Doctors Talk about RLS

"… in the vast majority of patients that I see with restless legs syndrome, the time from the initial presentation of symptoms until the diagnosis was established is usually several decades."

Alon Avidan, MD, MPH
Associate Director, Sleep Disorders Center
Director, UCLA Neurology Clinic
UCLA, Department of Neurology
Los Angeles, CA

1. RLS can be difficult to diagnose

AVIDAN:  My name is Alon Avidan.  I'm a neurologist, practicing in sleep medicine here at UCLA.  I've been in practice now for the last 9 years. And under my care, I currently have about 25 patients with restless legs syndrome. … in the vast majority of patients that I see with restless legs syndrome, the time from the initial presentation of symptoms until the diagnosis was established is usually several decades.

2. RLS is a real and serious medical condition

AVIDAN:  We like to use the phrase that “restless legs syndrome is the most common diagnosis that physicians have never heard of,” meaning that the condition is there, it is real, but unfortunately, we're not doing as good a job diagnosing and treating it. And when we validate their symptoms and when we tell them that there is a name behind their symptoms, a common name that can identify the symptoms as a medical illness, they have a sense of relief and a sense that finally there is an answer.

3. Treating RLS with MIRAPEX

AVIDAN: . . . I've had in my practice 5 patients who began on MIRAPEX with very nice improvement.  And it is fascinating because some patients, as long as they take the drug, sometimes as soon as they take the drug in as little as one night they will report an improvement. And, in fact, the vast majority of patients use the drug continuously during the day or during the evening specifically to address symptoms as they occur with very nice satisfactory results.

“… when you actually make the diagnosis and be able to give them a treatment that makes a difference, everybody wins in that situation.”

Stephon Brunton, MD
Clinical Professor
Department of Family Medicine
University of California, Irvine
University of Southern California, Los Angeles
Director, Faculty Development
Cabarrus/North-East Medical Center
Family Medicine Residency
Charlotte, NC

1. RLS can have a significant impact on daily activities

STEPHEN BRUNTON, MD:  I'm Stephen Brunton. I'm a family physician. I've been in practice about 34 years. I work in a family medicine training program, so I see patients directly as well as supervise the residents' patients. I think the problem with RLS is people assume that it's a trivial condition. But if you look at the impact that it has on patients' lives, it really is very disruptive. It impacts the way they feel the next day. So not only does it have an effect on the person themselves, but it also has effect on their friends, family, and all the interactions which they can have.

2. RLS is a real and serious medical condition

STEPHEN BRUNTON, MD:  Sometimes, if people have a problem explaining what's going on in their legs, I might suggest to them that they feel like they have this creepy-crawly, or a tingling, in their legs, and do they feel that they need to move their legs? That's often what will give the impression that maybe it is restless legs, that is, they need to move it to get some relief. This is a much more common condition than I think most people even realize, and I also don't think that people recognize how much of an impact it can have on certain patients' lives. And when we understand that, not only that it has an effect on their ability to sleep but all the impact that can have in terms of their daily functioning, and maybe increasing problems with depression and just ability to work, then we're more likely to ask the questions and more likely to intervene with those patients.

3. Treating RLS with MIRAPEX

STEPHEN BRUNTON, MD:  MIRAPEX, as a dopamine agonist, is certainly one of the options we offer patients. Patients have found that, when their symptoms are controlled, they're able to get back into a normal way of life. It's very satisfying to see patients who've had symptoms for years and gone undiagnosed. And when you actually make the diagnosis and be able to give them a treatment that makes a difference, everybody wins in that situation.

"RLS is often misdiagnosed because patients do have trouble communicating it.  They don't have a good word to describe it often."

Mark Buchfuhrer, MD
Pulmonologist and Sleep Medicine Specialist
Downey Regional Medical Center
Downey, CA
Medical Director
SomnoMedix Sleep Disorder Center
Lakewood, CA

1. Many doctors are not aware that RLS is a serious medical condition

BUCHFUHRER:  I'm Dr. Mark Buchfuhrer and I've been in practice for over 25 years.  I'm a general internist who also specialized in pulmonary disorders and sleep medicine.  In my practice I've seen over well over 500 restless leg patients, both in my practice personally and in consultation. When it's left untreated, restless legs, which tends to cause a lot of problems with insomnia, severe sleep deprivation, can lead to a lot of both mental and physical problems. Now that there's been a lot more education and publicity about restless legs, many doctors are becoming aware that this really is a serious condition worth taking care of and worth diagnosing and treating.

2. Symptoms and diagnosis of RLS

BUCHFUHRER:  When patients come in to doctors, the typical symptoms they come complaining of are of fatigue, not functioning well, not sleeping well.  Sometimes anxiety and depression, and sometimes pain in their legs.  They don't really have a good word for it.  So it's often hard for them to describe. RLS is often misdiagnosed because patients do have trouble communicating it.  They don't have a good word to describe it often. There's an awful lot of words that patients use.  Typically, patients will say they have the creepy crawlies. They have this urge to move their legs.

3. Treatment of RLS with MIRAPEX

BUCHFUHRER:  MIRAPEX, which is one of the dopamine agonists, has been a very helpful drug.  I've been using it for many years with great success.  It has very low side effects and it's very effective.  My overall experience with MIRAPEX has been very positive.  It's a medication that can be used with very low dose and works very, very well and both effectively and safe for most RLS patients.

"My patients have had excellent clinical benefit for RLS with the use of MIRAPEX."

Theresa Zesiewicz, MD
Associate Professor of Neurology
University of South Florida
Assistant Director, Parkinson's Disease and Movement Disorders Center
Tampa, FL

 

1. RLS is underdiagnosed and undertreated

THERESA ZESIEWICZ:  I'm Dr. Theresa Zesiewicz, and I'm an Associate Professor of Neurology at University of South Florida in Tampa. I'm a movement disorder specialist. I see anywhere from 2,500 to 3,000 patients a year, and I've probably seen 25,000 movement disorder patients in my career. I have diagnosed about 1,000 restless legs syndrome patients in my lifetime. Restless legs syndrome is one of the most common movement disorders in the world, and yet it is widely underdiagnosed and undertreated.

2. RLS is often misdiagnosed

THERESA ZESIEWICZ:  Restless legs syndrome may be misdiagnosed because if a sleep disruption is what the patient is complaining about, often that's what is being treated.… it's very important for physicians particularly to ask those patients who have problems with sleep whether their legs are bothering them at night, and whether they have the urge to move their legs.

3. Diagnosing and treating RLS

THERESA ZESIEWICZ: I routinely prescribe MIRAPEX to treat my patients who have moderate to severe restless legs syndrome. I'd estimate that 70 percent of my restless legs syndrome patients are taking MIRAPEX for their symptoms. My patients have had excellent clinical benefit for RLS with the use of MIRAPEX. They take it in low dose, it is very tolerable, it's very easy to take with a very easy titration.