Das Restless-Legs-Syndrom, eine diagnostische und therapeutische Herausforderung bei Kindern und Jugendlichen

Zusammenfassung

Das Restless-Legs-Syndrom (RLS) ist eine zentralnervöse, genetisch prädisponierte, durch biochemische Faktoren getriggerte chronisch-progrediente sensomotorische Störung, oft mit Beginn im Kindes- oder Jugendalter. Zugrundeliegend wird eine zerebrale Störung des Eisen- und Dopamin-Stoffwechsels postuliert. Diese manifestiert sich durch den unwiderstehlichen Zwang seine Extremitäten bewegen zu müssen, verbunden mit Parästhesien und Dysästhesien. Die Beschwerden nehmen in Ruhe und in der Nacht zu und bessern sich durch Bewegung. RLS sollte eigentlich mit Restless-Limbs-Syndrome übersetzt werden, da langfristig auch Beschwerden in den Armen auftreten können. Kinder ab 18 Monaten können bereits betroffen sein. Die Prävalenz im Kindes- und Jugendalter beträgt 2–4 %, in Assoziation mit ADHS noch höher. Die Diagnose des RLS beruht auf anamnestischen und somit subjektiv geprägten Aussagen, die bei Kindern mit beschränkten sprachlichen Ausdrucksmöglichkeiten schwierig zu werten sind. Bis zu 75 % der RLS-Betroffenen entwickeln im Schlaf periodische Extremitätenbewegungen, welche die Nachtruhe empfindlich stören können (PLMS, periodic limb movements in sleep). Mitbetroffen sind die kognitive Leistungsfähigkeit, Stimmung und Lebensqualität am Tag. Eisenmangel, Genussmittel und gewisse Medikamente können die Beschwerden verstärken. Im Gegensatz zum RLS können PLMS mit neurophysiologischen Messungen objektiviert werden. Therapeutisch steht an erster Stelle die Behandlung eines allfälligen Eisenmangels. Entwickelt wurden Algorithmen für intravenöse Therapien. Falls angezeigt, kommen L-Dopa oder Dopamin-Agonisten zur Anwendung. Da auch Kinder eine Zunahme der RLS-Symptome unter dieser Therapie erleben (Augmentationen), wird zunehmend eine primäre Gabe von Alpha-2-Liganden bevorzugt.

Dieser Artikel möchte auf die wichtige Aufgabe von Kinderärzten und Grundversorgern bei der rechtzeitigen Erkennung und Behandlung von RLS/PLMS hinweisen.

Abstract

The restless legs (1) is a central nervous, genetically determined and biochemically triggered chronically progressive sensorimotor disorder, starting as early as in childhood and adolescence. An intracerebral disturbance of iron and dopamine regulation ist postulated. It presents as the irresistible need to move the extremities, associated with paraesthesia and dysaesthesia. The symptoms increase at rest and at night and decrease while moving around. RLS preferrably should be translated as periodic limb movements in sleep, since on the long run the arms may also be affected. Children as young as 18 months have been reported to be affected. The prevalence of RLS in childhood and adolescence reaches about 2–4 %, and even higher in ADHD. RLS is diagnosed based on the clinical history and therefore depends on the child’s ability to express itself, a challenge in children with limited language development. Up to 75 % of pediatric RLS patients exhibit periodic limb movements in sleep (PLMS) which may disturb quality of sleep. Also affected are mood and cognitive functions throughout daytime. In contrast to RLS, PLMS are measurable with neurophysiological methods. Caffeine, nicotine, iron deficiency and certain pharmaceutical drugs may exacerbate RLS and PLMS. The first therapeutical measure is iron substitution, when indicated. Algorithms for intravenous therapy have been recently developped. L-Dopa and Dopamin agonists are available. In case of augmentations, a switch to alpha-2-ligands ist indicated. Alpha-2-ligands may be used as drug of first choice in children. This article aims to point out the important role of pediatricians and primary care givers in recognizing and treating RLS and PLMS

Schlüsselwörter

RLS - restless legs syndrome - PLMS - periodic limb movements in sleep - Eisen-Behandlung - ADHS - Wachstumsschmerzen

Key words

RLS - restless legs syndrome - PLMS - periodic limb movements in sleep - iron treatment - ADHD

