Published online Mar 27, 2018. doi: 10.4254/wjh.v10.i3.379
Peer-review started: October 31, 2017
First decision: December 26, 2017
Revised: December 27, 2017
Accepted: January 23, 2018
Article in press: January 23, 2018
Published online: March 27, 2018
To investigate the association between restless legs syndrome (RLS) and well-defined chronic liver disease, and the possible therapeutic options.
Two hundred and eleven patients with chronic liver disease, complaining of sleep disturbances, painful leg sensation and daily sleepiness, were included. Patients with persistent alcohol intake, recent worsening of clinical conditions, or hepatitis C virus were excluded. Diagnosis of RLS was suggested by the Johns Hopkins questionnaire and verified by fulfilling the diagnostic criteria by Allen. All patients were tested, both at baseline and during follow-up, with the Hamilton rating scale for depression, sleep quality assessment (PSQI), Epworth sleepiness scale (ESS), International Restless Legs Syndrome Study Group evaluation, and international RLS severity (IRLS) scoring system. Iron-free level, ferritin, folate, vitamin B12 and D-OH25 were detected. Neurological examinations and blood test occurred at the beginning of the therapy, after 2 wk, and at the 28th, 75th, 105th, 135th, 165th and 205th day. Regarding therapy, pramipexole or gabapentin were used.
Patients were moderately depressed, with evident nocturnal sleep problems and concomitant daily sleepiness. Sleep problems and involuntary leg movements had been underestimated, and RLS syndrome had not been considered before the neurological visit. All (211/211) patients fulfilled the RLS diagnostic criteria. Twenty-two patients considered their symptoms as mild, according to IRSL, but 189 found them moderate to very severe. No correlation was found between ammonium level and ESS or PSQI. Augmentation was rather precocious in our patients (135th day), and more frequent (35%) than previous data (8.3%-9.1%). The dosage of dopamine agonists was found to be associated with augmentation and appears in range with the literature. Previous intake of alcohol and lower levels of vitamins have been related to the phenomenon in our study.
RLS is a common disorder, requiring rapid diagnosis and treatment. Further research is therefore fundamental.
Core tip: The diagnosis of restless legs syndrome (RLS) relies on the presence of unpleasant sensation in the legs associated with the urge to move. Symptoms mostly begin during periods of rest or inactivity and worsen in the evening or night. Partial or total relief is related to movement. Chronic hepatic failure was recently described in association with RLS, but there are very limited studies, with no mention to treatment. We describe RLS syndrome associated with well-defined chronic liver disease along with therapeutic options, discussing risks, benefits and potential side effects, with a particular look at the augmentation phenomenon in hepatic failure.