Restless legs syndrome [Sindrom nemirnih nogu]

Miletić, Vladimir and Relja, Maja (2011) Restless legs syndrome [Sindrom nemirnih nogu]. Collegium Antropologicum, 35 (4). pp. 1339-1347. ISSN 0350-6134

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Abstract

Being of the most frequent causes of insomnia, which in the end leads to chronic fatigue, inadequate performance of daily activities, and serious disruption of quality of living, restless legs syndrome (RLS) is nowadays not only a serious medical problem but a socio-economical one as well. Prevalence of the disorder in general population is estimated at 5 to 15%. Family history is positive in over 50% of idiopathic RLS patients which points to genetic basis of the disorder. The characteristics of the secondary or acquired form of RLS are symptoms that start later in life as well as a rapid progression of the disease. On the other hand, idiopathic RLS more often starts at a younger age and the prognoses are better. Over twenty disorders and conditions are brought in connection with secondary RLS. Although the cause of primary RLS is still unknown, there is a strong connection between central metabolism of iron as well as dopamine levels and RLS manifestation. A differential diagnosis of RLS includes a wide specter of motor and sensory disorders. Diagnosis is based on clinical features and the history of disease. To correctly diagnose idiopathic RLS one must first eliminate secondary causes of RLS and then also exclude any disorders with clinical features that mimic those of RLS. It has been estimated that some 20 to 25% of patients need pharmacological therapy. Best initial therapy is the application of nonergot dopamine agonists. Anticonvulsants, benzodiazepines and opioides can be given to patients who are refractory to dopaminergic therapy, those suffering from RLS with emphasized painful sensory component and those with RLS connected with insomnia.

Abstract in Croatian

Kao jedan od najčešćih uzroka nesanice, što u konačnici uzrokuje kroničan zamor, neadekvatno obavljanje dnevnih aktivnosti te ozbiljno narušavanje kvalitete života, RLS danas predstavlja ne samo važan medicinski već i sociološko- -ekonomski problem. Prevalencija se u općoj populaciji procjenjuje na 5–15%. Obiteljska anamneza pozitivna je u više od 50% oboljelih od idiopatskog RLS-a, što upućuje na genetsku podlogu ovog poremećaja. Početak simptoma u starijoj životnoj dobi i brza progresija obilježja su sekundarnog-stečenog oblika RLS-a, za razliku od idiopatskog RLS-a koji se prezentira u mlađih osoba i ima bolju prognozu. Više od 20 poremećaja i stanja dovodi se u vezu sa sekundarnim RLS- -om. Iako se uzrok primarnog RLS-a ne zna, postoji veza između središnjeg metabolizma željeza i razine dopamina s pojavom RLS-a. Diferencijalna dijagnoza sindroma nemirnih nogu obuhvaća širok spektar motornih i senzornih poremećaja. Dijagnoza RLS-a se postavlja na temelju kliničke slike i povijesti bolesti pri tome zadovoljavajući esencijalne i pomoćne kriterije. Ispravno postavljanje dijagnoze idiopatskog RLS-a zahtijeva u prvom redu isključivanje sekundarnih uzroka RLS-a, a potom i poremećaja koji svojom kliničkom slikom mogu oponašati RLS. Pretpostavlja se da 20–25% oboljelih od RLS-a zahtijeva farmakološko liječenje. Najboljom početnom terapijom smatra primjena ne-ergotinskih dopaminskih antagonista. Antiepileptici, benzodiazepini i opioidi mogu se primjeniti u bolesnika refraktornih na dopaminergičku terapiju, u RLS-u s naglašenom bolnom senzornom komponentom te RLS-u povezanom s nesanicom. S obzirom na učestalost bolesti, mogućnost dijagnosticiranja te djelotvornost liječenja ne samo neurolozi i psihijatri već i liječnici primarne zdravstvene zaštite moraju biti upoznati s prepoznavanjem i liječenjem ovog sindroma.

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