepy crawly legs (occ in arms / trunk); paresthesia; at night or at rest; all relieved with movements; overwhelming urge to move; involuntary periodi jerking; nocturnal myoclonus; sleep disturbance; fatigue; restlessness
• Pointers: other areas involve i.e. arms; 80% have PLMS; provoked by immobility;  incident before age 30; above 80 yrs; 50% arms; loose iron 2-4 times faster; Dopamine agonist produce less augmentation & rebound; 85% reduction of  S/S considered successful Rx; >60% progressive dis; up to 40% have 1st degree relative;
• Path: Subcortical dysfunction due to decrease dopamine & brain iron; ? Opiod; SPECT: striatal dopamine D2 receptor binding; low ferritin level in serum/CSF
• LABS: CBC; iron; serum ferritin; transferring saturation; TIBC; chemistry panel with BUN/cr; AlcHb; FBS; folate; testosterone level; magnesium;
• Rx: clinical Dx is sufficient for starting Rx; all meds are off-label;
  • Mild to mod exercise; sleep hygiene, nutrition; TENS; mental stimulation; avoid stimulants; Dopaminergics: Sinemet
  • Dopamine agonists: 1st line of Rx. Requip; Mirapex; Pergolide; BromocriptinAnticonvulsants: Neurontin; Tegretol; Benzo: Clonazepam
  • Others: Baclofen; Clonidine; mild opiod hs; iron Ambien

   By Dr. Kazmi; MD. 4-11-2000                  Website:  pdrtv.com