• Literaturverzeichnis

• 1 KA E. Restless legs: a clinical study.. Acta Med Scand 1945; Supp (Suppl. 58) 1-123
• 2 Picchietti DL, Bruni O, de Weerd A. et al. Pediatric restless legs syndrome diagnostic criteria: an update by the International Restless Legs Syndrome Study Group.. Sleep medicine 2013; 14: 1253-1292
• 3 Picchietti DL. Should oral iron be first-line therapy for pediatric restless legs syndrome and periodic limb movement disorder?.. Sleep medicine 2017; 32: 22
• 4 Ferri R, Koo BB, Picchietti DL, Fulda S. Periodic leg movements during sleep: phenotype, neurophysiology, and clinical significance.. Sleep medicine 2017; 31: 29-38
• 5 Cielo CM, DelRosso LM, Tapia IE. et al. Periodic limb movements and restless legs syndrome in children with a history of prematurity.. Sleep medicine 2017; 30: 77-81
• 6 Boentert M, Dziewas R, Heidbreder A. et al. Fatigue, reduced sleep quality and restless legs syndrome in Charcot-Marie-Tooth disease: a web-based survey.. Journal of neurology 2010; 257: 646-652
• 7 Angriman M, Cortese S, Bruni O. Somatic and neuropsychiatric comorbidities in pediatric restless legs syndrome: A systematic review of the literature.. Sleep medicine reviews 2017; 34: 34-45
• 8 Sander HH, Eckeli AL, Costa Passos AD. et al. Prevalence and quality of life and sleep in children and adolescents with restless legs syndrome/Willis-Ekbom disease.. Sleep medicine 2017; 30: 204-920
• 9 Allen RP, Picchietti DL, Auerbach M. et al. Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis-Ekbom disease in adults and children: an IRLSSG task force report.. Sleep medicine 2018; 41: 27-44
• 10 Dye TJ, Jain SV, Simakajornboon N. Outcomes of long-term iron supplementation in pediatric restless legs syndrome/periodic limb movement disorder (RLS/PLMD).. Sleep medicine 2017; 32: 213-219
• 11 Allen RP, Picchietti DL, Garcia-Borreguero D. et al. Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria – history, rationale, description, and significance.. Sleep medicine 2014; 15: 860-873
• 12 Ferri R, Bruni O, Novelli L. et al. Time structure of leg movement activity during sleep in attention-deficit/hyperactivity disorder and effects of levodopa.. Sleep medicine 2013; 14: 359-366
• 13 Pullen SJ, Wall CA, Angstman ER. et al. Psychiatric comorbidity in children and adolescents with restless legs syndrome: a retrospective study.. Journal of clinical sleep medicine : JCSM: official publication of the American Academy of Sleep Medicine 2011; 7: 587-596
• 14 Konofal E, Lecendreux M, Cortese S. Sleep and ADHD.. Sleep medicine 2010; 11: 652-658
• 15 Velez-Galarraga R, Guillen-Grima F, Crespo-Eguilaz N. et al. Prevalence of sleep disorders and their relationship with core symptoms of inattention and hyperactivity in children with attention-deficit/hyperactivity disorder.. European journal of paediatric neurology : EJPN: official journal of the European Paediatric Neurology Society 2016; 20: 925-937
• 16 Yurumez E, Kilic BG. Relationship Between Sleep Problems and Quality of Life in Children With ADHD.. Journal of attention disorders 2016; 20: 34-40
• 17 Picchietti D, Allen RP, Walters AS. et al. Restless legs syndrome: prevalence and impact in children and adolescents – the Peds REST study.. Pediatrics 2007; 120: 253-266
• 18 Walters AS, Mandelbaum DE, Lewin DS. et al. Dopaminergic therapy in children with restless legs/periodic limb movements in sleep and ADHD. Dopaminergic Therapy Study Group.. Pediatric neurology 2000; 22: 182-186
• 19 Silvestri R, Gagliano A, Arico I. et al. Sleep disorders in children with Attention-Deficit/Hyperactivity Disorder (ADHD) recorded overnight by video-polysomnography.. Sleep medicine 2009; 10: 1132-1138
• 20 Sonuga-Barke EJ, Brandeis D, Cortese S. et al. Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments.. The American journal of psychiatry 2013; 170: 275-289
• 21 England SJ, Picchietti DL, Couvadelli BV. et al. L-Dopa improves Restless Legs Syndrome and periodic limb movements in sleep but not Attention-Deficit-Hyperactivity Disorder in a double-blind trial in children.. Sleep medicine 2011; 12: 471-477
• 22 Garcia-Borreguero D, Silber MH, Winkelman JW. et al. Guidelines for the first-line treatment of restless legs syndrome/Willis-Ekbom disease, prevention and treatment of dopaminergic augmentation: a combined task force of the IRLSSG, EURLSSG, and the RLS-foundation.. Sleep medicine 2016; 21: 1-11
• 23 Picchietti MA, Picchietti DL. Advances in pediatric restless legs syndrome: Iron, genetics, diagnosis and treatment.. Sleep medicine 2010; 11: 643-651
• 24 Simakajornboon N, Kheirandish-Gozal L, Gozal D. Diagnosis and management of restless legs syndrome in children.. Sleep medicine reviews 2009; 13: 149-156