Multicenter case-control study on restless legs syndrome in multiple sclerosis: the REMS study.
OBJECTIVE
To verify the existence of a symptomatic form of restless legs syndrome (RLS) secondary to multiple sclerosis (MS) and to identify possible associated risk factors.


METHODS
Prospective, multicenter, case-control epidemiologic survey.


METHODS
Twenty sleep centers certified by the Italian Association of Sleep Medicine.


METHODS
Eight hundred and sixty-one patients affected by MS and 649 control subjects.


METHODS
N/A.


RESULTS
Data regarding demographic and clinical factors, presence and severity of RLS, the results of hematologic tests, and visual analysis of cerebrospinal magnetic resonance imaging studies were collected. The prevalence of RLS was 19% in MS and 4.2% in control subjects, with a risk to be affected by RLS of 5.4 (95%confidence interval: 3.56-8.26) times greater for patients with MS than for control subjects. In patients with MS, the following risk factors for RLS were significant: older age; longer MS duration; the primary progressive MS form; higher global, pyramidal, and sensory disability; and the presence of leg jerks before sleep onset. Patients with MS and RLS more often had sleep complaints and a higher intake of hypnotic medications than patients with MS without RLS. RLS associated with MS was more severe than that of control subjects.


CONCLUSIONS
RLS is significantly associated with MS, especially in patients with severe pyramidal and sensory disability. These results strengthen the idea that the inflammatory damage correlated with MS may induce a secondary form of RLS. As it does in idiopathic cases, RLS has a significant impact on sleep quality in patients with MS; therefore, it should be always searched for, particularly in the presence of insomnia unresponsive to treatment with common hypnotic drugs.
Sleep Disorders Center, Scientific Institute and Ospedale San Raffaele, Via Stamira d'Ancona 20, 20127 Milan, Italy. manconi.mauro@hsr.it
Manconi
Mauro
M
Ferini-Strambi
Luigi
L
Filippi
Massimo
M
Bonanni
Enrica
E
Iudice
Alfonso
A
Murri
Luigi
L
Gigli
Gian Luigi
GL
Fratticci
Lara
L
Merlino
Giovanni
G
Terzano
Giovanni
G
Granella
Franco
F
Parrino
Liborio
L
Silvestri
Rosalia
R
Aricò
Irene
I
Dattola
Vincenzo
V
Russo
Giovanna
G
Luongo
Carmela
C
Cicolin
Alessandro
A
Tribolo
Antonella
A
Cavalla
Paola
P
Savarese
Mariantonietta
M
Trojano
Maria
M
Ottaviano
Salvatore
S
Cirignotta
Fabio
F
Simioni
Valentina
V
Salvi
Fabrizio
F
Mondino
Fiorella
F
Perla
Franco
F
Chinaglia
Giorgia
G
Zuliani
Cristina
C
Cesnik
Edward
E
Granieri
Enrico
E
Placidi
Fabio
F
Palmieri
Maria Giuseppina
MG
Manni
Raffaele
R
Terzaghi
Michele
M
Bergamaschi
Roberto
R
Rocchi
Raffaele
R
Ulivelli
Monica
M
Bartalini
Sabina
S
Ferri
Raffaele
R
Lo Fermo
Salvatore
S
Ubiali
Emilio
E
Viscardi
Massimo
M
Rottoli
Mariarosa
M
Nobili
Lino
L
Protti
Alessandra
A
Ferrillo
Franco
F
Allena
Marta
M
Mancardi
Gianluigi
G
Guarnieri
Biancamaria
B
Londrillo
Francesco
F
D000328:Adult; D016022:Case-Control Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000175:diagnosis / Q000453:epidemiology*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis / Q000453:epidemiology*; D011446:Prospective Studies; D012148:Restless Legs Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000453:epidemiology