Dr Lucio D’Anna is a Consultant Neurologist at the Department of Stroke & Neurosciences at Imperial College London NHS Trust. He is also Honorary Senior Lecturer at the Division of Brain Sciences, Imperial College London.
RLS Clinic led by Professor K Ray Chaudhuri
Restless legs syndrome (RLS), also known as Willis Ekbom disease (WED), is a common sensorimotor disorder characterised by an uncontrollable urge to move certain parts of the body, in particular the lower limbs which is initiated or aggravated during inactivity or rest and is mostly worse at nighttime. The presentation of the condition spans several specialties including neurology (movement disorders), sleep disorders, neuropsychiatry as well as presentations to haematology, nephrology and rheumatology.
Thomas Willis first described RLS in the seventeenth century, although there exist references to RLS in ancient Chinese and Greek literature. Karl Ekbom first used the term ‘Restless Legs Syndrome’ in 1945.
Restless legs syndrome is poorly recognized in the UK and is widely misdiagnosed. Treatment is often inadequate leading to poor sleep and its consequences. Over 1 million people may suffer from RLS in the UK and at least in 1/3 the condtion is severe needing specialist treatment and pathway.
Professor K Ray Chaudhuri and team:
Professor K Ray Chaudhuri recognized the need for specialized management of RLS and wil Eileen Gill formed RLS:UK in late 1990’s. This developed into a charity called RLS:UK /Ekbom Syndrome Association society later in 2010. Professor Chaudhuri has written two textbooks on RLS including the first textbook on RLS with Professors Per Odin and Warren Olanow.
He has contributed to several European RLS initiatives as well as being part of American Academy of Neurogy Task force on RLS which have published their new guidelines on treatment of RLS in the Neurology journal. He is also the author of a GP guideline for RLS (https://www.guidelines.co.uk/neurology-/rls-uk-restless-leg-syndrome-guideline/25) adopted by RLS:UK. In 2016 he was awarded the Andrew Wilson prize for services to people with RLS in the UK by RLS:UK.
Pathway for management of RLS in the clinic:
All patients referred for management of RLS in the clinic receive a specific pathway driven management plan.
- Pre assessment with health questionnaire
- RLS severity scale assessment
- RLS nonmotor symptoms assessment
- Anxiety and depression assessment
Patients are screened if they have had serum ferritin, vitamin B12, folate, haemoglobin and thyroid function tests. Once a diagnosis is confirmed after alternative diagnosis are excluded (positional discomfort, nocturnal cramps, PLM, radiculopathy, peripheral neuropathy), patients are then given full management advise with sleep hygiene and also a neuropsychiatry intervention if required by a specialist.
Additional tests offered if required are:
- Polysomnography in a sleep laboratory skilled in RLS management
- Nerve conduction studies if required
- Management of generalized anxiety state (often co existing with RLS)
- Pain management if painful variant of RLS
Treatment follows licenced and unlicensed treatment ( if the first option fails) and sometimes combined therapies. Management may follow a pathway as per the below image.
There are two recognised forms of RLS:
- Primary or idiopathic RLS has no known cause and usually begins before 40–45 years of age. It is often genetically linked and it is likely that another family member may also share the condition. Primary RLS can come and go, sometimes for months on end, and often gets worse with age.
- Secondary RLS often has a sudden onset and is usually associated with another medical condition (e.g. iron deficiency, anaemia) or the use of certain drugs. Several medications are ale to ameliorate RLS symptoms, however, many people living with RLS are misdiagnosed or not diagnosed at all.
RLS affects the legs but can affect the arms, head, and other parts of the body. Moving the affected body part can temporarily suspend the sensations associated with RLS, thereby providing temporary relief. RLS can cause considerable discomfort during waking hours, particularly when the patient is in a relaxed state.
However RLS is usually most acutely experienced in the evening or at night when people are trying to sleep. RLS can lead to long sleepless nights and daytime fatigue and invariably impacts on the quality of life of the patient, including their employment, and those close to them.
At Dementech Neuroscience, our team of clinicians can provide rapid and accurate diagnosis of this disease.
Diagnosis of RLS or PLMD
At Dementech Neurosciences, we offer the right treatment and management. Moreover, we offer the opportunity to participate in clinical trials testing novel pharmacological intervention, before they become available to the public, aiming to treat and delay the progression of the disease.