Prevalence of the Restless Legs Syndrome in Children
Picchietti D, Allen RP, Walters AS, Davidson JE, Myers A, Ferini-Strambi L
Pediatrics. 2007;120:253-266
The authors review the fact that a consensus for the diagnostic criteria for childhood restless legs syndrome (RLS) was published only in 2003. The childhood criteria include more stringent guidelines for diagnosing "definite" RLS and include "probable" and "possible" categories for children who don't meet the full RLS criteria.
The criteria are detailed, but the symptoms essentially include urges to move the legs; uncomfortable or even painful sensations; worsening sensations or symptoms when inactive; relief or reduction of symptoms when active; and evening or nocturnal increase in symptoms (see http://www.medscape.com/viewarticle/533366 for more detail).
This large-scale, international study (United States and United Kingdom) sought to determine more accurately the prevalence of RLS in children and to determine correlations among the diagnosis, clinical features, and care. Participants were 8 to 17 years old and were recruited from a market-research panel.
There were more than 10,000 respondents with complete data. The investigators obtained, by phone survey, data on RLS symptoms, assessed the impact of the symptoms on the child, assessed previous medical care and diagnoses related to the symptoms, and collected data on medical and family histories.
The participants were 4325 children aged 8 to 11 years old and 6198 children 12 to 17 years old. Of the sample of 10,523 with complete data (82% of families with an eligible child), 206 children had definite RLS (81 were 8 to 11 years old), a prevalence of 1.9% for children 8 to 11 years old and 2.0% for children 12 to 17 years old.
In general, the only difference between the US and UK samples was comorbid conditions, so the samples were combined for most analyses. There was no difference in prevalence of RLS between boys and girls. Twenty-seven percent of younger children with RLS and 52% of older children reported their symptoms to be in the "moderate-to-severe" range.
Just over 80% of the RLS patients had experienced what they described as growing pains compared with 63% of the non-RLS patients. Fewer than 10% of patients experienced "no distress" from their RLS symptoms, but 22% of younger children and 23% of older children reported that their RLS symptoms caused "extreme distress."
Children with RLS also had much higher rates of sleep disturbance compared with the children without RLS (69% vs 40%). There were strong family history correlations between children with RLS and family members with symptoms of RLS. In addition, although nearly 50% of the patients had sought medical care for RLS symptoms, only half received the diagnosis of RLS.
Few patients were treated with medications thought appropriate for RLS (there are no medications approved for children). Many of the comorbid diagnoses could be anticipated, such as growing pains and attention-deficit disorder, but depression and anxiety were also diagnosed in smaller percentages.
The authors conclude that approximately 2% of children have symptoms of RLS, and many are improperly diagnosed and treated. The impact of RLS on children and the distress caused by the condition is significant.
The authors put the prevalence of RLS into context, comparing the 2% of children with RLS in this study with the prevalence of diabetes and nonfebrile seizures (both < 1%). The suggestion is that we pay more attention (as providers) to those disorders and are familiar with their diagnoses, and perhaps RLS should receive similar attention. Certainly, the level of distress reported by these children and the impact on sleep hygiene bears consideration. The current direct-to-consumer advertising for RLS treatment (for adults) and the frequency with which RLS appears in the lay press will ensure that pediatric providers are asked many questions about RLS. So, it may be time for all of us to brush up on the diagnostic criteria and review salient questions to ask in clinical encounters.
Abstract
The Restless Legs Syndrome: Prevalence and Impact in Children and Adolescents -- The Peds REST Study
Picchietti D, Allen RP, Walters AS, Davidson JE, Myers A, Ferini-Strambi L
Pediatrics. 2007;120:253-266
Summary
The authors review the fact that a consensus for the diagnostic criteria for childhood restless legs syndrome (RLS) was published only in 2003. The childhood criteria include more stringent guidelines for diagnosing "definite" RLS and include "probable" and "possible" categories for children who don't meet the full RLS criteria.
The criteria are detailed, but the symptoms essentially include urges to move the legs; uncomfortable or even painful sensations; worsening sensations or symptoms when inactive; relief or reduction of symptoms when active; and evening or nocturnal increase in symptoms (see http://www.medscape.com/viewarticle/533366 for more detail).
This large-scale, international study (United States and United Kingdom) sought to determine more accurately the prevalence of RLS in children and to determine correlations among the diagnosis, clinical features, and care. Participants were 8 to 17 years old and were recruited from a market-research panel.
There were more than 10,000 respondents with complete data. The investigators obtained, by phone survey, data on RLS symptoms, assessed the impact of the symptoms on the child, assessed previous medical care and diagnoses related to the symptoms, and collected data on medical and family histories.
The participants were 4325 children aged 8 to 11 years old and 6198 children 12 to 17 years old. Of the sample of 10,523 with complete data (82% of families with an eligible child), 206 children had definite RLS (81 were 8 to 11 years old), a prevalence of 1.9% for children 8 to 11 years old and 2.0% for children 12 to 17 years old.
In general, the only difference between the US and UK samples was comorbid conditions, so the samples were combined for most analyses. There was no difference in prevalence of RLS between boys and girls. Twenty-seven percent of younger children with RLS and 52% of older children reported their symptoms to be in the "moderate-to-severe" range.
Just over 80% of the RLS patients had experienced what they described as growing pains compared with 63% of the non-RLS patients. Fewer than 10% of patients experienced "no distress" from their RLS symptoms, but 22% of younger children and 23% of older children reported that their RLS symptoms caused "extreme distress."
Children with RLS also had much higher rates of sleep disturbance compared with the children without RLS (69% vs 40%). There were strong family history correlations between children with RLS and family members with symptoms of RLS. In addition, although nearly 50% of the patients had sought medical care for RLS symptoms, only half received the diagnosis of RLS.
Few patients were treated with medications thought appropriate for RLS (there are no medications approved for children). Many of the comorbid diagnoses could be anticipated, such as growing pains and attention-deficit disorder, but depression and anxiety were also diagnosed in smaller percentages.
The authors conclude that approximately 2% of children have symptoms of RLS, and many are improperly diagnosed and treated. The impact of RLS on children and the distress caused by the condition is significant.
Viewpoint
The authors put the prevalence of RLS into context, comparing the 2% of children with RLS in this study with the prevalence of diabetes and nonfebrile seizures (both < 1%). The suggestion is that we pay more attention (as providers) to those disorders and are familiar with their diagnoses, and perhaps RLS should receive similar attention. Certainly, the level of distress reported by these children and the impact on sleep hygiene bears consideration. The current direct-to-consumer advertising for RLS treatment (for adults) and the frequency with which RLS appears in the lay press will ensure that pediatric providers are asked many questions about RLS. So, it may be time for all of us to brush up on the diagnostic criteria and review salient questions to ask in clinical encounters.
Abstract