Prevalence and Characteristics of Restless Legs Syndrome (RLS) in the Elderly and the Relation of Serum Ferritin Levels

with Disease Severity : Hospital-based Study from Istanbul, Turkey

Journal - Article Reading Presenter dr Putu Gede Sudira Moderator dr Abdul Gofir, Sp.S (K) Examiners dr Pernodjo Dahlan, Sp.S (K) dr Subagya, Sp.S
A. urgunlu et al. / Archives of Gerontology and Geriatrics 55 (2012) 7376

Preview
sensorimotor disorder unpleasant sensations in the lower extremities intense urge to move worsen in the evening or night underdiagnosed condition. estimated prevalence 0.6% to 24% general population, increasing with age, female preponderance

Preview
Diagnostic criteria IRLSSG in 1995 updated to IRLSSG in 2002. idiopathic or associated with iron deficiency, diabetes mellitus, rheumatoid arthritis, renal failure, peripheral neuropathy. positive family history underlying genetic predisposition as yet poorly defined

Preview
pathophysiology is unknown iron on dopamine synthesis Serum ferritin more reliable indicator of iron deficiency most of the patients with severe RLS had ferritin levels 45 - 50 mcg/L, may benefit from iron replacement therapy

Study Objective
investigate the prevalence and characteristics of RLS in elderly patients admitted to an out-patient clinic of a university hospital assess the relation of serum ferritin levels with disease severity.

Sample and Method

A prospective, hospital-based single center study. Ambulatory 1012 patients, admitted to out-patient clinic for follow-up for acute and chronic diseases between January 2009 - December 2010 Patients were evaluated with face-toface interview according to the consensus criteria of the IRLSSG

 The severity of RLS symptoms and their impact on daily activities and mood was evaluated by RLS severity rating scale proposed by IRLSSG Serum ferritin levels were measured by two-step sandwich-enzyme immunoassay (EIA) method (Automated Chemiluminescent Enzyme Immunoassay Analyzer).

Result

Symptoms restlessness leg (83.5%), crampy or painful sensations (16.5%). Nine patients already diagnosed with RLS

Comorbidities
hypertension (89.3%), depression (41.7%), osteoporosis and/or osteoarthrosis (39.8%), dyslipidemia (33.9%), iron deficiency anemia (31%), diabetes mellitus (23.3%), ischemic heart disease (13.5%), hypothyroidism (6.8%), congestive heart failure (5.8%), carpal tunnel syndrome (5.8%), chronic obstructive lung disease (4.8%).

Result

RLS Severity very severe 5 patients, severe 44 patients, moderate 34 patients, mild 20 patients.

Discussion (Prevalence vs Ethnic)

The prevalence of RLS in our elderly patients was 10.18%. The lowest prevalence was found to be 0.6% from Singapore. Study on prevalence of elderly subjects in French was 24.2% The studies of general population in Turkey 3.2% : 9.71% (east : west Turkey). Not differ by age.

Discussion (Prevalence vs Gender)

Higher prevalence in women. Positive family history in 26% cases. Previous literature was 2550%. Underdiagnosed condition
Declared when asked in detail the diagnostic criteria Duration was 4.80 4.65 years Only 9 out 103 were diagnosed before

Discussion (Comorbid and Ferritin)

There are comorbidities but no association was found between RLS and these comorbidities. Lower ferritin level on patients with severe and very severe RLS. Not only found on serum but also in CSF examination suggested impaired brain iron acquisition.

Conclusion Take Home Message

RLS was a common and underdiagnosed disease in elderly patients RLS patients with severe and very severe disease had lower ferritin levels than those of mild and moderate disease.

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