title: Multicenter case-control study on restless legs syndrome in multiple sclerosis: the REMS study.
abstract: 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.
authors.affiliation: Sleep Disorders Center, Scientific Institute and Ospedale San Raffaele, Via Stamira d'Ancona 20, 20127 Milan, Italy. manconi.mauro@hsr.it
authors.forename: Mauro
authors.initials: M
authors.lastname: Manconi
authors.forename: Luigi
authors.initials: L
authors.lastname: Ferini-Strambi
authors.forename: Massimo
authors.initials: M
authors.lastname: Filippi
authors.forename: Enrica
authors.initials: E
authors.lastname: Bonanni
authors.forename: Alfonso
authors.initials: A
authors.lastname: Iudice
authors.forename: Luigi
authors.initials: L
authors.lastname: Murri
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: Gigli
authors.forename: Lara
authors.initials: L
authors.lastname: Fratticci
authors.forename: Giovanni
authors.initials: G
authors.lastname: Merlino
authors.forename: Giovanni
authors.initials: G
authors.lastname: Terzano
authors.forename: Franco
authors.initials: F
authors.lastname: Granella
authors.forename: Liborio
authors.initials: L
authors.lastname: Parrino
authors.forename: Rosalia
authors.initials: R
authors.lastname: Silvestri
authors.forename: Irene
authors.initials: I
authors.lastname: Aricò
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Dattola
authors.forename: Giovanna
authors.initials: G
authors.lastname: Russo
authors.forename: Carmela
authors.initials: C
authors.lastname: Luongo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cicolin
authors.forename: Antonella
authors.initials: A
authors.lastname: Tribolo
authors.forename: Paola
authors.initials: P
authors.lastname: Cavalla
authors.forename: Mariantonietta
authors.initials: M
authors.lastname: Savarese
authors.forename: Maria
authors.initials: M
authors.lastname: Trojano
authors.forename: Salvatore
authors.initials: S
authors.lastname: Ottaviano
authors.forename: Fabio
authors.initials: F
authors.lastname: Cirignotta
authors.forename: Valentina
authors.initials: V
authors.lastname: Simioni
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Salvi
authors.forename: Fiorella
authors.initials: F
authors.lastname: Mondino
authors.forename: Franco
authors.initials: F
authors.lastname: Perla
authors.forename: Giorgia
authors.initials: G
authors.lastname: Chinaglia
authors.forename: Cristina
authors.initials: C
authors.lastname: Zuliani
authors.forename: Edward
authors.initials: E
authors.lastname: Cesnik
authors.forename: Enrico
authors.initials: E
authors.lastname: Granieri
authors.forename: Fabio
authors.initials: F
authors.lastname: Placidi
authors.forename: Maria Giuseppina
authors.initials: MG
authors.lastname: Palmieri
authors.forename: Raffaele
authors.initials: R
authors.lastname: Manni
authors.forename: Michele
authors.initials: M
authors.lastname: Terzaghi
authors.forename: Roberto
authors.initials: R
authors.lastname: Bergamaschi
authors.forename: Raffaele
authors.initials: R
authors.lastname: Rocchi
authors.forename: Monica
authors.initials: M
authors.lastname: Ulivelli
authors.forename: Sabina
authors.initials: S
authors.lastname: Bartalini
authors.forename: Raffaele
authors.initials: R
authors.lastname: Ferri
authors.forename: Salvatore
authors.initials: S
authors.lastname: Lo Fermo
authors.forename: Emilio
authors.initials: E
authors.lastname: Ubiali
authors.forename: Massimo
authors.initials: M
authors.lastname: Viscardi
authors.forename: Mariarosa
authors.initials: M
authors.lastname: Rottoli
authors.forename: Lino
authors.initials: L
authors.lastname: Nobili
authors.forename: Alessandra
authors.initials: A
authors.lastname: Protti
authors.forename: Franco
authors.initials: F
authors.lastname: Ferrillo
authors.forename: Marta
authors.initials: M
authors.lastname: Allena
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Mancardi
authors.forename: Biancamaria
authors.initials: B
authors.lastname: Guarnieri
authors.forename: Francesco
authors.initials: F
authors.lastname: Londrillo
mesh_terms: 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