Denise Sharon

Quality measures for the care of adult patients with restless legs syndrome

ABSTRACT The American Academy of Sleep Medicine (AASM) commissioned several Workgroups to develop quality measures for the care of patients with common sleep disorders, including adults with restless legs syndrome (RLS). Using the AASM process for quality measure development, the RLS Work-group developed three target outcomes for RLS management, including improving the accuracy of diagnosis, reducing symptom severity, and minimizing treatment complications. Seven processes were developed to support these outcomes. To achieve the outcome of improving accuracy of diagnosis, the use of accepted diagnostic criteria and assessment of iron stores are recommended. To realize the outcome of decreasing symptom severity, routine assessment of severity and provision of evidence-based treatment are recommended. To support the outcome of minimizing treatment complications, counseling about potential side effects and assessing for augmentation and impulse control disorders, when indicated, are recommended. Further research is needed to validate optimal practice processes to achieve best outcomes in adult patients with RLS.

Nonpharmacologic Management of Restless Legs Syndrome (Willis-Ekbom Disease): Myths or Science

The nonpharmacologic management of patients with restless legs syndrome (RLS) is an important part of the treatment. It can represent the entire treatment or it can be used as an adjuvant to pharmacologic options. The limited number of controlled studies allowed for a plethora of pseudoprofessional recommendations. Some of these suggestions may have a grain of truth and some are utterly dangerous. This review discusses the different potential treatments for RLS to facilitate the design of a tailored program for specific patients. Another goal of this review is to prompt the researcher to investigate some of the laymen suggestions.

Managing Concurrent Medications

Managing concurrent medications is a balancing act and in the case of RLS, with very limited evidence-based guidelines. It compels the physician to consider the most appropriate treatment for each of the disorders with its own symptomatology, as well as the possible interactions with other conditions, medications, age and person specific parameters. RLS is a lifetime condition, implying the need to adapt concurrent medications to the current patient condition. It is also a disorder with a natural progression that can compound the effects of some concurrent medications. It is therefore, important to regularly review medications’ lists, to devise individual treatment plans and to alert the patients and the other providers to possible interactions.

Restless Legs Syndrome and Sleep Related Movement Disorders

cl in ic s. co m This issue of Sleep Medicine Clinics highlights the current understanding of Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WED), sleep bruxism, leg cramps, and hypnic jerks—all part of sleep-related movement disorders. These pathologic entities are characterized by simple, usually stereotyped movements that interfere with the ability to achieve or maintain sleep. As such, their diagnosis and management may fall between the cracks of specializedmedicine. Frequently, patients transition between primary care, neurology or movement specialists, and sleep medicine and pain specialists. These transitions prolong the time elapsed between the initial symptoms and the diagnosis, sometimes up to 12 years, as mentioned in the article by Simakajornboon, Dye, andWalters onRLS/WEDandgrowingpains in children and adolescents. RLS is included with sleep-related movement disorders but might be also considered as an exception to this category. RLS is not diagnosed during sleep, but it can affect sleep. The patient typically engages in walking or nonstereotyped movements to ease the urge to move the legs, arms, or other body parts. The name itself has been an issue of debate lately. Karl-Axel Ekbom coined the expression of restless legs in his doctoral thesis in 1945 when he described the movement disorder as we know it today. However, arms or other body partsmay presentwith similar symptoms. Therefore, even though the symptoms typically start in the legs, it is not all