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RESTLESS LEG SYNDROME 26 mAR 1999 Restless Legs Syndrome (RLS) is poorly understood, insufficiently studied, and often misdiagnosed. I think that PD patients who report RLS may possibly at times confuse it with other movement disorders such as levodopa-induced dyskinesia or parkinsonian tremor. There is indeed a close relation between RLS and PD, as will be seen below. In any case the current (23 Mar 99) issue of Neurology contains 6 articles about RLS, which may illuminate the subject a little bit: Turjanski N it al; Neur 1999;52:932-937: RLS is a common disorder experienced by as much as 5% of the population. Positron Emission Tomography (PET) studies of striatal dopaminergic function in 13 RLS patients support the hypothesis of central dopaminergic dysfunction in RLS. Montplaisir J et al; Neur 1999;52:938-943: A controlled trial in 10 RLS patients of pramipexole (Mirapex), a new dopamine D3 agonist effective against PD, showed it to be the most potent therapeutic agent yet tested for RLS. Wetter T et al; Neur 1999;52:944-950: The long-acting D1 and D2 agonist pergolide (Permax) is already known to reduce RLS symptoms and subjectively to improve sleep quality. A formal crossover study in 30 patients confirmed that pergolide in low doses, combined with domperidone, is effective and well-tolerated treatment of sensorimotor symptoms and sleep disturbances in RLS. Tergau F et al; Neur 1999;52:1060-1063: They studied the effect of Transcranial Magnetic Stimulation (TMS) in 18 RLS patients and 17 controls, finding that the motor cortex is hyperexcitable in RLS, but suggesting that the origin of RLS is subcortical (supraspinal). Gemignani F et al; Neur 1999;52:1064-1096: Evaluating the frequency of RLS in 44 patients having Charcot- Marie-Tooth disease (another movement disorder) they found it in about 1/3 of those with CMT type 2, but nearly absent in other variants of CMT. They conclude that a disorder of sensory input plays a role in RLS. Chokroverty S, Jankovic J; Neur 1999;52:907-910 (editorial): Poor recognition, frequent misdiagnosis, and under-reporting have impeded studies of RLS. The agreed minimal diagnostic criteria are (1) intense, irresistible urge to move the legs, usually associated with peculiar sensation; (2) motor restlessness; (3) symptoms worse at rest and relieved by movement; and (4) symptoms worse in evening or at night. Movements during sleep are seen in about 80% of patients. Cheers, Joe -- J. R. Bruman (818) 789-3694 3527 Cody Road Sherman Oaks, CA 91403-5013