Prevalence of Restless Legs Syndrome in Migraine Patients: A Case-Control Study. Analysis of Risk Factors for Restless Legs Syndrome in Migraine Patients.

BACKGROUND: Restless legs syndrome (RLS) is a sensorimotor disorder. It can be idiopathic, associated to other diseases or to pharmacologic treatments. RLS has been reported to occur more frequently in migraine patients, but a clear pathogenetic link seems still under debate. We aimed to evaluate RLS prevalence in migraine, impact on sleep quality and the main clinical determinants of this association. METHODS: Migraine patients and age- and sex-matched controls were enrolled from 1st January 2011 to 30th December 2012. Migraine and RLS diagnosis complied with already published clinical criteria. Medical and pharmacological histories, as well as structured questionnaires were collected. RESULTS: RLS was found in 29/180 (16.1%) patients and 11/180 (6.1%) controls. The odds ratio (OR) for RLS was 2.95 (CI 95%, 1.42-6.11). Among migraine patients, after adjustment for possible confounding factors, familial history (OR 3.863, CI 1.076-13.873), and serotoninergic overload (OR 3.654, CI 1.347-9.916) were significantly associated with RLS occurrence. Pittsburgh Sleep Quality Index score was higher in migraine patients with RLS than in subjects without RLS. CONCLUSIONS: The confirmed association between migraine and RLS might be because of familial predisposition and to serotoninergic drugs effect, possibly interfering with the balance between dopaminergic and serotoninergic pathways.

Restless legs syndrome in dialysis patients: a comparison between hemodialysis and continuous ambulatory peritoneal dialysis.

Restless legs syndrome (RLS) is common in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). A few studies so far have investigated RLS prevalence in ESRD patients undergoing continuous ambulatory peritoneal dialysis (CAPD). The aim of this study was to compare the prevalence, characteristics, consequences and predictors of RLS between HD and CAPD patients. We recruited 58 HD and 28 CAPD patients. A neurologist expert in sleep medicine performed RLS diagnosis during a face-to-face interview. The prevalence of RLS was slightly higher in HD than in CAPD patients (19 vs. 10.7%). RLS appeared after the onset of kidney complaint in HD patients; in contrast, in CAPD patients RLS preceded the occurrence of renal disease. Five HD patients reported that RLS symptoms occurred throughout the dialysis session. HD patients with RLS(+) had a higher mean number of HD sessions per week and a longer mean duration of HD session than the RLS(-) ones. Prevalence of females was significantly higher in CAPD patients with RLS(+) than in the RLS(-) ones. RLS frequently affects both HD and CAPD patients. RLS impaired sleep in both groups, but use of dopaminergic agents was uncommon in our sample. Dialysis schedule was associated with RLS in HD patients, while female sex was related to RLS in CAPD patients. Awareness concerning RLS identification and treatment in HD and CAPD patients is recommended.

Gabapentin enacarbil in restless legs syndrome.

Restless legs syndrome (RLS) is a sleep-related movement disorder with a high prevalence in the general population. Patients affected by a severe form of the disorder may develop comorbidities, such as psychological distress, cognitive dysfunction and cardiovascular diseases; these patients require pharmacotherapy. Dopamine agonists represent the first line treatment for RLS patients but, if adverse events such as compulsive behaviors and augmentation occur, the pharmacological approach should be modified. Gabapentin is a GABA analogue used in the treatment of seizures and pain syndromes. This drug has an unfavorable pharmacokinetic profile; the prodrug gabapentin enacarbil was developed to overcome this limitation. Unlike oral gabapentin, gabapentin enacarbil shows no evidence of saturation and exposure to gabapentin is dose proportional. The extended release formulation of gabapentin enacarbil has the characteristics of an optimal drug therapy. Doses from 1200 to 1800 mg/day of gabapentin enacarbil appear effective in treating RLS after only a few days of treatment. The most frequently reported adverse events associated with gabapentin enacarbil are dizziness and somnolence, which are transient and of mild intensity. Further studies are required to confirm the long term efficacy and safety of gabapentin enacarbil on the symptoms of RLS.